From the Guidelines
Widening of the distal radioulnar joint (DRUJ) is typically caused by instability or injury to the joint, often resulting from traumatic injuries such as distal radius fractures, which can compromise the stabilizing structures of the joint, including the triangular fibrocartilage complex (TFCC) and the dorsal and volar radioulnar ligaments. The current evidence does not provide a clear recommendation for the treatment of DRUJ instability in patients with surgically treated distal radius fractures, as stated in a study published in The Journal of the American Academy of Orthopaedic Surgeons in 2010 1. Some key points to consider when evaluating DRUJ widening include:
- The role of traumatic injuries, such as distal radius fractures, in causing DRUJ instability
- The importance of early diagnosis and treatment to prevent chronic instability and subsequent osteoarthritis of the joint
- The potential need for surgical intervention, including TFCC repair, ligament reconstruction, or ulnar shortening osteotomy, in cases of severe instability
- The use of immobilization with a forearm cast or splint for 4-6 weeks in cases of mild instability, followed by physical therapy focusing on grip strengthening and range of motion exercises
- The management of pain with NSAIDs, such as ibuprofen or naproxen, for 1-2 weeks. It is essential to note that the evidence is limited, and more research is needed to fully understand the causes and optimal treatment of DRUJ widening, as the current study found that DRUJ instability was identified at the conclusion of treatment, and no instabilities were diagnosed or treated at the time of initial surgery 1.
From the Research
Causes of Distal Radioulnar Joint (DRUJ) Widening
The cause of DRUJ widening can be attributed to various factors, including:
- Traumatic injuries, which can lead to joint instability and subsequent widening 2
- Rheumatoid arthritis, which can cause pain, instability, and tendon rupture in the DRUJ 3
- Osteoarthritis (OA), which can result from distal radius trauma, joint instability, septic arthritis, or primary OA 4
- Congenital and degenerative processes, which can disturb the delicate balance of the joint, leading to arthritis and widening 5
Associated Conditions
DRUJ widening can be associated with various conditions, including:
- Instability and radioulnar convergence, which can occur after resection arthroplasties 6
- Tendon rupture, which can be a consequence of rheumatoid arthritis affecting the DRUJ 3
- Advanced arthritis, which may require surgical interventions such as Darrach resection, Sauve-Kapandji procedure, or DRUJ arthroplasty 2