Distal RadioUlnar Joint & TFCC Injuries

Distal Radioulnar Joint (DRUJ) & TFCC Injuries: Causes, Symptoms, Diagnosis, and Treatment

Introduction

The distal radioulnar joint (DRUJ) is a pivotal joint in the wrist that allows rotation of the forearm, enabling movements such as pronation and supination (turning the palm down and up). The triangular fibrocartilage complex (TFCC) is a critical structure that stabilizes the DRUJ and cushions the wrist. Injuries to the DRUJ and TFCC can cause pain, instability, and impaired wrist function, significantly affecting daily activities.

Anatomy and Background

Distal Radioulnar Joint (DRUJ): Formed by the articulation between the distal ends of the radius and ulna bones.
Triangular Fibrocartilage Complex (TFCC): A complex of ligaments, cartilage, and tendons including the articular disc, dorsal and volar radioulnar ligaments, ulnar collateral ligament, and sheath of the extensor carpi ulnaris tendon.
The TFCC acts as a stabilizer for the DRUJ and supports the ulnar side of the wrist.

Causes of DRUJ & TFCC Injuries

Trauma: Falls on an outstretched hand, wrist sprains, or direct blows.
Repetitive stress: Overuse injuries in athletes or manual laborers.
Distal radius fractures: Can disrupt the DRUJ and TFCC.
Degenerative changes: Age-related wear and tear.
Rheumatoid arthritis: Inflammatory destruction of the TFCC.
Ulnar variance abnormalities: Positive ulnar variance increases TFCC stress.

Symptoms

Ulnar-sided wrist pain, especially with rotation or gripping.
Clicking, popping, or snapping sensations in the wrist.
Swelling and tenderness over the ulnar side.
Decreased grip strength.
Feeling of wrist instability or “giving way.”
Limited range of motion, particularly in pronation and supination.

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Diagnosis

Clinical Examination

Palpation of the ulnar wrist for tenderness.
DRUJ stability tests (e.g., piano key test, ballottement test).
TFCC provocative tests (e.g., ulnar fovea sign, TFCC compression test).

Imaging Studies

Plain film is normally sufficient to diagnose the dislocation (assuming there is no interpretation error), however, CT plays an important role in assessing for associated occult fractures; the most common and important being scaphoid fracture.

Treatment and prognosis

X-rays: To assess bone alignment, fractures, and ulnar variance.
MRI: Gold standard for visualizing TFCC tears and soft tissue injuries.
CT scan: Useful for detailed bone and joint assessment.
Arthroscopy: Diagnostic and therapeutic tool for direct visualization.

Treatment Options

Non-Surgical Management

Rest and activity modification: Avoiding aggravating movements.
Immobilization: Wrist splints or casts for 4-6 weeks.
Nonsteroidal anti-inflammatory drugs (NSAIDs): To reduce pain and inflammation.
Physical therapy: Strengthening and range of motion exercises after immobilization.
Corticosteroid injections: For persistent inflammation.

Surgical Treatment

Arthroscopic debridement: Removal of torn or damaged TFCC tissue.
TFCC repair: Suturing of peripheral tears, especially in vascular zones.
DRUJ stabilization procedures: Reconstruction of ligaments or ulnar shortening osteotomy in cases of ulnar variance.
DRUJ fusion (arthrodesis): Considered in severe instability or arthritis.
Ulnar head resection (Darrach procedure): For irreparable TFCC damage in low-demand patients.

Postoperative Care and Rehabilitation

Immobilization in a splint or cast for 4-6 weeks post-surgery.
Gradual introduction of wrist and forearm range of motion exercises.
Strengthening exercises under supervision.
Avoidance of heavy lifting or strenuous activities until full recovery.
Regular follow-up to monitor healing and function.

Risks and Complications

Persistent pain or stiffness.
Residual instability or weakness.
Infection or wound healing problems.
Nerve injury.
Failure of repair or need for revision surgery.

Prognosis

Early diagnosis and appropriate treatment improve outcomes.
Many patients regain good wrist function with conservative management.
Surgical repair has high success rates, especially for peripheral TFCC tears.
Chronic or untreated injuries may lead to arthritis and permanent dysfunction.

When to See a Doctor

Seek medical evaluation if you experience:

Persistent ulnar-sided wrist pain after injury.
Clicking, instability, or weakness in the wrist.
Limited wrist motion affecting daily activities.
Swelling or deformity of the wrist.

Conclusion

Injuries to the distal radioulnar joint and triangular fibrocartilage complex can significantly impair wrist function and quality of life. Prompt diagnosis and tailored treatment—ranging from conservative care to surgical repair—are essential for optimal recovery. If you have wrist pain or instability, consult a hand specialist for a thorough evaluation and personalized management plan.

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