Distal Radioulnar Joint | Indications, Steps and More

The Distal radioulnar joint is a clinical examination that physiotherapists apply to assess the DRUJ’s stability and whether it is intact and healthy or not and contributed to the forearm rotation and load sharing between the radius and ulna. This  Distal radioulnar joint is most useful when there is suspected clinical instability, subluxation or dislocation of the DRUJ.

Indication for the Distal Radioulnar Joint

The DRUJ Test is indicated for patients presenting with: 

• Summarily, pain on the ulnar side of the wrist.
• Pain is felt along the length of the forearm when the hand is being pronated and supinated.
• Cases with suspected DRUJ instability after an injury.
• Long-term diseases such as rheumatic diseases with impact on the wrist joint.
• Impairment in motion of various degrees in the forearm.
• Protocol of Performing the Test by Physiotherapists

How to Perform the Distal Radioulnar Joint Test 

• Patient Positioning: The patient is sitting with his/her elbow in a 90-degree angle and [the position of the forearm is] medio-lateral.
• Therapist Positioning: the position of the therapist is that he/she is standing opposite to the patient.

Hand Placement:

1. In this step the therapist holds the patient's distal radius in his non-dominant hand.
2. The other hand takes hold on the distal ulna.

Movement:

1. The therapist performs a dorsal and volar force on the distal ulna making it a quick switch between the 2 movements.
2. It is evaluated for any sign of what is referred to as ‘shift’, crepitus, or pain.

Assessment Outcome of Distal radioulnar joint Test 

• Positive Test: Lack of stability or increased motion, pain or clunking means that there is likely to be an instability or pathology in the DRUJ.
• Negative Test: Lack of pain and no abnormality in movement of all structures on returning them to the neutral position can only mean that DRUJ is stable.

Differential Diagnosis of Distal radioulnar joint

• The DRUJ Test is useful in differentiating between:DRUJ instability and other wrist pathologies such as the TFCC tears.
• Wrist pain over the ulnar styloid with complaints of tendinitis or any lesion affecting the soft tissue.
• Pain in the forearm resulting from fractures, dislocations and other related injuries.

Related Distal radioulnar joint Test  

• Piano Key Test: To evaluate DRUJ instability, the ulna head is gripped and pressured down.*
• Ballottement Test: Assesses for instability or subluxation of the DRUJ.
• Fovea Sign: Lastly, tenderness on the area of the fovea should suggest injury to the TFCC.

Rehabilitation Protocols of Distal radioulnar joint Condition 

 It has been reported that specific regimens which attempt proprioceptive training and muscle strengthening are recommended for patients who have DRUJ instability.

• Surgical vs. Conservative Management: Surveys comparing surgical approach to conservative one and vice versa describe the value of an individual approach.
• Long-Term Outcomes: There is a dearth of data collected prospectively that looks at the outcomes of different management options for DRUJ instability.
• Innovative Techniques: There are other new methods recommended for solving the problems of DRUJ pathologies’ diagnosing and evaluating, for instance, dynamic US and MRI.

Key References:

1. Garcia-Elias, M. , & Scheck, M. (2020). Stability of the Distal Radioulnar Joint: From a Biomechanical Point of View. Journal of Hand Surgery.
2. Kim, J. P. , & Park, M. J. (2019). Management of Distal Radioulnar Joint Instability: Contemporary Ideas. Journal of Orthopedic Clinics of North America.
3. Zimmerman, R. M. , & Jupiter, J. B. (2018) Under this we have Chronic Distal Radioulnar Joint Instability. Hand Clinics.

With regard to these steps and knowledge, physiotherapists can apply the Use of Distal Radioulnar Joint Test to assess and treat comparable pathology systematically anchored on research findings.