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J Wrist Surg 2017; 06(02): 088-096
DOI: 10.1055/s-0037-1601367
Special Review: Biomechanics of DRUJ Instability
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Biomechanical Perspective on Distal Radioulnar Joint Instability

Shohei Omokawa
1   Department of Hand Surgery, Nara Medical University, Kashihara, Nara, Japan
,
Akio Iida
2   Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
,
Kenji Kawamura
2   Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
,
Yasuaki Nakanishi
2   Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
,
Takamasa Shimizu
2   Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
,
Tsutomu Kira
2   Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
,
Tadanobu Onishi
2   Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
,
Naoki Hayami
2   Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
,
Yasuhito Tanaka
2   Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
› Author Affiliations
Further Information

Publication History

28 December 2016

27 February 2017

Publication Date:
22 March 2017 (online)

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Abstract

Background The purpose of this article was to review the anatomy, kinematics of the distal radioulnar joint (DRUJ), and to discuss definition, classification, and diagnosis of DRUJ instability.

Methods A biomechanical perspective on physical examination of DRUJ ballottement test was documented. Physiological dynamic DRUJ translation and differences of the translation following sequential ligament sectioning and changes in different forearm and wrist positions were demonstrated. The clinical significance of each ligament's contribution to joint stability in specific wrist positions was addressed.

Conclusion Each ligament stabilizing the DRUJ contributed to joint stability depending on the direction (palmer or dorsal) and different positions of the wrist and forearm. DRUJ ballottement test in each wrist and forearm position may detect tears of specific ligament stabilizing the DRUJ.

Keywords

DRUJ - TFCC - biomechanics - anatomy - function
 

  • References

  • 1 Daneshvar P, Willing R, Pahuta M, Grewal R, King GJ. Osseous anatomy of the distal radioulnar joint: an assessment using 3-dimensional modeling and clinical implications. J Hand Surg Am 2016; 41 (11) 1071-1079
    CrossrefPubMedGoogle Scholar
  • 2 De Smet L, Fabry G. Orientation of the sigmoid notch of the distal radius: determination of different types of the distal radioulnar joint. Acta Orthop Belg 1993; 59 (3) 269-272
    Google Scholar
  • 3 Tolat AR, Stanley JK, Trail IA. A cadaveric study of the anatomy and stability of the distal radioulnar joint in the coronal and transverse planes. J Hand Surg [Br] 1996; 21 (5) 587-594
    CrossrefPubMedGoogle Scholar
  • 4 Huang JI, Hanel DP. Anatomy and biomechanics of the distal radioulnar joint. Hand Clin 2012; 28 (2) 157-163
    CrossrefPubMedGoogle Scholar
  • 5 Hagert E, Hagert CG. Understanding stability of the distal radioulnar joint through an understanding of its anatomy. Hand Clin 2010; 26 (4) 459-466
    Google Scholar
  • 6 Iida A, Omokawa S, Moritomo H , et al. Biomechanical study of the extensor carpi ulnaris as a dynamic wrist stabilizer. J Hand Surg Am 2012; 37 (12) 2456-2461
    CrossrefPubMedGoogle Scholar
  • 7 Gordon KD, Dunning CE, Johnson JA, King GJ. Influence of the pronator quadratus and supinator muscle load on DRUJ stability. J Hand Surg Am 2003; 28 (6) 943-950
    CrossrefPubMedGoogle Scholar
  • 8 Linscheid RL, Dobyns JH, Beckenbaugh RD, Cooney III WP, Wood MB. Instability patterns of the wrist. J Hand Surg Am 1983; 8 (5 Pt 2): 682-686
    PubMedGoogle Scholar
  • 9 Cooney III WP, Linscheid RL, Dobyns JH. Carpal instability: treatment of ligament injuries of the wrist. Instr Course Lect 1992; 41: 33-44
    PubMedGoogle Scholar
  • 10 Larsen CF, Amadio PC, Gilula LA, Hodge JC. Analysis of carpal instability: I. Description of the scheme. J Hand Surg Am 1995; 20 (5) 757-764
    CrossrefPubMedGoogle Scholar
  • 11 Mino DE, Palmer AK, Levinsohn EM. Radiography and computerized tomography in the diagnosis of incongruity of the distal radio-ulnar joint. A prospective study. J Bone Joint Surg Am 1985; 67 (2) 247-252
    CrossrefPubMedGoogle Scholar
  • 12 Park MJ, Kim JP. Reliability and normal values of various computed tomography methods for quantifying distal radioulnar joint translation. J Bone Joint Surg Am 2008; 90 (1) 145-153
    CrossrefPubMedGoogle Scholar
  • 13 Lo IK, MacDermid JC, Bennett JD, Bogoch E, King GJ. The radioulnar ratio: a new method of quantifying distal radioulnar joint subluxation. J Hand Surg Am 2001; 26 (2) 236-243
    CrossrefPubMedGoogle Scholar
  • 14 Wechsler RJ, Wehbe MA, Rifkin MD, Edeiken J, Branch HM. Computed tomography diagnosis of distal radioulnar subluxation. Skeletal Radiol 1987; 16 (1) 1-5
    CrossrefPubMedGoogle Scholar
  • 15 Pirela-Cruz MA, Goll SR, Klug M, Windler D. Stress computed tomography analysis of the distal radioulnar joint: a diagnostic tool for determining translational motion. J Hand Surg Am 1991; 16 (1) 75-82
    CrossrefPubMedGoogle Scholar
  • 16 Fujitani R, Omokawa S, Akahane M, Iida A, Ono H, Tanaka Y. Predictors of distal radioulnar joint instability in distal radius fractures. J Hand Surg Am 2011; 36 (12) 1919-1925
    CrossrefPubMedGoogle Scholar
  • 17 Saito T, Nakamura T, Nagura T, Nishiwaki M, Sato K, Toyama Y. The effects of dorsally angulated distal radius fractures on distal radioulnar joint stability: a biomechanical study. J Hand Surg Eur Vol 2013; 38 (7) 739-745
    CrossrefPubMedGoogle Scholar
  • 18 Nishiwaki M, Welsh M, Gammon B, Ferreira LM, Johnson JA, King GJ. Volar subluxation of the ulnar head in dorsal translation deformities of distal radius fractures: an in vitro biomechanical study. J Orthop Trauma 2015; 29 (6) 295-300
    CrossrefPubMedGoogle Scholar
  • 19 Dy CJ, Jang E, Taylor SA, Meyers KN, Wolfe SW. The impact of coronal alignment on distal radioulnar joint stability following distal radius fracture. J Hand Surg Am 2014; 39 (7) 1264-1272
    CrossrefPubMedGoogle Scholar
  • 20 Nakamura T, Yabe Y, Horiuchi Y. Functional anatomy of the triangular fibrocartilage complex. J Hand Surg [Br] 1996; 21 (5) 581-586
    CrossrefPubMedGoogle Scholar
  • 21 Nakamura T, Yabe Y. Histological anatomy of the triangular fibrocartilage complex of the human wrist. Ann Anat 2000; 182 (6) 567-572
    CrossrefPubMedGoogle Scholar
  • 22 Kleinman WB. Stability of the distal radioulna joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function what we have learned in 25 years. J Hand Surg Am 2007; 32 (7) 1086-1106
    CrossrefPubMedGoogle Scholar
  • 23 Benjamin M, Evans EJ, Pemberton DJ. Histological studies on the triangular fibrocartilage complex of the wrist. J Anat 1990; 172: 59-67
    PubMedGoogle Scholar
  • 24 Moritomo H. Anatomy and clinical relevance of the ulnocarpal ligament. J Wrist Surg 2013; 2 (2) 186-189
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Iida A, Omokawa S, Moritomo H , et al. Effect of wrist position on distal radioulnar joint stability: a biomechanical study. J Orthop Res 2014; 32 (10) 1247-1251
    CrossrefPubMedGoogle Scholar
  • 26 Moritomo H. The distal interosseous membrane: current concepts in wrist anatomy and biomechanics. J Hand Surg Am 2012; 37 (7) 1501-1507
    CrossrefPubMedGoogle Scholar
  • 27 Moritomo H. The distal oblique bundle of the distal interosseous membrane of the forearm. J Wrist Surg 2013; 2 (1) 93-94
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Tang JB, Ryu J, Kish V. The triangular fibrocartilage complex: an important component of the pulley for the ulnar wrist extensor. J Hand Surg Am 1998; 23 (6) 986-991
    CrossrefPubMedGoogle Scholar
  • 29 Lester B, Halbrecht J, Levy IM, Gaudinez R. “Press test” for office diagnosis of triangular fibrocartilage complex tears of the wrist. Ann Plast Surg 1995; 35 (1) 41-45
    CrossrefPubMedGoogle Scholar
  • 30 Tay SC, Tomita K, Berger RA. The “ulnar fovea sign” for defining ulnar wrist pain: an analysis of sensitivity and specificity. J Hand Surg Am 2007; 32 (4) 438-444
    CrossrefPubMedGoogle Scholar
  • 31 King GJ, McMurtry RY. Physical examination of the wrist and hand. In: Gilula LA, Yin Y, , eds. Imaging of the Wrist and Hand. Philadelphia: WB Saunders; 1996: 5-18
    Google Scholar
  • 32 Cooney WP, Bishop AT, Linscheid RL. Physical examination of the wrist. In: Cooney WP, Linscheid RL, Dobyns JH, , eds. The Wrist, 1st ed. Philadelphia: Lippincott Williams and Wilkins; 1998: 236-261
    Google Scholar
  • 33 Lindau T, Adlercreutz C, Aspenberg P. Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures. J Hand Surg Am 2000; 25 (3) 464-468
    CrossrefPubMedGoogle Scholar
  • 34 Nakamura T. Pathology, diagnosis and treatment of distal radioulnar ligament instability [in Japanese]. J Jpn Orthop Assoc 2008; 82 (2) 90-90
    PubMedGoogle Scholar
  • 35 Nakamura R, Horii E, Imaeda T, Tsunoda K, Nakao E. Distal radioulnar joint subluxation and dislocation diagnosed by standard roentgenography. Skeletal Radiol 1995; 24 (2) 91-94
    PubMedGoogle Scholar
  • 36 Iida A, Omokawa S, Akahane M, Kawamura K, Takayama K, Tanaka Y. Distal radioulnar joint stress radiography for detecting radioulnar ligament injury. J Hand Surg Am 2012; 37 (5) 968-974
    CrossrefPubMedGoogle Scholar
  • 37 Wijffels M, Stomp W, Krijnen P, Reijnierse M, Schipper I. Computed tomography for the detection of distal radioulnar joint instability: normal variation and reliability of four CT scoring systems in 46 patients. Skeletal Radiol 2016; 45 (11) 1487-1493
    CrossrefPubMedGoogle Scholar
  • 38 Oneson SR, Timins ME, Scales LM, Erickson SJ, Chamoy L. MR imaging diagnosis of triangular fibrocartilage pathology with arthroscopic correlation. Am J Roentgenol 1997; 168 (6) 1513-1518
    CrossrefPubMedGoogle Scholar
  • 39 Haims AH, Schweitzer ME, Morrison WB , et al. Limitations of MR imaging in the diagnosis of peripheral tears of the triangular fibrocartilage of the wrist. Am J Roentgenol 2002; 178 (2) 419-422
    CrossrefPubMedGoogle Scholar
  • 40 Blazar PE, Chan PS, Kneeland JB, Leatherwood D, Bozentka DJ, Kowalchick R. The effect of observer experience on magnetic resonance imaging interpretation and localization of triangular fibrocartilage complex lesions. J Hand Surg Am 2001; 26 (4) 742-748
    CrossrefPubMedGoogle Scholar
  • 41 Anderson ML, Skinner JA, Felmlee JP, Berger RA, Amrami KK. Diagnostic comparison of 1.5 tesla and 3.0 tesla preoperative MRI of the wrist in patients with ulnar-sided wrist pain. J Hand Surg Am 2008; 33 (7) 1153-1159
    CrossrefPubMedGoogle Scholar
  • 42 Ehman EC, Hayes ML, Berger RA, Felmlee JP, Amrami KK. Subluxation of the distal radioulnar joint as a predictor of foveal triangular fibrocartilage complex tears. J Hand Surg Am 2011; 36 (11) 1780-1784
    CrossrefPubMedGoogle Scholar
  • 43 Moritomo H, Arimitsu S, Kubo N, Masatomi T, Yukioka M. Computed tomography arthrography using a radial plane view for the detection of triangular fibrocartilage complex foveal tears. J Hand Surg Am 2015; 40 (2) 245-251
    CrossrefPubMedGoogle Scholar
  • 44 Hess F, Farshad M, Sutter R, Nagy L, Schweizer A. A novel technique for detecting instability of the distal radioulnar joint in complete triangular fibrocartilage complex lesions. J Wrist Surg 2012; 1 (2) 153-158
    Article in Thieme ConnectPubMedGoogle Scholar
  • 45 Hermansdorfer JD, Kleinman WB. Management of chronic peripheral tears of the triangular fibrocartilage complex. J Hand Surg Am 1991; 16 (2) 340-346
    CrossrefPubMedGoogle Scholar
  • 46 Ruch DS, Yang CC, Smith BP. Results of acute arthroscopically repaired triangular fibrocartilage complex injuries associated with intra-articular distal radius fractures. Arthroscopy 2003; 19 (5) 511-516
    CrossrefPubMedGoogle Scholar
  • 47 Nakamura T, Iwamoto T, Matsumura N, Sato K, Toyama Y. Radiographic and arthroscopic assessment of DRUJ instability due to foveal avulsion of the radioulnar ligament in distal radius fractures. J Wrist Surg 2014; 3 (1) 12-17
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Atzei A, Rizzo A, Luchetti R, Fairplay T. Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesion with distal radioulnar joint instability. Tech Hand Up Extrem Surg 2008; 12 (4) 226-235
    CrossrefPubMedGoogle Scholar
  • 49 Tse WL, Lau SW, Wong WY , et al. Arthroscopic reconstruction of triangular fibrocartilage complex (TFCC) with tendon graft for chronic DRUJ instability. Injury 2013; 44 (3) 386-390
    CrossrefPubMedGoogle Scholar
  • 50 Onishi T, Omokawa S, Iida A , et al. Biomechanical study of distal radioulnar joint ballottement test. J Orthop Res 2016; DOI: 10.1002/jor.23355.
    PubMedGoogle Scholar
  • 51 Moriya T, Aoki M, Iba K, Ozasa Y, Wada T, Yamashita T. Effect of triangular ligament tears on distal radioulnar joint instability and evaluation of three clinical tests: a biomechanical study. J Hand Surg Eur Vol 2009; 34 (2) 219-223
    CrossrefPubMedGoogle Scholar
  • 52 Szabo RM. Distal radioulnar joint instability. J Bone Joint Surg Am 2006; 88 (4) 884-894
    CrossrefPubMedGoogle Scholar