Longitudinal incongruity of the DRUJ Discussion
Longitudinal incongruity of the distal radioulnar joint may result in
chronic ulnar wrist pain due to several possible problems. Simple
incongruity of the distal radioulnar joint may lead to degenerative joint
disease. If the ulna is relatively too long, the triangular fibrocartilage
may be damaged and the ulna may impinge on the proximal surface of the
lunate, a condition referred to as ulnolunate impaction syndrome. This
problem may be spontaneous, or may be due to relative shortening of the
radius from a fracture. Only millimeters of relative length shift may be
enough to produce symptoms. Distal radius fractures are the most common
etiology, but patients may develop proximal migration of the radius
following a radial head or neck fracture - referred to as the
Essex-Lopresti lesion. In these cases, the dramatic elbow injury often
directs attention away from the wrist, which may not become symptomatic for
months. If symptoms develop, they may improve, stay the same, or improve
symptomatically with the passage of time. Conservative treatment is usually
recommended initially, with surgery reserved for refractory cases. Ulnar
shortening or resection arthroplasty may be indicated, depending on the
clinical situation, presence of tendinitis and condition of the distal
radioulnar joint. Preliminary arthroscopy may be helpful in defining
surgical indications.
Discussion Home Page