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