Biomechanics of the Distal Radioulnar Joint

Palmer, Andrew K.; Werner, Frederick W.

doi:10.1097/00003086-198407000-00005

Cited by 648 publications

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“…22 Some reports have described malalignment in the DRUJ as a relative contraindication for ulnar shortening osteotomy, 21 due to the risk of degenerative changes. [22][23][24] Although about half of patients showed development of a bony spur at the DRUJ in this study, no radiological parameters correlated with spur formation. We do not consider a reversed obliquity of the sigmoid notch as a contraindication for ulnar shortening osteotomy.…”

Section: Discussionmentioning

confidence: 53%

“…Larger ulnar variance increases the load on the ulnar carpus. 23,32 However, ulnocarpal impaction syndrome can also occur in ulnar neutral and negative wrists because of the inverse relationship between ulnar variance and TFCC thickness 33 and because ulnar variance changes with forearm rotation and dynamic ulnar impaction occurs as a result of relative lengthening of the ulna with pronation and forced finger flexion. 2 The diagnosis should therefore be made only after careful physical examination including tests such as the ulnocarpal stress test.…”

Section: Discussionmentioning

confidence: 99%

“…Malalignment with respect to ulnar inclination and the sigmoid notch has been considered a relative contraindication for ulnar shortening osteotomy, 21 which might cause degenerative changes in the DRUJ. [22][23][24] Some types of DRUJ may be more susceptible to develop problematic incongruity after ulnar shortening osteotomy. 24 We designed the present study to evaluate the long-term clinical results of ulnar shortening osteotomy to compare clinical results and radiological and arthroscopic findings.…”

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confidence: 99%

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Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

et al. 2014

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The ulnar side of the wrist has been referred to as the "black box" of the wrist, and pathologies of this region have been compared with those of low back pain, 1,2 given the complex anatomy, myriad differential diagnosis, and varied treatment outcomes. Ulnar-sided wrist pain and arise from an acute traumatic injury or a chronic degenerative condition. Common causes of ulnar-sided wrist pain include isolated injuries to the triangular fibrocartilage complex (TFCC) or lunotriquetral ligament as well as ulnar impaction syndrome, which consists of a combination of these 2 conditions along with an Keywords ► ulnar shortening osteotomy ► ulnar-sided wrist pain ► TFCC ► DRUJ ► arthroscopy AbstractBackground The purpose of ulnar shortening osteotomy is literally to shorten the ulna. It can tighten the triangular fibrocartilage complex (TFCC), ulnocarpal ligaments, and interosseous membrane. Nowadays, this method is used to treat ulnar-sided wrist pain, for which we have also started to use a treatment algorithm. The purpose of this study was to review the long-term and clinical results based on our algorithm. Materials and Methods We retrospectively reviewed 30 patients with ulnocarpal impaction syndrome after a minimum follow-up of 5 years (Group A) and then retrospectively evaluated 66 patients with recalcitrant ulnar wrist pain treated based on our algorithm (Group B). Description of Technique Ulnocarpal abutment was confirmed arthroscopically. The distal ulna was approached through a longitudinal incision between the extensor carpi ulnaris and flexor carpi ulnaris. We performed a transverse resection of the ulna fixed with a small locking compression plate. The contralateral side served as the reference for the length of shortening (mean, 2.4 mm; range, 1-5 mm). Disappearance of ulnar abutment was then confirmed again arthroscopically. Results (Group A) Most patients showed good long-term clinical results. About half of the patients showed a bony spur at the distal radioulnar joint (DRUJ), but the clinical results did not significantly correlate with presence of bony spurs. Radiological parameters wre not related to the presence of bony spurs. (Group B) Twenty-four of the 66 patients investigated prospectively underwent an ulnar shortening osteotomy, with all showing good clinical results at 18 months postoperatively. Conclusions Ulnar shortening osteotomy can change the load of the ulnar side of the wrist and appears useful for ulnar-sided wrist pain in the presence of ulnar impaction. Level of evidence IV

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

et al. 2014

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“…Anatomically located between the ulna and the carpus, the TFCC serves as a load-bearing structure absorbing 18-20% of the load across the wrist [32]. In ulnar-positive morphology, however, the force transmitted across the joint is increased and conversely decreased in ulnar-negative morphology [33].…”

Section: Triangular Fibrocartilage Complex/distal Radioulnar Joint Anmentioning

confidence: 99%

“…Concomitant ulnar shortening osteotomy (USO) or wafer procedure may be considered. Shortening the ulna decreases the load across the ulnar carpal joint and can help relieve symptoms stemming from any impaction of that joint [32]. In patients whom require <2-3 mm of shortening, a wafer procedure, either open or arthroscopic, can be considered.…”

Section: Operative Treatmentmentioning

confidence: 99%

Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU)

Pang

Yao

2017

Curr Rev Musculoskelet Med

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Purpose of review The goal of this manuscript is to review key historic and recent literature regarding extensor carpi ulnaris (ECU), triangular fibrocartilage complex (TFCC) and distal radioulnar joint (DRUJ) injuries, particularly in athletes. Recent findings Many recent studies examining the ECU focus on clinical and radiographic diagnosis. Several physical exam findings are described in addition to the use of MRI and US. Imaging studies must be clinically correlated due to high incidence of findings in asymptomatic patients.In regard to the TFCC/DRUJ, there are numerous recent studies that support the use of MRA as an adjunctive diagnostic study. There are also a number of repair constructs that are described for the various different kinds of TFCC pathology reviewed here. Summary In summary, there are a number of options for the diagnosis and treatment of ulnar-sided wrist pain. Patient factors, especially in the athletic population, must be taken into account when approaching any patient with these pathologies.

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Morphology of the articular surfaces of the distal radio-ulnar joint

1996

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Background The two articular surfaces of the distal ulna get an important role in load transmission and stabilization of the distal radio‐ulnar joint. The present study describes the morphology of the distal radio‐ulnar joint surfaces in terms of the functional relationships between the shape of the ulnar articular facets and the predominant contact situation in this joint. Methods Besides macroscopic dissection and radiological investigation the model of the “inclined plane” has been used to simulate force transmission across the radio‐ulnar joint concerning the angle between the distal and the radial articular surfaces of the ulnar head. Results The presented morphological parameters of the radio‐ulnar joint surfaces verify that the transmitted forces are effective in both a radio‐ulnar and an axial direction. The protection and the captaincy of this joint are limited by its great mobility. The investigations show that signs of an increased load pressure are frequently found in the joints that also show degenerative changes. As a morphological sign of the force transmission, distinct spongious trabecles are formed perpendicularly to the articular circumference in those ulnar heads that show a stolid angle between their articular facets. Conclusions Because of the individuality of the morphological data only qualitative statements can be made both the predominant shapes of the ulnar head, in particular about the loading of its articular surfaces. The angle between its two articular facets influences the force transmission through the radio‐ulnar joint as well as the spongious architecture of the subchondral bone of the ulnar head. © Wiley‐Liss, Inc.

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Biomechanics of the Distal Radioulnar Joint

Cited by 648 publications

References 0 publications

Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU)

Morphology of the articular surfaces of the distal radio-ulnar joint

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