The distal radioulnar joint (DRUJ) is the pivot joint at the wrist between the head of the ulna (convex) and the sigmoid notch of the distal radius (concave), stabilised by the triangular fibrocartilage complex (TFCC). The DRUJ allows forearm rotation from the distal end, with the radius rotating around the fixed ulnar head. The ulnar variance (relative length of ulna vs radius) significantly affects DRUJ mechanics.
DRUJ instability from TFCC tears or distal radius malunion produces a painful click and weakness during forearm rotation. The press test (patient presses up from a chair, bearing weight through the wrist in pronation) reproduces DRUJ pain. DRUJ stabilisation by TFCC repair or reconstruction (Adams-Berger procedure) restores rotation stability. Ulnocarpal impaction from positive ulnar variance causes TFCC central perforation and lunate-triquetrum osteochondral changes; ulnar shortening osteotomy or arthroscopic wafer procedure reduces the variance and unloads the TFCC.
TFCC peripheral tear from forearm pronation injury disrupts the primary DRUJ stabilisers producing ulnar-sided wrist pain, DRUJ click, and instability on stress testing; arthroscopic TFCC peripheral repair restoring the fibrocartilage insertion to the ulnar fovea is the preferred treatment for acute instability.
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