The distal radioulnar joint has a synovial sac that extends proximal to the sigmoid notch as the prestyloid recess and distal to the articular disc, communicating with the radiocarpal joint only when the TFCC articular disc has a perforation. The DRUJ recess is separated from the radiocarpal joint by the intact TFCC in normal anatomy, constituting a separate joint compartment injected independently during wrist arthrography.
The DRUJ compartment is injected separately from the radiocarpal joint in three-compartment wrist arthrography, along with the radiocarpal and midcarpal compartments. Communication between the DRUJ and the radiocarpal on arthrography indicates a TFCC articular disc perforation or central tear. The prestyloid recess, visible on MRI as a small fluid collection between the ulnar styloid and the triquetrum in normal individuals, should not be mistaken for pathological TFCC tear. DRUJ arthroscopy through 6R and direct DRUJ portals assesses TFCC integrity, the cartilage of the sigmoid notch, and the foveal ligament attachments.
Flow of contrast from the DRUJ compartment into the radiocarpal space on DRUJ injection indicates a TFCC tear, since the intact articular disc normally separates these two compartments; conversely, radiocarpal injection with contrast entering the DRUJ indicates a proximal TFCC defect, guiding the level of arthroscopic repair.
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