The DRUJ is the distal pivot of forearm rotation, complementing the proximal radioulnar joint at the elbow. The sigmoid notch of the radius rotates around the ulnar head, stabilised by the TFCC (the primary stabiliser) and the dorsal and palmar radioulnar ligaments. DRUJ instability from distal radius fracture malunion or TFCC disruption produces painful forearm rotation limitation.
DRUJ instability is assessed by the piano key test (dorsal pressure on the ulnar head in both pronation and supination) and the radius stress test. Instability after distal radius fracture requires TFCC repair or radioulnar ligament reconstruction. The Darrach procedure (ulnar head resection) and Sauve-Kapandji procedure (distal ulnar fusion with proximal pseudarthrosis) address chronic DRUJ arthritis.
TFCC disruption producing painful forearm rotation managed with TFCC repair or radioulnar ligament reconstruction.
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