The inferior radioulnar joint is the distal pivot of forearm rotation, where the radius swings around the ulnar head during pronation and supination, stabilised primarily by the triangular fibrocartilage complex (TFCC). DRUJ instability from TFCC tears or malunited distal radius fractures produces a prominent ulnar head and painful forearm rotation. The DRUJ is among the most technically challenging joints to reconstruct surgically.
DRUJ instability produces a painful, prominent ulnar head and restricted or painful forearm rotation that is confirmed by the piano key test (dorsal-palmar ulnar head compression) and ballottement of the ulnar head. Isolated TFCC tears from a fall on the outstretched hand or distal radius malunion are the most common causes. Wrist arthroscopy is both diagnostic and therapeutic for TFCC pathology.
Distal radioulnar joint instability from TFCC tears or distal radius malunion producing a prominent ulnar head and painful forearm rotation, managed with TFCC repair or DRUJ reconstruction.
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