Subluxation-related ulnar neuropathy (SUN) syndrome related to distal radioulnar joint instability

2011 ◽  
Vol 37 (7) ◽  
pp. 652-664 ◽  
Author(s):  
P. S. C. Malone ◽  
C. E. Hutchinson ◽  
N. S. Kalson ◽  
C. J. Twining ◽  
G. Terenghi ◽  
...  
Keyword(s):  
Imaging Study ◽  
Distal Radioulnar Joint ◽  
Ulnar Neuropathy ◽  
Diagnostic Study ◽  
Historical Cohort ◽  
Radioulnar Joint ◽  
Qualitative And Quantitative ◽  
Druj Instability ◽  
Level Ii ◽  
Quantitative Analyses

Ulnar neuropathy coexistent with distal radioulnar joint (DRUJ) instability has previously been observed in our practice. The aim of this study was to define this phenomenon and investigate the hypothesis that the cause of this intermittent, positional ulnar neuropathy is related to kinking of the ulnar nerve about the DRUJ. Ulna neuropathy was present in 10/51 (19.6%) of a historical cohort of patients who presented with DRUJ instability. Nine subsequent patients with DRUJ instability and coexistent ulnar neuropathy underwent 3-T magnetic resonance imaging to better understand the mechanism of the observed syndrome. Both 3D qualitative and quantitative analyses were used to assess the presence of nerve ‘kinking’, displacing the nerve from its normal course and causing nerve compression/distraction in the distal forearm and Guyon’s canal. Results of the quantitative analysis were statistically significant ( p < 0.05). The clinical features of the condition have been delineated and termed subluxation-related ulnar neuropathy or SUN syndrome. The imaging study was a level II diagnostic study.

scholarly journals Clinical and Non-Clinical Aspects of Distal Radioulnar Joint Instability

2012 ◽  
Vol 6 (1) ◽  
pp. 204-210 ◽  
Author(s):  
MME Wijffels ◽  
PRG Brink ◽  
IB Schipper
Keyword(s):  
Distal Radioulnar Joint ◽  
Lateral View ◽  
Joint Capsule ◽  
Clinical Aspects ◽  
Clinical Tests ◽  
Radioulnar Joint ◽  
Radiologic Evaluation ◽  
Druj Instability ◽  
Common Diagnosis ◽  
Extensive Range

Untreated distal radioulnar joint (DRUJ) injuries can give rise to long lasting complaints. Although common, diagnosis and treatment of DRUJ injuries remains a challenge. The articulating anatomy of the distal radius and ulna, among others, enables an extensive range of forearm pronosupination movements. Stabilization of this joint is provided by both intrinsic and extrinsic stabilizers and the joint capsule. These structures transmit the load and prevent the DRUJ from luxation during movement. Several clinical tests have been suggested to determine static or dynamic DRUJ stability, but their predictive value is unclear. Radiologic evaluation of DRUJ instability begins with conventional radiographs in anterioposterior and true lateral view. If not conclusive, CT-scan seems to be the best additional modality to evaluate the osseous structures. MRI has proven to be more sensitive and specific for TFCC tears, potentially causing DRUJ instability. DRUJ instability may remain asymptomatic. Symptomatic DRUJ injuries treatment can be conservative or operative. Operative treatment should consist of restoration of osseous and ligamenteous anatomy. If not successful, salvage procedures can be performed to regain stability.

scholarly journals Radius distraction could contribute to long-term stability for treating distal radioulnar joint instability during volar plating of distal radius fracture: a retrospective case series study

2021 ◽  
Author(s):  
Cheng-Yu Yin ◽  
Hui-Kuang Huang ◽  
Duretti Fufa ◽  
Jung-Pan Wang
Keyword(s):  
Surgical Technique ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Case Series ◽  
Distal Radioulnar Joint ◽  
Radius Fracture ◽  
Radioulnar Joint ◽  
Druj Instability

Abstract BackgroundThe surgical technique of radius distraction for stabilization of distal radioulnar joint (DRUJ) if intraoperative DRUJ instability was found after the fixation of distal radius fracture has been previously described, but this surgical technique lacks clinical and radiographic effect in minimal 3 years follow-up. We therefore evaluated the clinical outcome and radiographic results of radius distraction in minimal 3 years follow-up.MethodsWe reviewed the case series of distal radius fracture with concomitant DRUJ instability receiving radius distraction from the senior author over a 5-year period (January 1st, 2013 to June 30th, 2017) retrospectively, and the evaluation of clinical and radiographic outcomes was performed at clinic as long-term follow-up; a total 34 patients had been evaluated.ResultsAt minimal post-operative 36 months follow-up, all cases demonstrated acceptable wrist range of motion with stable DRUJs and low NRS of wrist pain (0.6, SD 0.7) and DASH score (mean 9.1, SD 6.2), and there were no cases suffering from nonunion of distal radius. The mean ulnar variance of injured wrist and uninjured wrist were − 1.2 mm and 0.2mm, respectively (SD 1.0 and 0.6) with significant statistical difference.ConclusionsRadius distraction during volar fixation of distal radius fracture should be consider if DRUJ instability was found by the radioulnar stress test intraoperatively, and the long-term DRUJ stability could be achieved by maintenance of normal-to-negative ulnar variance, with decreased wrist pain and satisfactory function outcome.Level of EvidenceTherapeutic Level IV

scholarly journals Radius-ulna shaft fracture with distal radioulnar joint instability in a case of ipsilateral malunited colles fracture: a case report

2021 ◽  
Vol 7 (3) ◽  
pp. 695
Author(s):  
Neetin P. Mahajan ◽  
Prasanna Kumar G. S. ◽  
Kishor Jadhav ◽  
Kartik Pande ◽  
Tushar Patil
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Shaft Fracture ◽  
Distal Radioulnar Joint ◽  
Fracture Site ◽  
Ulnar Variance ◽  
Radioulnar Joint ◽  
Druj Instability ◽  
Colles Fracture ◽  
K Wires

<p class="abstract">Malunion of the distal end of radius is a known consequence of the conservative management. The functional impairment depends on the severity of the deformity and it can be associated with distal radioulnar joint (DRUJ) instability. Subsequent radius ulna fracture in an elderly osteoporotic patient is a challenging task to manage. A 60 year old female patient came with radius ulna shaft fracture with DRUJ instability with ipsilateral malunited distal radius fracture. We managed with open reduction and internal fixation using 3.5 mm locking compression plate (LCP) with ulnar shortening and K wires for DRUJ. At one year, follow-up, patient is having good clinical and radiological outcome without any complications. Radius ulna shaft fracture in cases of malunited colles fracture with positive ulnar variance with DRUJ instability can be managed well with open reduction and internal fixation of radius-ulna shaft which provides stable fixation, ulnar shortening at the fracture site to maintain the neutral/negative ulnar variance and DRUJ fixation using K wires. Use of multiple vicryl sutures to tie the plate to the bone gives additional stability in osteoporotic bones till the fracture unites and prevents implant failure. Combination of the above mentioned procedures helps in getting good functional outcome in elderly osteoporotic patients.</p>

scholarly journals Anatomic Reconstruction of the Triangular Fibrocartilage Complex for the Treatment of Chronic Instability of the Distal Radioulnar Joint. A Systematic Review

2021 ◽  
Vol 49 (02) ◽  
pp. e97-e104
Author(s):  
Ignacio Miranda ◽  
Francisco J. Lucas ◽  
Vicente Carratalá ◽  
Joan Ferràs-Tarragó ◽  
Francisco J. Miranda
Keyword(s):  
Systematic Review ◽  
Surgical Techniques ◽  
Case Series ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Anatomic Reconstruction ◽  
Wrist Arthroscopy ◽  
Radioulnar Joint ◽  
Druj Instability ◽  
Triangular Fibrocartilage

Abstract Introduction Peripheral injuries of the triangular fibrocartilage complex (TFCC) can produce pain and instability of the distal radioulnar joint (DRUJ). There are several techniques for the reconstruction of the TFCC. The aim of the present paper was to summarize the tendon plasties of the DRUJ ligaments for the anatomic reconstruction of TFCC, to analyze the surgical techniques, and to evaluate their outcomes. Methods In order to perform a systematic review, we searched in the literature the terms DRUJ instability OR chronic distal radioulnar joint instability OR distal radioulnar tendon plasty. Results In total, 11 articles with level of evidence IV (case series) were retrieved. Most studies achieved good results, with recovery of wrist stability, improvement of the pain, and increase in grip strength in the functionality tests. In the historical evolution of the published series, wrist surgeons tried to perform a more anatomical plasty, with a more stable fixation and less invasive techniques. Conclusion The Adams procedure continues to be a valid and reproducible technique for the treatment of chronic DRUJ instability. If wrist arthroscopy and implants are available and surgeons have been technically trained, the authors recommend an arthroscopy-assisted technique, or, if possible, an all-arthroscopic TFCC reconstruction with implant fixation of the plasty in its anatomical points of insertion. Comparative studies between open and arthroscopic TFCC reconstruction techniques are needed.

Delayed-Onset Ulnar Neuropathy at the Wrist Associated With Distal Radioulnar Joint Arthritis After Radius Malunion: Report of Two Cases

2010 ◽  
Vol 35 (2) ◽  
pp. 233-236 ◽  
Author(s):  
Hyun Sik Gong ◽  
Kyung Hwan Kim ◽  
Young Hak Roh ◽  
Young Ho Lee ◽  
Moon Sang Chung ◽  
...  
Keyword(s):  
Distal Radioulnar Joint ◽  
Ulnar Neuropathy ◽  
Radioulnar Joint ◽  
Delayed Onset ◽  
Joint Arthritis ◽  
Radius Malunion

THE BEAUTY OF STABILITY: DISTAL RADIOULNAR JOINT STABILITY IN ARTHROSCOPIC TRIANGULAR FIBROCARTILAGE COMPLEX REPAIR

Hand Surgery ◽  
2013 ◽  
Vol 18 (01) ◽  
pp. 21-26 ◽  
Author(s):  
Chris Tang ◽  
Boris Fung ◽  
Rebecca Chan ◽  
Margaret Fok
Keyword(s):  
Stress Test ◽  
Distal Radioulnar Joint ◽  
Small Sample ◽  
Triangular Fibrocartilage Complex ◽  
Radioulnar Joint ◽  
Transosseous Suture ◽  
Sigmoid Notch ◽  
Druj Instability ◽  
Triangular Fibrocartilage

The triangular fibrocartilage complex (TFCC) has an important role in the stability of the distal radioulnar joint (DRUJ) stability. We designed a new method of TFCC tear repair that has satisfactory post-operative DRUJ stability. From May 2004 to August 2010, 14 patients who underwent this operation were reviewed. The average post-operative follow-up period was 8.2 months; 66.7% of the patients with TFCC tear in sigmoid notch had clinical DRUJ instability, while only 50% of tear in fovea and 16.7% of tear in base of ulnar styloid had clinical DRUJ instability. Transosseous suture via inside-outside technique was used for repair. At the final follow-up, all 14 patients have soft end point with < 5 mm translations of the DRUJ shown by the stress test. Based on this small sample with satisfactory outcome assessed by the Mayo modified wrist score and DRUJ stability, we recommend TFCC tear in sigmoid notch, which has a higher chance of DRUJ instability, to be repaired by transosseous suture.

scholarly journals A Novel Technique to Assess Distal Radioulnar Joint Stability Using Increasing Torque

2018 ◽  
Vol 08 (04) ◽  
pp. 327-334 ◽  
Author(s):  
Klara Nilsson ◽  
Peter Hallberg ◽  
Erik Tesselaar ◽  
Simon Farnebo
Keyword(s):  
Reference Values ◽  
Distal Radioulnar Joint ◽  
Radiographic Evaluation ◽  
Dominant Hand ◽  
Joint Stability ◽  
Level Of Evidence ◽  
4D Ct ◽  
Radioulnar Joint ◽  
Level Ii ◽  
Dc Servomotor

Background Previous studies on computed tomography (CT) in patients with a suspected triangular fibrocartilage complex (TFCC) injury have not been successful in assessing distal radioulnar joint (DRUJ) laxity. The aim of this study was to develop a novel servomotor-driven device for the assessment of DRUJ by applying increasing torque to the DRUJ in pronation and supination. Methods A custom-built device was designed to function during four-dimensional (4D) CT of the wrist. A torque meter, positioned between the incoming hand holder, and a direct current (DC) servomotor were used for angular positioning and for applying rotational force to the patient's arm. A total of 110 healthy participants were recruited to gather reference values for the range of motion (ROM), maximum torque in neutral and supinated/pronated position, and the ability to withstand an increasing, device-generated torque in these positions. The device was also used during 4D DRUJ CT in five patients with suspected TFCC injuries. Results A gender- and age-relevant reference chart for ROM and torque was created. Men showed a tendency (ns) toward having a larger ROM and increasing strength with increasing age, whereas women showed the opposite. Also, the dominant hand showed a tendency toward having a larger ROM and being stronger than the nondominant hand (ns). A smaller cohort of patients (n = 5) with suspected TFCC injuries showed a significantly decreased ability to withstand increasing torque in both supination (2.1 ± 0.3 vs. 3.1 ± 0.2 s; p < 0.005) and pronation (2.3 ± 0.5 vs. 3.1 ± 0.4 s; p < 0.0005) and also showed a clear laxity on real-time 4D CT image sequences. Decreased strength at all positions was also found (average 74% decrease compared to noninjured side). Conclusion Reference values for torque strength and ability to withstand increasing torque can be used clinically in the assessment of patients with symptoms that could represent ligamentous injuries to the TFCC. The ability to use the device during CT enables radiographic evaluation of instability during increasing torque. Level of Evidence This is a Level II study.

Extensor Retinaculum Reconstruction of the Distal Radioulnar Joint in Adolescents

Hand ◽  
2020 ◽  
pp. 155894472096670
Author(s):  
Andrea S. Bauer ◽  
Stella J. Lee ◽  
Michael D. Smith ◽  
Donald S. Bae ◽  
Peter M. Waters
Keyword(s):  
Distal Radius ◽  
Distal Radioulnar Joint ◽  
Surgical Reconstruction ◽  
Extensor Retinaculum ◽  
Radioulnar Joint ◽  
Druj Instability ◽  
Outcome Scores ◽  
High Level ◽  
Age Range ◽  
Prior Injury

Background This study characterizes the outcomes and complications of surgical reconstruction of distal radioulnar joint (DRUJ) instability using the extensor retinaculum (Herbert sling). Our hypothesis was that extensor retinaculum reconstruction is a reliable method of DRUJ stabilization in adolescents. Methods This was a retrospective study of pediatric patients treated surgically using the Herbert sling for DRUJ instability at a single institution. We identified 22 subjects who underwent surgery at an average of 16.2 years of age (range, 12-18 years). Medical records and available imaging were reviewed for all subjects, and patients were contacted to participate in the prospective completion of the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Results Preoperative symptoms were more commonly pain (95%) than feelings of DRUJ instability (45%), although 100% had instability on physical examination. Eight (36%) patients demonstrated limited supination preoperatively. Twenty-one subjects (95%) noted prior injury to that wrist, 15 of which were distal radius fractures. Surgery consisted of stabilization of the DRUJ using extensor retinaculum, in concert with other procedures to address all potential causes of wrist pain. Postoperatively, DRUJ stability was maintained in 21 of 22 subjects. Of the 12 patients who provided functional outcome scores, median QuickDASH score was 7.6 (range, 0-45). Conclusions Distal radioulnar joint instability in adolescents is often preceded by fracture of the distal radius. Surgeons must maintain a high level of suspicion to appropriately diagnose DRUJ instability, which is often not an isolated pathoanatomical problem. The Herbert sling technique using extensor retinaculum can successfully confer DRUJ stability in this population.

scholarly journals FUNCTIONAL RESULTS POST-TRIANGULAR FIBROCARTILAGE COMPLEX RECONSTRUCTION WITH EXTENSOR CARPI ULNARIS WITH OR WITHOUT ULNAR SHORTENING IN CHRONIC DISTAL RADIOULNAR JOINT INSTABILITY

Hand Surgery ◽  
2005 ◽  
Vol 10 (02n03) ◽  
pp. 169-176 ◽  
Author(s):  
Jui-Tien Shih ◽  
Hung-Maan Lee
Keyword(s):  
Functional Results ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Radioulnar Joint ◽  
Extensor Carpi Ulnaris ◽  
Druj Instability ◽  
Sport Activities ◽  
Triangular Fibrocartilage ◽  
Post Traumatic

From September 1996 to September 2001, 37 adult patients were diagnosed with chronic triangular fibrocartilage complex (TFCC) tears with distal radioulnar joint (DRUJ) instability in our clinic. They had all received the procedure of TFCC reconstruction with partial extensor carpi ulnaris (ECU) combined with or without ulnar shortening. There were 36 males and one female in the study with a mean age of 22.4 years. The follow-up period ranged from 25 to 48 months with a mean of 36.2 months. All patients received the rehabilitation programme and were re-examined at our outpatient department. The results were graded according to the Mayo Modified Wrist Score. Eleven of the 37 patients rated their wrists "excellent", 22 rated "good", and four rated "fair". Overall, a total of 33 patients (89%) rated satisfactorily and returned to work or sport activities. Therefore, TFCC reconstruction with partial ECU tendon combined with or without ulnar shortening procedure is an effective method for post-traumatic chronic TFCC tears with DRUJ instability suggested by this study.

scholarly journals Posttraumatic distal radius growth arrest as a cause of the development of distal radioulnar joint instability in children

2021 ◽  
Vol 9 (1) ◽  
pp. 87-94
Author(s):  
Yaroslav N. Proschenko ◽  
Sergey Yu. Semenov
Keyword(s):  
Distal Radius ◽  
Wrist Joint ◽  
Growth Arrest ◽  
Clinical Manifestations ◽  
Growth Zone ◽  
Distal Radioulnar Joint ◽  
Time Interval ◽  
Radius Fractures ◽  
Radioulnar Joint ◽  
Druj Instability

BACKGROUND: The distal radial physis is involved in the injury process in approximately 15% of distal radius fractures. Distal radius physeal arrest and the normal functioning of the distal ulna growth lead to lengthening and dislocation of the head of the ulna in the distal radioulnar joint (DRUJ). These changes, in turn, lead to pain syndrome and forearm dysfunction, which is a manifestation of DRUJ instability. AIM: This study aims to evaluate the results of a study of pediatric patients with traumatic DRUJ instability. MATERIALS AND METHODS: An analysis of the results of the examination of 11 children aged from 13 to 17 years with traumatic type DRUJ instability due to the distal radius growth arrest. RESULTS: According to the X-ray examination data, all children showed closure of the distal growth zone of the radius and ulnar positive variant (ulna +). The shortening of the radius was calculated. Also, the time interval between the injury and the discovery of the wrist joint pathology was estimated. All types of radius fractures with growth plate involvement can cause physeal arrest, leading to a DRUJ instability. The interval from the acute wrist injury with damage to the distal radius growth zone to develop clinical manifestations of a DRUJ instability is 2.4 years on average. CONCLUSION: The development of this type of traumatic DRUJ instability is typical only in children since changes occur in the presence of an active growth zone and are associated with previous fractures of the distal radius. Therefore, a long-term dispensary observation by a traumatologist-orthopedist is necessary for patients with this pathology.

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