SussexHandSurgery

What is Distal Radio UlnarJoint (DRUJ) arthritis?

Sometimes the DRUJ wears out andbecomes arthritis. This is commonwith inflammatory arthritis patterns(such as rheumatoid arthritis) butcan also occur with simple ‘wearand tear’ as in osteoarthritis. It isnot clear why this joint should wearout in some people rather thanothers but it probably relates to theexact shape of the joint, how wellaligned the radius and ulna bone arewhen they move against each otherand any injuries that the jointsustains over time.

What symptoms do youget with DRUJ arthritis?

Some people seem to toleratedamage to the DRUJ well butothers develop pain in the joint.This is often worse with loading(heavier activity) and also withactivities involving rotating theforearm (turning a key orscrewdriver for instance).

Swelling around the ulnar (littlefinger) side of the wrist also occur.The extensor tendons (whichstraighten up the fingers) areparticularly close to the back of

this joint, especially the tendonsto the little finger. If the swellingin the joint is very marked thelittle finger extensor tendons canbe involved and even tear apartand stop working. This is a veryurgent situation to deal with asonce one tendon has gone thenext ones along are at increasedrisk of tearing.

In later cases the joint maybecome unstable resulting inclunking and clicking when theforearm is rotated.

How is the diagnosis ofDRUJ arthritis made?

The story from you, the patient,and a careful examination usuallysuggest a problem on the ulnarside of the wrist.

An Xray of the wrist will oftenshow characteristic changes ofinflammatory or osteoarthritissome of which are predictors ofproblems with the extensortendons.

A Magnetic Resonance Imaging(MRI) scan or ComputerisedTomography (CT) scan issometimes ordered to give moreinformation about the soft tissuesand joint alignment.

What treatments areavailable for DRUJ arthritis?

Most patients with this condition donot need surgery but manage withvarious combinations of painkillers,splints and activity modification.

Steroid injections might be offeredto try and reduce localinflammation within the joint.

If the pain is more severe or thetendons are at risk surgery mightbe recommended. This mightneed to be arranged urgently if thetendons are showing signs of wearor have already torn. The surgerywill need to address theunderlying cause of the problem(dealing with the arthritic joint) aswell as cleaning up (or repairing)the tendons. Various options areavailable for the joint includingremoving all or part of the joint orreplacing the joint. A careful softtissue repair is very important inall these operations. Your surgeonwill advise you regarding this.

What are the results oftreatment for DRUJ arthritis?

Once the joint has becomearthritic or the tendons have wornthrough it is not possible torestore completely normalfunction of the tendons and joints.Treatment is aimed at relievingsymptoms as much as possibleand improving each patient’sfunction. Caught early tendondamage can be minimised andgood movement of the digitsre-gained after surgery, with thehelp of the hand therapists.

What isDistal Radio Ulnar

Joint Arthritis?

CONDITIONDistal Radio UlnarJoint Arthritis

The DRUJ is the joint between the end of theradius and ulna bones, just before the wrist.This joint is where forearm rotation occurs(twisting movements of the hand and wrist).There is also a pivot between the radius andulna bones near the elbow and the two worktogether to allow forearm rotation.

CONDITION

Normal Wrist Xray

Distal RadioUlnar Joint

End of ulnaEnd of radius

‘Scalloping’ of an arthritic DRUJ – a sign of dangerfor the extensor tendons

Worn outend of ulna –odd shape

Arthritis at thebase of the thumb

is also present

‘Scalloping’ ofdistal radius –

very obvious inthis patient

www.sussexhandsurgery.co.uk © Sussex Hand Surgery January 2018

These notes are intended as a guide and some of thedetails may vary depending on your individualcircumstance and at the discretion of your surgeon.