The joint between the distal ulna and the radius allows forearm rotation--palm up and palm down motion. In a nonrheumatoid patient the most common cause of pain at the distal radioulnar joint (DRUJ)is in the aftermath of a distal radius fracture. There may have been involvement of the DRUJ by the fracture itself, or the stabilizing ligaments may have been injured. Additionally, chronic subluxation or dislocation may severely restrict motion.
Surgical treatment is directed at restoring motion and relieving pain. For years this has been successsfully accomplished by resecting the Distal ulna (Darrach prodecure) in association with a reconstruction of the stabilizing ligaments--capsulodesis or tenodesis. In a lower demand wrist, as in those patients with rheumatoid disease as the etiology, this is a fabulous option. However, when grip is important and the wrist is expected to experience forceful demands, a newer option may be better--both in terms of sustained pain relief and restoration of strong grip (see the article regarding distal ulna arthroplasty on this page).
