What is the DRUJ joint? I saw an interview with Erin Andrews and one of my favorite NFL players. She was trying to find out about his DRUJ injury. So what is that?
Erin Andrews has become one of the most forthright American sports broadcasters. Her interviews are directive and to the point! As a host for FOX College Football (Fox Sports) and ESPN Sports, she keeps up on all the plays, players, and injuries. So it's no surprise she has enough savvy herself to ask about a DRUJ injury.
DRUJ stands for distal radioulnar joint. The DRUJ is located between the two bones of the forearm. Since these two bones (the radius and the ulna) meet up at the elbow and down at the wrist, the word "distal" (meaning at the far end) tells us we are talking about the connection point at the wrist end of the bones.
The place where these two bones meet is designed to allow for rotation and gliding motions. These movements make it possible to shake a bell, wring out a wet rag, turn your palm up to receive change, take care of personal toileting needs, and many more activities of daily living. There is an S-shaped notch on the ulnar bone where the head of the radius sets. It's this special anatomy combined with the soft tissues that hold everything together that makes everything work together so well.
But sometimes, due to a traumatic injury, inflammation, aging (degeneration), or a congenital problem (present at birth), the DRUJ becomes painful and/or unstable. Wrist fracture is a common cause of post-traumatic arthritis at this joint. Improper healing and deformity at the DRUJ from any trauma can create this type of painful arthritis.
Pain, tenderness, and loss of wrist and forearm motion are the main symptoms. But crepitus (that crunching, crackling sound and feeling when moving the wrist) is reported by some patients. And "clunking" is possible when there is subluxation (partial dislocation) of the joint.
Any of these symptoms can be addressed with proper management and treatment. Conservative care is always advised first. A physical therapist guides the patient through ways to modify activities that aggravate the condition while addressing the pain and loss of motion. For a football player steroid injections and taping will probably also be used.
Surgery may be needed for the patient who does not respond well to nonoperative care or when there is significant, disabling instability and/or arthrosis (degenerative disease of the DRUJ). There are many different ways to approach this problem surgically.
Resection arthroplasty is one of the first approaches considered for this problem when conservative care isn't enough. This involves removing a small portion of the bone to eliminate the painful anatomy. Most of the motion is preserved without all the pain.
Part or all of the joint can be removed and replaced. This is referred to as either a partial or total arthoplasty. A third surgical choice is referred to as a salvage option. Salvage means "to save" as much of the joint and surrounding soft tissues as possible.
This type of approach often means sacrificing forearm motion in order to preserve function and strength. Some examples of salvage procedures for DRUJ instability include creating a one-bone forearm (OBF). This is a fusion technique. Another salvage procedure is a wide excision of the distal ulna (removal of a large portion of the bottom of the ulnar bone).
Whatever happens to this player, you can be sure Erin Andrews will be following up and giving us the scoop. Stay tuned!