Distal ulnar radial joint causes symptoms complications and treatment

The distal radioulnar joint (DRUJ) is one of the most important joints in the wrist, as it plays a major role in allowing smooth rotation of the hand and forearm during daily activities such as writing, carrying objects, and even opening doors. However, due to injuries, repetitive strain, or certain medical conditions, this joint may develop inflammation or instability, leading to bothersome pain and weakness in hand movement that can significantly affect daily life. In some cases, dislocation of the joint or tears in the surrounding ligaments and cartilage may occur, requiring early diagnosis and treatment to prevent complications. In this article by Dalili Medical, we will discuss the causes of distal radioulnar joint problems, the most common symptoms and complications, methods of diagnosis and treatment through medications or surgery, as well as important tips that can help speed up recovery and restore normal wrist movement.

What Is the Distal Radioulnar Joint (DRUJ)?

The distal radioulnar joint (DRUJ) is an important synovial joint located at the distal end of the forearm, where it connects the radius and ulna bones near the wrist. It is primarily responsible for forearm pronation and supination, meaning the inward and outward rotation of the hand.

This joint is formed by the head of the ulna and the ulnar notch of the radius. It is considered a pivot joint that allows the radius to rotate around the ulna. The joint is stabilized and supported by several strong ligaments, most importantly the triangular fibrocartilage complex (TFCC), which plays a major role in maintaining joint stability.

Is a Distal Radioulnar Joint Injury Serious?

Not all injuries are serious, but neglecting treatment may lead to complications, including:

Chronic joint instability
Wrist joint arthritis over time
Permanent weakness in hand and wrist movement

Is a TFCC Tear Related to the Distal Radioulnar Joint?

Yes, a TFCC tear is directly related to the distal radioulnar joint because the TFCC is one of the main structures responsible for stabilizing it. A tear in the TFCC may lead to:

Pain on the side of the wrist
Reduced joint stability
Difficulty with rotational movements

Can Arthritis Develop as a Complication?

Yes, arthritis of the distal radioulnar joint may develop if instability or injuries are not properly treated, especially in chronic or neglected cases.

Does Carrying Heavy Objects Harm the Joint?

Yes, carrying heavy objects can increase pressure on the joint, which may cause:

Increased pain
Worsening instability
Delayed healing and recovery

It is recommended to avoid excessive strain, especially during the treatment and recovery period.

Is Wearing a Splint Helpful?

Yes, a splint is an important treatment option in many cases because it helps to:

Stabilize the wrist and joint
Reduce painful movement
Protect the joint during recovery

However, it should be used according to the doctor’s instructions and for a specific period of time.

Is Complete Recovery Possible?

Yes, many patients can achieve significant improvement or near-complete recovery, especially with:

Early diagnosis
Commitment to appropriate treatment
Regular physical therapy sessions

The earlier the treatment begins, the better the chances of full recovery and restoration of normal hand function.

Does Wrist Clicking Mean There Is a DRUJ Problem?

Not always. Wrist clicking can be normal in some cases. However, if it is associated with pain, weak grip strength, or a feeling of wrist instability, it may indicate an injury to the distal radioulnar joint or the triangular fibrocartilage complex (TFCC).

Can the Condition Be Managed Without Surgery?

Yes, mild to moderate cases can often be managed and improved without surgery through:

Physical therapy
Reducing stress on the wrist
Using a brace or splint
Taking anti-inflammatory medications when needed

Can Sports Injuries Cause Problems in This Joint?

Yes, especially sports that involve:

Repetitive wrist rotation
Heavy weightlifting
Falling onto the hand

Examples include tennis, bodybuilding, and some combat sports.

Does Using a Computer or Phone Affect the Joint?

Yes, prolonged use with poor hand positioning or repetitive wrist movements over long periods can strain the joint and increase pain, especially if there is a previous injury.

Can the Distal Radioulnar Joint Cause Numbness?

Numbness may occur in some cases if there is inflammation or pressure on nearby nerves. However, severe or persistent numbness requires careful medical evaluation to rule out other possible causes.

Can a Dislocation Occur in the Joint?

Yes, a partial or complete dislocation can occur, usually due to:

Accidents or severe falls
Wrist bone fractures
Severe ligament injuries

Does Rheumatoid Arthritis Affect the Distal Radioulnar Joint?

Yes, rheumatoid arthritis can lead to:

Chronic inflammation of the joint
Cartilage erosion
Weakness or instability of the joint
Progressive deformities over time

Can Hand Strength Be Affected After Injury?

Yes, especially in cases involving:

Persistent pain
Joint instability
Ligament injuries or TFCC tears

Patients may notice weak grip strength and difficulty carrying objects.

Is Physical Therapy Painful?

Physical therapy may cause mild discomfort at first, but it is performed gradually and under specialist supervision to avoid severe pain and ensure safe improvement.

Is It Safe to Drive During the Injury?

That depends on the severity of the condition. Driving may be difficult or unsafe if there is:

Severe wrist pain
Weak grip strength
Limited hand movement

Does Sleeping on the Injured Hand Cause Harm?

Yes, direct pressure on the wrist during sleep may increase pain or swelling. It is recommended to avoid sleeping on the injured hand and to keep it in a comfortable position.

Is Returning to Work Usually Quick?

Recovery time varies depending on several factors, including:

The type of work (office-based or manual labor)
Severity of the injury
The type of treatment or surgery performed

Office work is usually easier and quicker to return to compared to physically demanding jobs.

Does This Problem Only Affect Older Adults?

No, it can affect people of all age groups, but it is more common in cases of:

Sports injuries
Accidents and falls
Repetitive or excessive wrist use

Causes of Distal Radioulnar Joint (DRUJ) Problems

1. Bone Fractures

Radius fractures near the wrist, such as a Colles fracture
Ulna fractures
Direct wrist injuries caused by falls or accidents

2. Ligament and Cartilage Injuries

Tears of the triangular fibrocartilage complex (TFCC), one of the most important stabilizing structures of the joint
Loosening or tearing of the ligaments connecting the two bones
Weakness in the supporting structures of the joint, leading to instability

3. Joint Arthritis (Degeneration)

Occurs with aging
Can result from repetitive or excessive wrist use
Leads to cartilage wear and bone-on-bone friction

4. Inflammatory Diseases

Rheumatoid arthritis
Autoimmune diseases causing chronic inflammation and swelling in the joint
May lead to progressive joint erosion and deformity over time

5. Improper Fracture Healing

When a fracture heals in an abnormal position
This changes the mechanics of the joint
It may result in chronic pain or joint instability

6. Repetitive Movements and Overuse

Jobs or activities that involve repetitive wrist rotation
Such as using screwdrivers, prolonged typing, or sports like tennis
These activities can lead to chronic stress on the ligaments and cartilage

7. Congenital or Rare Causes

Congenital differences in bone structure
Cases of joint weakness or instability without a clear cause
Certain rare conditions associated with abnormal bone growth

Symptoms of Distal Radioulnar Joint (DRUJ) Problems

1. Pain on the Side of the Wrist

Pain appears on the outer side of the wrist near the ulna bone
The pain increases with wrist rotation or while holding objects
It may be constant or occur mainly during physical activity

2. Weakness in Rotational Hand Movement

Difficulty turning the hand upward or downward
A feeling that the movement is abnormal or not smooth
Difficulty performing tasks such as opening doors or using keys

3. Clicking or Grinding Sensation

A clicking sound during wrist movement
A sensation of grinding inside the joint
Sometimes the patient may feel that the joint is unstable

4. Joint Instability

A feeling that the wrist is “giving way” or unstable
Abnormal movement of the bones during use
Symptoms may worsen when carrying objects or during physical effort

5. Swelling

Mild or noticeable swelling around the wrist
Swelling may increase after activity or strain

6. Weak Hand Strength

Difficulty gripping objects firmly
Reduced grip strength compared to normal
Quick fatigue during hand use

7. Pain with Pressure

Clear pain when pressing on the ulnar side of the wrist
This symptom may help identify the exact site of injury

Diagnosis of Distal Radioulnar Joint (DRUJ) Problems

First: Medical History

The doctor asks the patient about symptom details, such as:

The exact location of pain
Whether there is clicking or a feeling of instability
Whether pain increases with wrist rotation
Any previous injury or fall on the hand
Weak grip strength or difficulty moving the hand

Second: Clinical Examination

1. Joint Stability Test

The doctor moves the radius and ulna bones to check for:

Normal stability
Or looseness and instability

2. Pain Assessment

Pressure is applied to the ulnar side of the wrist to identify the precise location of pain.

3. Forearm Movement Evaluation

Two important movements are examined:

Turning the hand downward (Pronation)
Turning the hand upward (Supination)

Pain or difficulty during these movements may indicate a joint problem.

Imaging and Diagnostic Tests

X-ray

X-rays help detect:

Fractures
Partial dislocations
Arthritis or joint degeneration
Bone alignment abnormalities

MRI Scan

MRI is one of the most important investigations and is used to identify:

TFCC tears
Ligament injuries
Internal inflammation and swelling

CT Scan

CT scans are useful for evaluating:

Detailed joint structure
Joint instability
Complex fractures or deformities

Diagnostic Arthroscopy

In some cases, wrist arthroscopy may be used because it allows:

Direct visualization of the joint and cartilage
Accurate diagnosis in cases unclear on imaging studies

Complications of Distal Radioulnar Joint (DRUJ) Problems

1. Chronic Joint Instability

Persistent feeling that the wrist is unstable or “slipping”
Difficulty using the hand normally
Recurrent pain with movement or physical effort

2. Joint Arthritis

Progressive cartilage wear
Friction between the radius and ulna bones
Chronic pain with wrist stiffness

3. Reduced Forearm Mobility

Especially in the movements of:

Turning the hand upward
Turning the hand downward

This may make simple daily activities difficult.

4. Weak Grip Strength

Difficulty holding objects firmly
Reduced hand strength compared to normal
Rapid fatigue during use

5) TFCC Tear or Damage (Triangular Fibrocartilage Complex)

Persistent pain on the ulnar side of the wrist
Clicking or a feeling of friction during movement
Increased joint instability

6) Partial or Complete Joint Dislocation

In severe or advanced cases, the following may occur:

Bones shifting out of their normal position
Visible deformity or abnormal prominence at the wrist
Severe pain that limits movement

7) Chronic Joint Inflammation

Recurrent swelling of the wrist
Feeling of warmth or occasional inflammation
Persistent pain even at rest

8) Impact on Daily Activities

The patient may experience difficulty with:

Opening doors
Writing for long periods
Carrying objects
Performing sports or manual work

9) Post-Surgical Complications (in some cases)

If surgery is required, possible complications may include:

Temporary wrist stiffness
Temporary weakness in movement
Possible recurrence of instability
Irritation or inflammation of surrounding tendons

Medical Treatment of DRUJ Problems

First: Pain Relievers and Anti-Inflammatory Drugs

These are used to reduce pain and inflammation around the joint.

Common examples:

Ibuprofen
Diclofenac
Naproxen

Benefits:

Reduce joint inflammation
Relieve pain during movement
Improve hand function

Important notes:

Should be taken after meals
Not recommended for long-term use without medical supervision
May not be suitable for patients with stomach or kidney problems

Second: Simple Pain Relievers

Used in mild cases or when anti-inflammatory drugs are not tolerated.

Example:

Paracetamol

Benefits:

Pain relief
Improved daily comfort

Third: Topical Treatments (Creams and Gels)

Applied directly to the wrist area.

Example:

Diclofenac gel

Benefits:

Local pain relief
Fewer side effects compared to oral medications

Fourth: Cortisone Injections

Used in moderate or chronic cases that do not respond to basic medications.

Benefits:

Strong reduction of joint inflammation
Relatively fast pain relief

Important notes:

Should not be repeated frequently
Overuse may weaken tissues and cartilage

Fifth: Rheumatoid Disease Medications

If the cause is an autoimmune disease such as rheumatoid arthritis, specific medications are prescribed by a rheumatologist to control disease activity and prevent joint deterioration.