Distal Radioulnar Joint Issues and Treatment Options

Radial bone issues

Hello Doctor, my left wrist sometimes hurts when I rotate it, like when checking the time on a watch.
Sometimes I feel weak when lifting heavy objects.
This has been going on for over six months.
Initially, when the pain started, I saw a doctor who took X-rays and diagnosed me with a distal radioulnar joint subluxation, indicating that the two bones were somewhat separated.
However, surgery was not recommended because the recovery prognosis was not very good.
Later, I consulted another doctor who suggested a "distal radioulnar joint button reconstruction surgery." After an MRI, it was found that there was also nerve damage, so the doctor recommended two surgeries: one to bring the bones closer together and another to repair the nerve.
However, due to my work situation, I may not be able to undergo surgery.
I would like to know if surgery is necessary for complete recovery.
Besides taking pain and anti-inflammatory medications and applying heat, are there any other methods to improve my condition? Thank you, Doctor.

Ray, 30~39 year old female. Ask Date: 2016/10/14

Dr. Chen Yongxue reply Orthopedics

Hello, if you have already identified the key symptoms of the problem, you should have some understanding of the situation.
If conservative treatment is effective, shouldn't there have been some improvement after more than six months?

Reply Date: 2016/10/14

More Info

The distal radioulnar joint (DRUJ) is a critical joint in the wrist that allows for the rotation of the forearm, enabling movements such as turning a doorknob or checking the time on a watch. Issues with this joint can lead to pain, instability, and loss of strength, particularly when lifting objects. Based on your description, it seems you are experiencing symptoms consistent with a DRUJ injury, specifically a partial dislocation and potential nerve damage.

Understanding Your Condition
1. Partial Dislocation: A partial dislocation, or subluxation, of the distal radioulnar joint can occur when the radius and ulna bones do not align properly. This misalignment can cause pain during rotation and when lifting heavy objects, as you have experienced.

2. Nerve Damage: The mention of nerve damage is concerning, as it can lead to weakness and numbness in the hand. This can significantly affect your grip strength and overall hand function.

3. MRI Findings: The MRI results likely provided insight into the extent of the injury, including any soft tissue damage, such as ligaments or tendons, and the condition of the nerves.

Treatment Options
1. Non-Surgical Management:
- Physical Therapy: Engaging in physical therapy can help strengthen the muscles around the wrist and improve stability. A physical therapist can provide exercises tailored to your specific needs, focusing on range of motion, strength, and proprioception.

- Bracing: A wrist brace or splint can provide support and limit movement, which may help alleviate pain and prevent further injury.

- Pain Management: Continuing with anti-inflammatory medications can help manage pain and swelling. Additionally, modalities such as heat or cold therapy can provide symptomatic relief.

2. Surgical Options:
- DRUJ Stabilization: If conservative measures fail and the pain persists, surgical intervention may be necessary. The "distal radioulnar joint button reconstruction" you mentioned is a procedure designed to stabilize the joint and restore its function. This type of surgery can be beneficial, especially if there is significant instability or if conservative treatments have not provided relief.

- Nerve Repair: If there is confirmed nerve damage, a separate procedure may be required to repair the nerve. This can help restore function and sensation to the affected areas of your hand.

Considerations Before Surgery
- Timing: Given your work commitments, it’s essential to weigh the benefits of surgery against your current lifestyle. Surgery can lead to a more definitive resolution of your symptoms, but it also requires time for recovery and rehabilitation.

- Consultation: It’s advisable to have a thorough discussion with your orthopedic surgeon about the potential outcomes of surgery versus continued conservative management. They can provide insights based on your specific case, including the likelihood of improvement with non-surgical options.

Conclusion
In summary, while surgery may provide a more permanent solution to your distal radioulnar joint issues, there are non-surgical options that can help manage your symptoms in the meantime. Engaging in physical therapy, using bracing, and managing pain with medications are all valid strategies. However, if your symptoms persist or worsen, surgical intervention may ultimately be necessary to restore function and alleviate pain. It’s crucial to maintain open communication with your healthcare provider to determine the best course of action for your specific situation.

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