The inevitable failure of reconstruction

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The inevitable failure of reconstruction

What is distal radio-ulna joint? The distal radio-ulna joint DRUJ is the distal far joint between the radius and ulna bones.

The forearm is made of 2 bones: They are linked just below the elbow and just above the wrist.

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In between they do not meet but are linked by a long stout ligament. The joints at the elbow proximal radio-ulna joint and at the wrist DRUJ allow the radius to rotate around the ulna thus allowing forearm movement: The distal ulna bone also gives support to the wrist bones. At the far end of the ulna is a ligament complex called the triangular fibrocartilaginous complex TFCC.

This stabilises the radius to the ulna and helps support the wrist. This could be considered a DRUJ problem but is better considered under wrist ligament injuries - see information sheet. In most cases this heals back well with either no instability or mild instability but with minimal or no symptoms.

Some patients have aching over the ulnar little finger side of the wrist, some stiffness particularly into supination turning the palm up and reduced grip strength.

The inevitable failure of reconstruction

Wrist fractures and soft tissue injuries occur a all ages so these problems can present at any age. It may follow a fracture although very few fractures give rise to DRUJ arthritis. Mostly it occurs for no obvious reason. The have The inevitable failure of reconstruction combination of pain over the DRUJ and stiffness in forearm rotation both pronation and supination.

One or the other may predominate. Why does it occur? The problem is one of damage to the ligamentous complex that secures the radius to the ulna. When weakened this allows for excess movement at the DRUJ which may be both uncomfortable and cause stiffness.

Normal joints are lined with articular cartilage and lubricated with a little bit of fluid that is continually renewed. Either due to general wear and tear or a structural abnormality in a joint such as a previous fracture break or operation the lining of the joint thins and may wear away leading to bone rubbing on bone.

This is not necessarily painful but may be. The joint tries to protect itself by forming a little more new bone at the edges and producing more joint fluid. These lead to stiffness and deformity. What happens if nothing is done? This is referred to as the natural history i. The symptoms tend to stabilise out within a year or so of injury.

By then people either have problems or do not. Unless there is a change in activity such as undertaking heavier work then the symptoms tend not to change long term. Once arthritis has started it will almost inevitably progress i. This does not however mean that the patient's symptoms will necessarily increase although they may.

This can lead to increasing pain and stiffness and hence disability. Making the diagnosis The Hand specialist who sees the patient will ask questions about their symptoms, when they started, how they progressed, what treatment if any they have had and other questions relevant to the problems.

They will then examine the patient looking at the elbows, wrists and hands. It is usually necessary to demonstrate some tenderness to confirm the site of the symptoms but this should not be too painful. What test s might be performed? Tests also known medically as Investigations include X-rays, scans, blood tests and particularly in the hand electrical tests known as EMGs or Neurophysiology.

These may be used to help make or confirm a diagnosis after a patient has described their symptoms and been examined. The diagnosis is usually obvious after listening to and examining a patient.

Typically an X-ray is requested on the same day to delineate the extent of joint damage, although the X-ray findings do not correlate well with the symptoms with some patients having few X-ray changes but marked symptoms and vice versa.

For instability special scans may be necessary to help delineate the problem further. The patient lies on a bed and passes through the tunnel whilst X-rays are shone from various directions at the area of the body being investigated.Critical Theory has a narrow and a broad meaning in philosophy and in the history of the social sciences.

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PRISM 4, no. 2 FeatuReS | 31 Inevitable Conflicts, avoidable Failures Preparing for the third Generation of Conflict, Stabilization, and Reconstruction Operations.

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