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Medical Professionals

DRUJ: Novel approaches to diagnosis and treatment

Dec. 22, 2018

Often dubbed "" ulnar wrist pain is a common, debilitating condition that frustrates both patients and practitioners. Mayo Clinic has developed a diagnostic algorithm designed to address the major components and enhance the management of distal the 1 last update 2020/08/05 radioulnar joint (DRUJ) conditions.Often dubbed "" ulnar wrist pain is a common, debilitating condition that frustrates both patients and practitioners. Mayo Clinic has developed a diagnostic algorithm designed to address the major components and enhance the management of distal radioulnar joint (DRUJ) conditions.

"" says Sanjeev (Sanj) Kakar, M.D., an orthopedic surgeon at Mayo Clinic in Rochester, Minnesota. The algorithm was developed in conjunction with Marc Garcia-Elias, M.D., Ph.D., a specialist in carpal instability at the Kaplan Hand Institute in Barcelona, Spain.

Arthritis Curehow to Arthritis Cure for The '' algorithm

Arthritis Curehow to Arthritis Cure for Ulnar wrist pathology is common and generally involves derangements to several for 1 last update 2020/08/05 structures. "" Dr. Kakar says.Ulnar wrist pathology is common and generally involves derangements to several structures. "" Dr. Kakar says.

Questions in the algorithm

Questions in the algorithm

Venn diagram illustrates the questions in the Four-Leaf Clover algorithm.

As described in the April 2016 for 1 last update 2020/08/05 issue of the Journal of Hand Surgery, the Four-Leaf Clover algorithm focuses on four key factors. Physicians should ask if the DRUJ dysfunction is influenced by:As described in the April 2016 issue of the Journal of Hand Surgery, the Four-Leaf Clover algorithm focuses on four key factors. Physicians should ask if the DRUJ dysfunction is influenced by:

  • Bone deformity, such as distal radius malunion or radioulnar length discrepancy
  • Cartilage defect, due to factors such as arthritis
  • The nature of the static stabilizers of the DRUJ, such as triangular fibrocartilage complex (TFCC) injury
  • The quality of dynamic restraints such as the extensor carpi ulnaris (ECU) tendon and the possible presence of associated pathology

"" Dr. Kakar says. ""

Dr. Kakar cites the example of athletes presenting with ulnar-sided wrist pain. Their pain is often due to a TFCC injury, but they may have concomitant injuries to other structures. Mayo Clinic is collaborating with the United States Tennis Association to try to prevent and treat these injuries.

""https://www.mayo.edu/research/faculty/kaufman-kenton-r-ph-d/bio-00077935"" Dr. Kakar says. ""

The ''

For people with DRUJ arthritis, ulnar head replacement can relieve pain and restore functional anatomy and kinematics. However, up to 30 percent of patients may need revision surgery, mostly due to implant instability and persistent pain.

Lateral meniscal allograft stitched together to form a ring

Lateral meniscal allograft stitched together to form a ring

Photograph shows the lateral meniscal allograft stitched together to form a ring that is placed within the sigmoid notch, thereby deepening its concavity for implant stability.

Mayo Clinic surgeons, building on the clinic's tradition of innovation, have devised a technique that may help. Termed the "" the technique involves an ulnar head partial replacement with DRUJ interposition arthroplasty using a lateral meniscal allograft as a stabilizer. The allograft is trimmed to match the size of the sigmoid notch; the two edges of the meniscus are sutured together to form a ring, deepening the concavity of the sigmoid notch and thereby providing stability to the implant.

""/biographies/elhassan-bassem-t-m-d/bio-20055031"" Dr. Kakar says.

In the July 2017 issue of the Journal of Hand Surgery (European Volume), Mayo Clinic researchers described favorable outcomes of patients who underwent the procedure. After a mean follow-up of 20 months, all patients experienced a marked reduction in pain and had an increase in postoperative range of motion, with an average increase in grip strength of 43 percent to the unaffected extremity. No patient reported symptoms of implant instability.

"" Dr. Kakar says. ""

For more information

Kakar S, et al. The "" treatment algorithm: A practical approach to manage disorders of the distal radioulnar joint. Journal of Hand Surgery. 2016;41:551.

Kakar S, et al. Ulnar head replacement and sigmoid notch resurfacing arthroplasty with a lateral meniscal allograft: "" Journal of Hand Surgery (European Volume). 2017;42:567.

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