Theory - Wrist


 Wrist Joint
Articular Slope of Radius – obliquely forwards 11 degrees ,
Ulnarwards – 22 degrees
Radial Styloid – 11 mm .

Wrist
Wrist taken to  30 degree adduction
most stable at 30 degrees Adduction (Carpus most inside radial Socket ) , aka postion of Function ,neutral inclination to adopt this position , FCU responsible for this.
            With Adduction , Scaphoid tilts dorsally and slides radially.
When  wrist taken  in Neutral position
                        Tightening of long muscles
                        Carpus dragged into the slope
                       
When wrist taken to further abduction
                        More tightening of muscle and carpus dragged more to the slope.
                        Space between Trapezium and radial styloid closes .
                        Scaphoid moves out flexing palmarwards and sliding ulnarwards.

Scaphoid
Most unstable of all carpal bone.
 With wrist flexion , extension Scaphoid follows , Lunate and Triquetrum passively follow,guided by Interosseous ligament.

Instability of DRU Joint
Causes – Trauma , RA,Excision of Distal end of Ulna ,
            Improperly reduced Galeazi fracture dislocation
Symptoms
Painful restriction of supination  , pronation , cluinking , undue prominence of ulnar   head
Signs
            Tenderness over DRU Jt
            Grip Strenth reduced

Unstable ulna – balloted by hodling patient’s forearm pronated and  pushing sharply upon    
the prominent ulna head
            Imagings – X-ray –Evidence of previous injury , surgery or RA
                              CT – most effective way of demonstrating Radioulnar incongruity
                            
            Treatment
                               Depends on Cause.
                               If Ulna head intact – reattach TFCC- Arthroscopic or Open
                              Ulnar shortening (tightens ulnar corner and improves stability ) 


           

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