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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