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Orthotic Management Of The Distal Radioulnar Joint (DRUJ)

Orthotic Management Of The Distal Radioulnar Joint (DRUJ)

The Problem with the Distal Radioulnar Joint

How to restore the rhythm of the radius and ulnar without constraining motion:

Loss of TFC integrity leads to instability of the DRUJ disrupting the rhythm of the radius as it travels around the ulnar styloid. This blog describes how a properly designed orthosis can be employed to restore stability without disrupting the rhythm of the rotating radius.

DRUJ wrist                     radius around the ulna wrist bone

    The TFC is the primary stabilizer of the DRUJ            The “pirouette” of the radius around the ulna

The Answer for Treatment

To restore stability, apply basic orthotic principles of pressure distribution and application of force for the most adjustable and successful design option.

When choosing an orthotic option, adhere to the basic principles:

Pressure Distribution

P = force /area of application

Points and Direction of Force

Minimum of 2 pts. required to stabilize rotation

Blog - ortho principles    

It's important to choose a design that distributes pressure and allows the wearer to alter the degree and direction of force to: “Provide a counterforce which mimics the stabilizers to seat the ulnar head in the sigmoid notch with just enough force to position the joint in its anatomical position.”1

 VH O’Brien, J Thurn  “A simple distal radioulnar joint orthosis” J Hand Ther 26 (2013) 287-290 Elsevier

                               THIS                                                                NOT THIS       

counterforce                   counterforce of wrist joints

Three Orthotic Principles

The following are the pros and cons of three orthotic designs.

Orthotic Design: Option 1 of 3

Circumferential wrap directing equal force medially to prevent “separation” of the ulna and radius

Pro:  Ease of application

Con: Does not allow adjusting the direction of force

Con: Circumferential force may compress the ulna into the sigmoid notch

 medically directed force        wrist widget

                                                                Wrist WidgetTM

Medically directed force = compression of the ulna into the sigmoid notch

Orthotic Design: Option 2 of 3

Circumferential wrap with a single point of force palmarward over or around the ulnar styloid

Pro:  Ease of application, comfort

Con: Lacks counterforce and the ulnar pad or donut may be misaligned on the ulnar styloid

 orthotic design     ulnar compressions wrap      wrist band

                                               Squeeze Ulnar Compression Wrap          Bullseye Wrist Band

Lack of counterforce applies majority of force on the ulna and constrains the radius

Orthotic Design: Option 3 of 3

A corrective strap and compression pads applied over a non-slip base sleeve offer adjustable counterforce force palmarly on the ulnar styloid and dorsally on the radial styloid

Pro: Wearer can locate and balance counterforce according to comfort

Con: Requires proper positioning of counterforce pads

 orthotic design         3pp wrist pop for tfcc

                                                         3pp Wrist POP (Point of Pressure)

The 3pp® Wrist POP™ both adheres to orthotic principles and avoids circumferential force. Both the direction and degree of force can be varied by altering the location and thickness of corrective pads. Non-slip foam lining eliminates over tightening and breathable material is comfortable for long-term wear.

For more information on the 3pp Wrist POP click on the button below  

3pp wrist pop


     Learn about the 3pp Wrist P.O.P. Splint






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