Orthotic Management Of The Distal Radioulnar Joint (DRUJ)

Posted by Julie Belkin on Fri, May 04,2018 @ 12:55 PM

The Problem

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.

Blog- DRUJ-1                     Blog ulna2

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

The Answer

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       

blog This                   Blog- not his

 

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

 blog1        blog2

                                                                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

 blog1a     blog2a      blog3a

                                               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

 blog1b         blog2b

                                                         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  

wrist pop_product_sqaure.jpg

    

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

 

 

 

 

 

 

Tags: distal radioulnar joint, orthotic managment, druj

This blog is presented for informational purposes. We will gladly answer questions pertaining to products, however, we cannot provide specific patient diagnoses or treatment recommendations.

 


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