To understand and apply the different radiological techniques for assessing Distal Radioulnar Joint instability using standard radiographs, MRI, ultrasound and dynamic CT imaging.

Distal radioulnar joint (DRUJ) instability is an important cause of ulnar sided wrist pain, often associated with distal radial fractures. DRUJ instability can also manifest as an isolated injury and is occasionally seen in the context of DRUJ arthritis. DRUJ instability is often underappreciated both clinically and radiologically, leading potentially to long-term morbidity if the diagnosis is missed 1. By convention, the stability of the DRUJ is described by the relationship of the distal ulnar to the radius with dorsal subluxation being more common than...

Radiography Plain radiographs can be helpful in identifying features suggestive of DRUJ subluxation secondary to DRUJ instability. Dorsal subluxations are most common and result from a fall onto a pronated hand, while volar subluxations occur less frequently, usually from forced supination. Radiographic features suggestive of instability include widening of the radioulnar joint on the AP view, significant shortening of the radius, fracture at the base of the ulnar styloid or obvious dislocation on the lateral view 3. On a true lateral view of the wrist,...

Radiological assessment of DRUJ instability can be assessed using different methods. Familiarity with the different techniques is important to confidently make this frequently missed and important diagnosis.

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