What is a positive piano key test?

What is a positive piano key test?

The piano-key test involves depressing the distal ulna from dorsal to volar with the hand pronated. A positive result is characterized by painful laxity in the affected wrist compared with the contralateral wrist. The results are usually positive in cases of DRUJ synovitis.

What causes DRUJ instability?

Distal Radioulnar Joint Instability occurs when articular contact between the two forearm bones at the wrist follows an abnormal path in rotation. Though this is an exceptionally stable and mobile joint, it is prone to injury when someone falls on an outstretched hand (FOOSH) with the wrist pronated.

Why is DRUJ more stable in supination?

Tensioning of the ECU tendon and MPQ in supination results in increased DRUJ stability [3,9,11,14]. The distal oblique fibers of the IM prevent the distal radius from luxation during rotation [5,13,15-19]. The primary intrinsic stabilizer of the DRUJ is the TFCC, predominantly the radioulnar ligaments of the TFCC.

What is the DRUJ?

Conditions. DRUJ stand for ‘Distal Radio-ulnar Joint’ . The radius and ulna bones in the forearm form a closed loop with a proximal joint at the elbow and a distal joint at the wrist. The DRUJ is stabilised primarily by the strong ligaments surrounding it and secondarily by the congruency of the bony surfaces.

How do you test for DRUJ?

Different physical tests for the diagnosis of DRUJ instability have been described, including the Ballottement test, radius pull test, clunk test, extensor carpi ulnaris (ECU) test, and press test. The Ballottement test is considered the most reliable physical examination test for DRUJ instability.

How do you assess DRUJ?

Evaluation of the DRUJ begins with palpation over the distal radius and lunate articulation that proceeds ulnarly to the sigmoid notch and distal ulna. Pain that occurs with forearm pronation and supination may suggest DRUJ disease. The examiner must be careful to rotate the forearm at the wrist, not at the hand.

What is DRUJ joint?

The distal radioulnar joint (DRUJ) is part of the complex forearm articulation that includes proximal radioulnar joint (PRUJ), forearm bones, and interosseous membrane (IOM) allowing pronosupination. It is functionally and anatomically integrated with the ulnocarpal articulation of wrist.

What is a DRUJ procedure?

It involves the removal of a very small section of bone from the ulna bone close to the wrist followed by fixation with a plate. The effect of slightly shortening the ulna bone is to tighten the ligaments between the radius and ulna bones and so provide greater stability to the DRUJ.

What is distal radius?

The radius is one of two forearm bones and is located on the thumb side. The part of the radius connected to the wrist joint is called the distal radius. When the radius breaks near the wrist, it is called a distal radius fracture.

What is the supination lift test?

Supination test: The patient grabs the underside of a table with the forearms supinated; this causes a load on the TFCC and dorsal impingement, which will cause pain if there is a peripheral, dorsal tear.

Does the druj move synchronously with the radioulnar joint?

• During forearm motion, the DRUJ moves synchronously with the proximal radioulnar joint – any injury or deformity involving the radius or ulna can alter the function of both joints Courtesy of Thomas E. Trumble, MD http://www.youtube.com/watch?v=LG9gwWt4sTU

Is the ulnar pull test for distal radioulnar joint instability useful?

The ulnar pull test in the coronal plane was the most sensitive test for detecting a significant increase in diastasis relative to the intact DRUJ. Keywords: distal radioulnar joint; distal radioulnar joint instability; instability; stress examination.

What are the different types of stress tests for druj?

After each component of the DRUJ was sectioned, we performed three radiographic stress tests-squeeze test, ulnar pull in coronal plane, and simulated DRUJ ballotment test.

What does the druj ballotment test detect?

The simulated DRUJ ballotment test detected a significant increase in dorsal translation of the ulna relative to the intact DRUJ with sectioning of the foveal insertion of the TFCC (4.9 mm) and the DOB (5.6 mm).