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Distal Radial Ulnar Joint (DRUJ) Compression Test

Exams and Signs

Historical Overview

  • To treat distal radioulnar joint (DRUJ) injuries, physicians often use the Sauvé-Kapandji procedure. Sauvé and Kapandji reported this procedure in 1936, with similar methods introduced by Berry in 1930 and Steindler in 1932.1

Description

  • The DRUJ compression test is often used after trauma to the forearm and wrist, such as distal radius fractures.2
  • Patients with rheumatoid arthritis (RA) often present with triangular fibrocartilage complex (TFCC) or DRUJ instability.3

Pathophysiology

  • The DRUJ compression test can help diagnose post-traumatic arthritis, osteoarthritis, RA, or tendon rupture.3

Instructions

  1. Obtain an accurate and complete patient history, including any past injuries. Ask the patient to rate on a scale from 1 to 10, how much pain s/he usually experiences in the affected hand and/or wrist.
  2. With proximal rotation of the forearm, compress the ulna against the radius in the area of the DRUJ.
  3. Check for instability and tenderness in the area of the DRUJ.
  4. Also check for crepitus and swelling in the wrist; this may indicate arthritis.3
  5. Examine the contralateral hand and wrist.

Variations

  • In cases of RA, the wrist may move in the ulnar direction along the distal radius.3

Related Signs and Tests

  • Range of motion (ROM), active
  • Grip strength
  • Piano key test
  • Radiographs
  • Axial forearm computed tomography (CT)

Additional Information

Definition of Positive Result
  • A positive result occurs when the patient experiences increased tenderness with compression of the area of the DRUJ.
Definition of Negative Result
  • A negative result occurs when the patient does not experience increased tenderness with compression of the area of the DRUJ. 
Comments and Pearls
  • It is important to stabilize severe DRUJ injuries, before the patient develops chronic DRUJ instability.2
  • To treat RA, options for operative procedures include the Sauvé-Kapandji procedure and the Darrach distal ulna resection. The Sauvé-Kapandji procedure is more often used for younger patients.5
  • To improve the reliability of the DRUJ compression test, use axial forearm CT in pronation and supination. The CT images may help reveal arthritic changes.4
Diagnoses Associated with Exams and Signs
Videos
Distal Radioulnar Joint Compression Test
References
  1. Sebastin SJ, Larson BP, Chung KC. History and evolution of the Sauvé-Kapandji procedure. J Hand Surg Am 2012;37(9):1895-902. PMID: 22763060
  2. Garrigues GE, Sabesan V, Aldridge JM 3rd. Acute distal radioulnar joint instability. J Surg Orthop Adv 2008;17(4):262-6. PMID: 19138499
  3. Rayan G, Akelman E. The Hand: Anatomy, Examination and Diagnosis. Philadelphia: Lippincott Williams & Wilkins, 2012
  4. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
  5. Lee SK, Hausman MR. Management of the distal radioulnar joint in rheumatoid arthritis. Hand Clin 2005;21(4):577-89. PMID: 16274868
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