Biomechanical study of distal radioulnar joint ballottement test

Onishi, Tadanobu; Omokawa, Shohei; Iida, Akio; Nakanishi, Yoko; Kira, Tsutomu; Moritomo, Hisao; Ruxasagluwang, Sompob; Kraisarin, Jirchart; Shimizu, Takamasa; Tanaka, Yasuhito

doi:10.1002/jor.23355

Cited by 30 publications

(27 citation statements)

References 9 publications

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“…This was in accordance to the conditions in some previous studies. 6,11 These settings enable measurement of the applied force and relative displacement of the ulna-radius. An ultrasound scanner equipped with a linear array transducer was set to a depth of 20 mm.…”

Section: Measurementmentioning

confidence: 99%

“…Several methods to quantify the DRUJ displacement have been reported in cadaver studies. [2][3][4][5][6] In addition, several clinical methods with computed tomography (CT) have quantified DRUJ stability, i.e., the radioulnar line method, the subluxation ratio method, the epicenter method and the radioulnar ratio method. [7][8][9][10][11][12] These methods measure radioulnar translation by evaluating the ulnar position relative to the radius position, resulting in a ratio.…”

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confidence: 99%

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Reliability of Quantitative Assessment of Distal Radioulnar Joint Stability With Force‐Monitor Ultrasonography

Yuine

Yoshii

Tung

et al. 2019

Journal Orthopaedic Research

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The purpose of this study was to evaluate the reliability of ultrasound assessment of the displacement-force relationships for distal radioulnar joint (DRUJ) stability. Non-dominant wrists of 10 healthy male subjects were evaluated by force-monitor ultrasonography. This apparatus was developed to apply cyclic compression to the wrist with pre-determined transducer displacement conditions in the range of 0.1-3.0 mm. The subject's wrist was placed on the table with the forearm in the pronated position. The transducer was placed on the dorsal surface of the distal radius and ulna, perpendicular to the long axis of the forearm. The center of the ulnar head was at the DRUJ level. The distance between the dorsal surface of the distal radius and the ulnar head was measured at an initial and a pressed-down position. Changes in radioulnar displacement, force to the wrist and the displacement/force ratio were evaluated. The measurements were performed independently by two raters. The intra-class correlation coefficients (ICCs) for the radioulnar displacement were 0.76, 0.68, and 0.93, in the 1.0, 2.0, and 3.0 mm transducer displacement conditions, respectively. The ICCs for the force to the wrist were 0.18, 0.67, and 0.34, in different transducer displacement conditions, respectively. The ICCs for the displacement/force ratios were 0.68, 0.67, and 0.97, in different transducer displacement conditions, respectively. The highest ICC for the radioulnar displacement and the displacement/force ratio was observed in the 3.0 mm displacement condition. This assessment of displacement-force relationships may be useful to quantify DRUJ stability.

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Section: Measurementmentioning

confidence: 99%

mentioning

confidence: 99%

Reliability of Quantitative Assessment of Distal Radioulnar Joint Stability With Force‐Monitor Ultrasonography

Yuine

Yoshii

Tung

et al. 2019

Journal Orthopaedic Research

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“…Exam maneuvers include the piano key test, ulnocarpal stress test, pisiform boost test, press test, DRUJ ballottement, and dynamic examination of the ulnar head with active pronation and supination [41][42][43]. Additional tests, such as a positive ulnar fovea sign, may also indicate ulnotriquetral ligament injury [44].…”

Section: Clinical Exammentioning

confidence: 99%

Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU)

Pang

Yao

2017

Curr Rev Musculoskelet Med

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Purpose of review The goal of this manuscript is to review key historic and recent literature regarding extensor carpi ulnaris (ECU), triangular fibrocartilage complex (TFCC) and distal radioulnar joint (DRUJ) injuries, particularly in athletes. Recent findings Many recent studies examining the ECU focus on clinical and radiographic diagnosis. Several physical exam findings are described in addition to the use of MRI and US. Imaging studies must be clinically correlated due to high incidence of findings in asymptomatic patients.In regard to the TFCC/DRUJ, there are numerous recent studies that support the use of MRA as an adjunctive diagnostic study. There are also a number of repair constructs that are described for the various different kinds of TFCC pathology reviewed here. Summary In summary, there are a number of options for the diagnosis and treatment of ulnar-sided wrist pain. Patient factors, especially in the athletic population, must be taken into account when approaching any patient with these pathologies.

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“…We have conducted several experimental studies to determine the contribution of each ligament to DRUJ stability and to evaluate changes in joint stability in different forearm and wrist positions. 6,50,51 Physiological Dynamic Translation of the Distal Radioulnar Joint…”

Section: Biomechanical Perspectives On Distal Radioulnar Joint Instabmentioning

confidence: 99%

“…Technique A previous biomechanical study using cadaver wrists demonstrated that, compared with other manual stress tests, the DRUJ ballottement test was the most accurate for evaluating instability. 50 The DRUJ ballottement test is usually conducted with the forearm in neutral rotation and is interpreted as positive if the examiner identifies noticeable displacement of the radius relative to the ulnar head or a lack of end-point resistance. Examiners may recognize DRUJ instability depending on the magnitude of movement of the examiner's fingernail grasping the ulnar head and the radius.…”

Section: Technique and Biomechanics Of The Druj Ballottement Testmentioning

confidence: 99%

A Biomechanical Perspective on Distal Radioulnar Joint Instability

et al. 2017

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The distal radioulnar joint (DRUJ) is inherently unstable, and the curvature of the sigmoid notch of the radius (radius of curvature: 18 mm) is twice as large as that of the ulnar head (8 mm).1 During forearm rotation, both dorsal-palmar and proximal-distal translation occurs between the joint surfaces. Although there is considerable variation between individuals, the osseous architecture of the sigmoid notch is a dorsally open wedge (10 degrees) and its dorsal length (10 mm) is greater than its volar length (6 mm). has been demonstrated between the obliquity of the DRUJ and ulnar variance. 1,4The deep ligamentous portions of the triangular fibrocartilage complex (TFCC) provide the primary intrinsic stabilization of the DRUJ. These fibers, which attach at the ulnar fovea and lie on the axis of forearm rotation, are the most isometric and undergo the least length changes during pronosupination movement. The palmar deep fibers of the RULs may be taut in pronation to prevent dorsal ulnar head subluxation, and the dorsal deep fibers may be taut in supination to restrain the ulna from palmar migration relative to the radius.5 Supplemental stability is provided by superficial fibers of the RUL, which may have a checkrein effect during forearm rotation. The ulnocarpal ligament (UCL) complex and the floor of the extensor carpi ulnaris (ECU) tendon sheath, including the ulnar collateral ligament, are the other components of the TFCC and also stabilize the AbstractBackground The purpose of this article was to review the anatomy, kinematics of the distal radioulnar joint (DRUJ), and to discuss definition, classification, and diagnosis of DRUJ instability. Methods A biomechanical perspective on physical examination of DRUJ ballottement test was documented. Physiological dynamic DRUJ translation and differences of the translation following sequential ligament sectioning and changes in different forearm and wrist positions were demonstrated. The clinical significance of each ligament's contribution to joint stability in specific wrist positions was addressed. Conclusion Each ligament stabilizing the DRUJ contributed to joint stability depending on the direction (palmer or dorsal) and different positions of the wrist and forearm. DRUJ ballottement test in each wrist and forearm position may detect tears of specific ligament stabilizing the DRUJ.

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Biomechanical study of distal radioulnar joint ballottement test

Cited by 30 publications

References 9 publications

Reliability of Quantitative Assessment of Distal Radioulnar Joint Stability With Force‐Monitor Ultrasonography

Reliability of Quantitative Assessment of Distal Radioulnar Joint Stability With Force‐Monitor Ultrasonography

Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU)

A Biomechanical Perspective on Distal Radioulnar Joint Instability

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