Clinical Presentation
32yo male presents with: "Wrist pain after fall"
History
Electrician fell from ladder 3 days ago while holding a power drill. Landed on outstretched hand. Seen at another ED where X-rays showed "no fracture" and was discharged with a splint. Returns today with persistent pain, especially when turning doorknobs or using a screwdriver.
Examination Findings
- Mild swelling over distal ulna dorsally
- Point tenderness over DRUJ
- Pain with resisted supination/pronation
- Positive DRUJ ballottement test (piano key sign)
- Full range of wrist flexion/extension
- Neurovascularly intact
Learning Objectives
- Understand the anatomy of the DRUJ and its stabilizing structures
- Recognize clinical features of DRUJ instability
- Perform and interpret the DRUJ examination correctly
- Explain why DRUJ injuries are commonly missed on initial presentation