Imaging the distal radioulnar joint

Imaging the DRUJ requires knowledge of the complex bony, muscular, and ligamentous anatomy that contribute to this unique joint. Standard well-positioned radiography is always the appropriate first step in any imaging evaluation of the wrist. High-resolution MRI of the wrist, preferably performed at 3T, helps to delineate the important ligamentous structures relevant to the DRUJ and ulnar wrist, whether the joint is unstable or not. The presence of instability on physical examination is an indication for dynamic CT evaluation. Close attention to technique, no matter what the modality of choice, offers the best chance for success in providing added value with imaging. Finally, communication between the radiologist and hand surgeon allows the advanced imaging examinations to be tailored to the specific clinical problem for the most effective use of resources for each individual patient.