Wrist #1 - Answers
- Madelung's deformity, idiopathic.
AP and lateral view of left wrist
Click the images for more detailed views.
Findings:
- increased width between the distal radius and ulna.
- relatively long ulna compared to radius (positive ulnar variance).
- decreased carpal angle.
- triangularization of the distal radial epiphysis.
- wedging of the carpus between the deformed radius and the protruding
ulna, with the lunate at the apex of the wedge.
This process was first described by Madelung (oddly enough), who described
a painful wrist deformity in a young woman in 1878. The roentgen findings
in this disorder include:
Roentgenographic
Abnormalities
in Madelung's Deformity |
| Radius |
- dorsal and ulnar curvature
- decreased length
- triangularization of distal epiphysis
- premature fusion of medial half of distal epiphysis
- ulnar and volar angulation of distal articular surface
|
| Ulna |
- dorsal subluxation
- enlargement and distortion of ulnar head
- changes in length of ulna
|
| Carpus |
- wedging of carpus between deformed radius and protruding ulna
- triangular or "vee"-shaped configuration of carpus with lunate
at apex
- arched curvature in lateral projection
|
Confusion continues as to the etiology of this deformity. Most recently,
it has been classified into several types:
- Post-traumatic
- extension injuries to radial epiphysis
- excessive or repetitive loading of an immature joint
- Dysplastic
- multiple hereditary exostosis syndrome
- dyschondrosteosis (a mesomelic variety of dwarfism)
- onycho-osteodysplasia syndrome (HOOD syndrome: nail-patella syndrome)
- Genetic
- Idiopathic
- more commonly bilateral than unilateral
- asymmetrical in severity
- much more common in females
- clinical manifestations usually seen in adolescents or young adults
- visible deformity
- pain
- fatigue
- limited range of motion
- clinical course
- symptoms may progress for years, then become stationary
- precocious osteoarthritis may result from this deformity
- some patients require surgical intervention
- spontaneous rupture of extensor tendons seen rarely
The wrist abnormalities seen in some of the conditions listed above
may not fit the classic description of Madelung's deformity. Rather, they
may exhibit a "reverse" Madelung's deformity, in which the distal
end of the radius is tilted dorsally, the carpus shifted dorsally, and
the distal end of the ulna dislocated anteriorly.
References:
- Madelung OW. Die spontane Subluxation der Hand nach vorne. Verh Dtsch
Ges Chir 1878;7:259.
- Resnick D. Bone and joint imaging. Philadelphia, WB Saunders, 1989.
- De Smet L, Claessens A, Fabry G. Gymnast wrist. Acta Orthop Belg 1993;59:377-380.
- Ioan DM, Maximilian C, Fryns JP. Madelung deformity as a pathognomonic
feature of the onycho-osteodysplasia syndrome. Genet Couns 1992;3:25-29.
- Vender MI, Watson HK. Acquired Madelung-like deformity in a gymnast.
J Hand Surg Am 1988;13:9-21.
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Used by permission of Michael L. Richardson, M.D. (mrich@u.washington.edu)
© University of Washington Department of Radiology
