Madelung Deformity in a Collegiate Gymnast: A Case Report

Abstract

OBJECTIVE: To present the case of a 21-year-old female collegiate gymnast with acute left wrist pain. BACKGROUND: Madelung deformity is a developmental abnormality of the wrist. It is characterized by anatomic changes in the radius, ulna, and carpal bones, leading to palmar and ulnar wrist subluxation. It is more common in female patients and is usually present bilaterally. The deformity usually becomes evident clinically between the ages of 6 and 13 years. DIFFERENTIAL DIAGNOSIS: Traumatic distal radius physeal arrest, congenital anatomic variant. TREATMENT: The athlete was treated with symptomatic therapeutic modalities and nonsteroidal anti-inflammatory medication for pain. She was able to continue to participate successfully in competitive gymnastics, minimally restricted, with the aid of palmar wrist tape and a commercially available wrist brace to prevent end-range wrist extension. UNIQUENESS: Madelung deformity can result in wrist pain and loss of forearm rotation, leading to decreased function of the wrist and hand. This patient was able to participate successfully in elite- and college-level gymnastics with no wrist pain or injury until the age of 21 years. Furthermore, she was able to continue to participate, experiencing only periodic pain, with the aid of taping and bracing support and without the need for reconstructive surgery. CONCLUSIONS: Although rare, Madelung deformity is typically corrected surgically in athletes with chronic pain and disability. This case demonstrates an example of successful conservative management in which the athlete continued to participate in sport.

A, Left wrist anterior-posterior radiograph. B, Clenched-fist anterior-posterior radiograph revealing radial bow deformity and Madelung deformity.