Conservative Management of Madelung Deformity of the Wrist in a 15-Year-Old Male: A Case Report

Abstract

A 15-year-old boy presented to an outpatient sports medicine clinic with mysterious wrist pain for three months. Imaging diagnosed this mysterious wrist pain as a Madelung deformity, a rare condition characterized primarily by the early cessation of growth in the volar-ulnar distal physis of the radius. Patients may present with restricted wrist range of motion, pain, and ulnar tenderness, but they may also be asymptomatic. Traditionally, treatment is surgical, but this case was managed with conservative measures primarily, with improvements in both function and outcomes. This case report should serve as a reminder to include rare diagnoses in the differential when working up joint pain and to show the role of conservative management in Madelung deformity.

Keywords: conservative medical management; madelung deformity; madelung’s deformity; pediatric imaging; pediatric sports medicine.

Figure 1. Lateral X-ray of the wrist joint. The distal ulna has undergone dorsal subluxation (blue arrow), and the hand is subluxated volarly (red arrow).

Figure 2. Anteroposterior X-ray. The joint angle of the carpus is approximated based on current positioning (orange lines). The radius has an increased inclination angle (blue lines). A spur is noted on the medial surface of the radius (red arrow).

Figure 3. MRI of the wrist joint. The radial physis is clearly visualized, and the volar-lateral physis is notably absent, indicating premature closure. The articular cartilage displays an elongated configuration. Chronic tears of the foveal and ulnar attachments to the TFCC are noted dorsally.

Figure 4. MRI of the wrist joint. Positive ulnar variance with marrow edema at the ulnar head is seen (red oval).

Figure 5. MRI of the left wrist. Here, a Vicker’s ligament is visualized (red arrow), originating from the metaphysis of the distal radius. There are findings consistent with dysplasia of the radial epiphysis. Increased volar tilt and radial inclination are noted.