Edgar A. Perez-Curet, MD
Resident
VA Caribbean Heakthcare Systems
Bayamon, Puerto Rico, United States
Anna V. Blanco-Cintron, MD
Resident Physician PGY-2
Veterans Affair San Juan Hospital
San Juan, Puerto Rico, United States
Anelys Torres-Rivera, MD
Attending Physician
VA Caribbean Healtcare System
San Juan, Puerto Rico, United States
Madelung Deformity (MD) in a female young adult
Case Description:
A 28-year-old accountant professional female patient was evaluated due to persistent pain in both lower arms, particularly at the wrists and hands. Upon examination, bone protrusions were found on wrists, with significant limitation of movement and occasional severe pain limiting her work-life. Imaging revealed bowing of the bones in both lower arms with increased space between them at the wrist joint. The primary care physician has attempted to alleviate the symptoms using wrist splints, but the patient has not experienced any relief.
The patient showed signs of Madelung's Deformity during a physical examination. She opted for conservative management and underwent eight sessions of occupational therapy, including laser therapy, paraffin baths, tendon gliding exercises, and adaptive activities for daily living. The therapy resulted in significant improvement in symptoms and enhanced daily living activities.
Discussions:
Madelung’s deformity is a rare congenital condition affecting the wrists, caused by abnormal growth of the distal radial physis. In the congenital form, it is believed to be due to abnormal development of the Vickers ligament, which restricts distal radial growth. However, it can also be acquired through traumatic injury. This condition can cause severe limitations, and treatment varies depending on several factors, with many cases requiring surgical evaluation. While conservative management is effective for mild to moderate cases of Madelung’s deformity, this case suggests that therapies and modalities may play a role in improving range of motion, reducing pain, increasing strength, and enhancing quality of life in moderate to severe cases of Madelung’s deformity.
Conclusions:
This case highlights how untreated MD in a young adult can significantly limit quality of life. While surgery is important, a structured therapy program could also improve outcomes. Further research into alternative treatments, like the laser therapy used in this case, may enhance results.
