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Madelung's Deformity - observation

Exams and Signs

Historical Overview

  • Madelung’s deformity was first described in detail by its namesake in 1878.1

Description

  • Madelung’s deformity is diagnosed primarily by observation, in patients aged 6–13 years.
  • In severe and chronic cases, patients may present with extensor tendon rupture.2

Pathophysiology

  • Madelung’s deformity is often genetic.3 It also can arise from infection, rheumatoid arthritis (RA), trauma to the distal radius physis, or isolated osteochondroma.

Instructions

  1. Observe the patient’s distal radius physis for evidence of irregular growth arrest.
  2. Check for arching of the radius and anterior translation of the hand and wrist.
  3. Ask the patient if s/he experiences nocturnal paresthesia, decreased strength, stiffness, or pain, which can impede daily activities.2
  4. Confirm the diagnosis by taking a complete patient history.
  5. Examine the contralateral hand and wrist; Madelung’s deformity is often bilateral.2

Variations

  • Check the patient for volar distal radioulnar joint (DRUJ) instability.4

Related Signs and Tests

  • Extensor tendon exam
  • Flexor tendon exam
  • Range of motion (ROM), active
  • Range of motion (ROM), passive
  • Radiographs
  • Magnetic resonance imaging (MRI), without contrast 

Differential Diagnoses

  • Dyschondosteosis
  • Rheumatoid arthritis
  • Léri-Weill syndrome
  • Turner syndrome
  • Infection
  • Trauma

Additional Information

Presentation Photos and Related Diagrams
Clinical Photos of Madelung's Disease
  • Madelung's deformity left upper extremity
    Madelung's deformity left upper extremity
  • Madelung's deformity right upper extremity
    Madelung's deformity right upper extremity
  • Left Madelung's deformity X-ray
    Left Madelung's deformity X-ray
Definition of Positive Result
  • A positive result occurs when the patient’s distal radius physis shows evidence of irregular growth arrest and Madelung’s deformity is observed.
Definition of Negative Result
  • A negative result occurs when the patient’s distal radius physis does not show evidence of irregular growth arrest and Madelung’s deformity is not  observed
Comments and Pearls
  • When treating Madelung’s deformity, follow-up is important, because pain may worsen as a patient grows.5
  • Conservative treatment for Madelung’s deformity includes NSAIDs and a resting splint. Before skeletal maturity, operative treatment includes release of Vicker’s ligament and radial physiolysis, to avoid continuing deterioration. After skeletal maturity, a dome osteotomy of the radius is often used.6
Diagnoses Associated with Exams and Signs
References
  1. de Billy B, Gastaud F, Repetto M, et al. Treatment of Madelung’s deformity by lengthening and relaxation of the distal extremity of the radius by Ilizarov’s technique. Eur J Pediatr Surg 1997;7(5):296-8. PMID: 9402490
  2. Ghatan AC, Hanel DP. Madelung deformity. J Am Acad Orthop Surg 2013;21(6):372-82. PMID: 23728962
  3. Rayan G, Akelman E. The Hand: Anatomy, Examination and Diagnosis. Philadelphia: Lippincott Williams & Wilkins, 2012 
  4. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012
  5. Tranmer A, Laub D. Madelung deformity. Eplasty 2016;16. PMID: 27602178
  6. Kozin SH, Zlotolow DA. Madelung deformity. J Hand Surg Am 2015;40(10):2090-8. PMID: 26341718
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