Conservative management of Madelung deformity: a case report.

Abstract

Introduction: Various surgical techniques have been developed for the management of Madelung deformity. However, there is inadequate information about conservative treatment for Madelung deformity. This case report demonstrates the role of conservative treatment in a particular case where there were no known etiological factors of Madelung deformity and discusses its outcomes.

Case presentation: A 30-year-old female patient presented with deformity and pain in her right wrist. Physical examination indicated a volar displacement of the right hand, a dorsal prominence of the ulna, and restricted joint motion in the wrist. The radiographs revealed a radially inclined radius and a triangular carpal configuration. According to these findings, the right wrist was diagnosed with Madelung deformity.

Outcomes: Following conservative treatment including splinting, activity modification, therapeutic ultrasound, cold packs, and exercise, assessments at weeks 8 and 12 showed significant improvements for the patient. The patient reported no pain at rest or at night, with activity pain decreasing from an initial 5/10 to 2/10 on the Visual Analogue Scale. While range of motion improved, except for radial deviation, it remained lower in the affected wrist compared to the unaffected side. Although there was a slight decrease in range of motion from week 8 to week 12, it remained higher than baseline measurements. The grip strength values, initially at 80% of the unaffected side, exhibited an increase but did not reach the level of the unaffected side. Scores from the Patient-Rated Wrist Evaluation and the Quick Disability of the Arm, Shoulder, and Hand questionnaires showed reductions compared to baseline at weeks 8 and 12, surpassing the 14-point minimal clinically important difference. However, the week 12 assessment indicated an increase in survey results relative to week 8.

Conclusion: Implementation of conservative treatment for Madelung deformity resulted in symptom alleviation and enhancement of the patient's condition.