Images in Clinical Rheumatology
Madelung's Deformity
Deformidad de Madelung
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"125" "paginaFinal" => "126" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Domingo Ly-Pen, José Luis Andreu" "autores" => array:2 [ 0 => array:3 [ "nombre" => "Domingo" "apellidos" => "Ly-Pen" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "José Luis" "apellidos" => "Andreu" "email" => array:2 [ 0 => "jlandreu@arrakis.es" 1 => "jlandreus@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Deformidad de Madelung" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1267 "Ancho" => 950 "Tamanyo" => 138954 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Lateral X-ray of both wrists.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Clinical Case</span><p id="par0005" class="elsevierStylePara elsevierViewall">The patient is a 39-year-old woman who presented nocturnal paresthesia lasting for 6 months on both hands, but predominantly right (dominant hand). She presented mechanical pain of both wrists, with a visual analog score (VAS) of 90/100. Upon examination, there was a solid tumor on the posterior side of both wrists (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), painful limitation of extension of the wrist and supination, mainly on the left side. The hemogram and blood chemistry were normal, as well as the neurophysiological study of the median and ulnar nerves. A karyotype demonstrated mosaicism (86% XX, 5% XXX, 9% X).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The posteroanterior wrist X-rays (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) showed typical Madelung deformity changes on the right wrist<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>: shortening of the radius compared to the ulna, dorsally and radially curved radius, dorsal and radial convexity, an angle similar to the distal radial joint surface, a mismatch of the distal radioulnar joint and carpal dislocation. The lateral projection (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) demonstrated anterior arching of the radius and dorsal dislocation on the ulnar head; the carpus was also dislocated on the ulnar side and anteriorly in the distal radioulnar joint, in a way that made the wrist bones appear to follow the arch of the radius.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The patient was diagnosed with a carpal tunnel syndrome due to Madelung's deformity and was programmed for an evaluation by the orthopedics department but, due to a delay, medical treatment with local steroid infiltrations was carried out. 1<span class="elsevierStyleHsp" style=""></span>ml of triamcinolone was injected into the right wrist using a standard technique.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The pain improved in the next 2 days (VAS: 50/100), disappearing completely after one week (VAS: 0/100).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comments</span><p id="par0015" class="elsevierStylePara elsevierViewall">Otto Wihelm Madelung described the deformity carrying his name for the first time in 1878.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Madelung's deformity is much more common in adolescent women, with the appearance of a slow growing tumor on the dorsal ulnar side of the wrists, local pain and a reduction in motility. Our patient presented slowly increasing pain, becoming intense at 6 months. In fact, the main symptoms were nocturnal paresthesia, motivated by an entrapment of the median nerve in the carpal tunnel. These symptoms, associated to Madelung's deformity, have been previously described by other authors.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Madelung deformity is the consequence of the disorganized growth of the radial epiphysis, leading to arching of the radius, a premature fusion of the epiphysis and a delay in the development of the ulnar part and the anterior part of the distal radial epiphysis. These alterations cause an inclined radial distal joint surface to the anterior and ulnar area, which leads to an anterior translation of the hand and the wrist, and a dorsal dislocation of the ulna in its distal posterior part.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Initial medical treatment consists normally of analgesics, non-steroidal anti-inflammatory drugs and muscle relaxants, which are not very effective. Splints may be employed to avoid excessive joint mobilization.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In cases such as ours, in which the most bothersome symptoms are derived from a median nerve compression in the carpal tunnel, a local infiltration of steroid may significantly alleviate nocturnal paresthesia in a few days.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Surgical treatment must be considered based on 4 factors<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>: (a) patient age and the possibility of distal ulnar growth; (b) severity of deformity; (c) severity of symptoms, and (d) clinical and radiographic findings. The objectives of surgical treatment are: alleviation of pain, esthetic correction of the deformity and improvement of joint motion, the latter being the most difficult to attain.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Ethical Responsibilities</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Protection of people and animals</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors state that no experiments were performed on persons or animals for this study.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Data confidentiality</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors state that they have followed their workplace protocols regarding the publication of patient data and all patients included in the study have received enough information and have given their written informed consent to participate in the study.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Right to privacy and informed consent</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors state that they have obtained informed consent from patients and/or subjects referred to in this article. This document is in the possession of the corresponding author.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflict of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical Case" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Comments" ] 2 => array:3 [ "identificador" => "sec0015" "titulo" => "Ethical Responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Right to privacy and informed consent" ] ] ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of Interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-02-02" "fechaAceptado" => "2013-05-15" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ly-Pen, D, Andreu JL. Deformidad de Madelung. Reumatol Clin. 2014;10:125–126.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1266 "Ancho" => 950 "Tamanyo" => 162316 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Panel A shows the ulnar aspect of both wrists, with a prominence that corresponds to the ulnar head, better seen on the left wrist. Panel B shows a lateral view of the left wrist.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1231 "Ancho" => 950 "Tamanyo" => 189881 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Posteroanterior X-ray of both wrists.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1267 "Ancho" => 950 "Tamanyo" => 138954 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Lateral X-ray of both wrists.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Lamberti PM. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 290 | 55 | 345 |
| 2024 September | 314 | 47 | 361 |
| 2024 August | 467 | 70 | 537 |
| 2024 July | 504 | 42 | 546 |
| 2024 June | 365 | 57 | 422 |
| 2024 May | 456 | 52 | 508 |
| 2024 April | 374 | 38 | 412 |
| 2024 March | 2143 | 51 | 2194 |
| 2024 February | 397 | 64 | 461 |
| 2024 January | 412 | 61 | 473 |
| 2023 December | 363 | 32 | 395 |
| 2023 November | 501 | 57 | 558 |
| 2023 October | 830 | 54 | 884 |
| 2023 September | 527 | 65 | 592 |
| 2023 August | 568 | 43 | 611 |
| 2023 July | 614 | 47 | 661 |
| 2023 June | 675 | 44 | 719 |
| 2023 May | 744 | 38 | 782 |
| 2023 April | 484 | 27 | 511 |
| 2023 March | 962 | 40 | 1002 |
| 2023 February | 638 | 33 | 671 |
| 2023 January | 523 | 33 | 556 |
| 2022 December | 464 | 40 | 504 |
| 2022 November | 734 | 55 | 789 |
| 2022 October | 595 | 44 | 639 |
| 2022 September | 661 | 46 | 707 |
| 2022 August | 462 | 45 | 507 |
| 2022 July | 253 | 54 | 307 |
| 2022 June | 362 | 47 | 409 |
| 2022 May | 404 | 61 | 465 |
| 2022 April | 370 | 44 | 414 |
| 2022 March | 349 | 53 | 402 |
| 2022 February | 411 | 40 | 451 |
| 2022 January | 408 | 53 | 461 |
| 2021 December | 345 | 47 | 392 |
| 2021 November | 285 | 44 | 329 |
| 2021 October | 373 | 63 | 436 |
| 2021 September | 294 | 42 | 336 |
| 2021 August | 269 | 47 | 316 |
| 2021 July | 247 | 32 | 279 |
| 2021 June | 332 | 46 | 378 |
| 2021 May | 338 | 52 | 390 |
| 2021 April | 949 | 132 | 1081 |
| 2021 March | 772 | 48 | 820 |
| 2021 February | 333 | 23 | 356 |
| 2021 January | 281 | 29 | 310 |
| 2020 December | 216 | 30 | 246 |
| 2020 November | 288 | 28 | 316 |
| 2020 October | 176 | 14 | 190 |
| 2020 September | 188 | 26 | 214 |
| 2020 August | 106 | 26 | 132 |
| 2020 July | 92 | 10 | 102 |
| 2020 June | 80 | 13 | 93 |
| 2020 May | 79 | 16 | 95 |
| 2020 April | 81 | 16 | 97 |
| 2020 March | 31 | 3 | 34 |
| 2018 May | 10 | 0 | 10 |
| 2018 April | 186 | 12 | 198 |
| 2018 March | 121 | 9 | 130 |
| 2018 February | 81 | 3 | 84 |
| 2018 January | 57 | 17 | 74 |
| 2017 December | 72 | 12 | 84 |
| 2017 November | 72 | 27 | 99 |
| 2017 October | 65 | 10 | 75 |
| 2017 September | 82 | 11 | 93 |
| 2017 August | 90 | 10 | 100 |
| 2017 July | 104 | 24 | 128 |
| 2017 June | 93 | 41 | 134 |
| 2017 May | 147 | 36 | 183 |
| 2017 April | 114 | 47 | 161 |
| 2017 March | 205 | 78 | 283 |
| 2017 February | 193 | 21 | 214 |
| 2017 January | 159 | 12 | 171 |
| 2016 December | 140 | 21 | 161 |
| 2016 November | 111 | 17 | 128 |
| 2016 October | 238 | 32 | 270 |
| 2016 September | 300 | 29 | 329 |
| 2016 August | 271 | 25 | 296 |
| 2016 July | 105 | 21 | 126 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 September | 1 | 0 | 1 |
| 2015 August | 2 | 0 | 2 |
| 2015 July | 89 | 7 | 96 |
| 2015 June | 113 | 27 | 140 |
| 2015 May | 116 | 37 | 153 |
| 2015 April | 84 | 29 | 113 |
| 2015 March | 122 | 29 | 151 |
| 2015 February | 150 | 26 | 176 |
| 2015 January | 118 | 33 | 151 |
| 2014 December | 81 | 31 | 112 |
| 2014 November | 86 | 15 | 101 |
| 2014 October | 75 | 16 | 91 |
| 2014 September | 69 | 21 | 90 |
| 2014 August | 71 | 26 | 97 |
| 2014 July | 75 | 35 | 110 |
| 2014 June | 108 | 17 | 125 |
| 2014 May | 62 | 25 | 87 |
| 2014 April | 162 | 17 | 179 |
| 2014 March | 60 | 17 | 77 |
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