Investigations
The key investigation in Madelung's Deformity is radiography:
- AP film:
- shows defect at the location of the distal radial facet where the lunate sits
- radial epiphysis on its ulnar side narrows to a point
- may be spike of bone in the metaphysis
- radius shorter and bowed compared to ulna
- carpus seems to overlap distal radius and ulna as it is subluxed
- in chevron carpus:
- lunate pyramidal
- scaphoid ring sign as it flexes forward
- lateral:
- bowing of radius
- notch in distal radius, the position of which depends on the point of abnormal growth:
- palmar in classical Madelung's deformity
- dorsal in the less frequent reversed Madelung's deformity
- central in chevron carpus
- subluxation of carpus
MRI may help with the identification of soft tissue anomalies eg a thickened radiolunotriquetral ligament.
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