Skip to main content

Advertisement

SpringerLink
Log in

High resolution 3.0 Tesla MR imaging findings in patients with bilateral Madelung’s deformity

  • Anatomic Variations
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Purpose

Madelung deformity (MD) is a rare, normally painful abnormality of the wrist and forearm which characteristically begins in adolescence. Usually the deformity appears between the age of 8 and 14 years, often progressing from initially mild functional pain to fatigue and loss of strength and finally, reduced mobility. We present the MR-findings in three patients with bilateral MD, using a high-resolution imaging protocol adapted for 3.0 Tesla (3.0 T) examinations.

Materials and methods

Wrist images of three patients were acquired at a 3.0 T Scanner (Gyroscan Intera, Philips Medical Systems, Best, The Netherlands), using a dedicated phased array coil. The imaging protocol consisted of coronal T1-weighted Turbo-spin-echo (T1w-TSE) and coronal and sagittal T2-weighted TSE sequences (T2w-TSE).

Results

MR-images of these three girls demonstrated severe volar bayonet configuration of the forearms with a dorsal prominence of the ulnar head, also a curved distal radial articular surface with increased ulnar angulation, due to a deceleration of growth in the ulnar portion of the distal epiphysis. The proximal carpal row showed pyramidal configuration. Also visible was a prominent short radiolunate ligament, the so called Vickers ligament, which originates from the ulnar border of the radius, inserts into the volar pole of the lunate and likely contributes to carpal pyramidalization. Furthermore, the images demonstrated an anomalous hypertrophied and elongated volar radiotriquetral ligament which, to our knowledge, has been described elsewhere only in another case.

Conclusion

High resolution imaging at 3.0 T permitted a detailed analysis of the complex pathomorphology in patients with MD. Investing the better signal-to-noise ratio at higher field strengths into spatial resolution an excellent image quality could be obtained, depicting the Vickers ligament and the anomalous volar radiotriquetral ligament in this rare disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Anderson BL, Lomasney LM, Demos TC, Bielski RJ (1997) Radiologic case study. Madelung’s deformity of the wrist. Orthopedics 20(576):569–571

    Google Scholar 

  2. Arora AS, Chung KC (2006) Otto W. Madelung and the recognition of Madelung’s deformity. J Hand Surg [Am] 31:177–182

    Article  Google Scholar 

  3. Barr C, Bauer JS, Malfair D, Ma B, Henning TD, Steinbach L, Link TM (2007) MR imaging of the ankle at 3 Tesla and 1.5 Tesla: protocol optimization and application to cartilage, ligament and tendon pathology in cadaver specimens. Eur Radiol 17:1518–1528

    Article  PubMed  Google Scholar 

  4. Brooks TJ (2001) Madelung deformity in a collegiate gymnast: a case report. J Athl Train 36:170–173

    PubMed  Google Scholar 

  5. Carter PR, Ezaki M (2000) Madelung’s deformity. Surgical correction through the anterior approach. Hand Clin 16:713–721, x-xi

    CAS  Google Scholar 

  6. Cook PA, Yu JS, Wiand W, Lubbers L, Coleman CR, Cook AJ 2nd, Kean JR, Cook AJ (1996) Madelung deformity in skeletally immature patients: morphologic assessment using radiography, CT, and MRI. J Comput Assist Tomogr 20:505–511

    Article  PubMed  CAS  Google Scholar 

  7. Dannenberg M, Anton JI, Spiegel MB (1939) Madelung’s deformity. Consideration of its roentgenological diagnostic criteria. AJR 42:671–676

    Google Scholar 

  8. Felman AH, Kirkpatrick JA Jr (1969) Madelung’s deformity: observations in 17 patients. Radiology 93:1037–1042

    PubMed  CAS  Google Scholar 

  9. Grigelioniene G, Schoumans J, Neumeyer L, Ivarsson A, Eklof O, Enkvist O, Tordai P, Fosdal I, Myhre AG, Westphal O, Nilsson NO, Elfving M, Ellis I, Anderlid BM, Fransson I, Tapia-Paez I, Nordenskjold M, Hagenas L, Dumanski JP (2001) Analysis of short stature homeobox-containing gene (SHOX) and auxological phenotype in dyschondrosteosis and isolated Madelung deformity. Hum Genet 109:551–558

    Article  PubMed  CAS  Google Scholar 

  10. Lenk S, Ludescher B, Martirosan P, Schick F, Claussen CD, Schlemmer HP (2004) 3.0 T high-resolution MR imaging of carpal ligaments and TFCC. Rofo: Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 176:664–667

    Article  PubMed  CAS  Google Scholar 

  11. Madelung (1879) Die spontane Subluxation der Hand nach vorne. Arch f klin Chir 23:395–412

  12. Nielsen JB (1977) Madelung’s deformity. A follow-up study of 26 cases and a review of the literature. Acta Orthop Scand 48:379–384

    Article  PubMed  CAS  Google Scholar 

  13. Ross JL, Scott C Jr, Marttila P, Kowal K, Nass A, Papenhausen P, Abboudi J, Osterman L, Kushner H, Carter P, Ezaki M, Elder F, Wei F, Chen H, Zinn AR (2001) Phenotypes Associated with SHOX Deficiency. J Clin Endocrinol Metab 86:5674–5680

    Article  PubMed  CAS  Google Scholar 

  14. Saupe N, Prussmann KP, Luechinger R, Bosiger P, Marincek B, Weishaupt D (2005) MR imaging of the wrist: comparison between 1.5- and 3-T MR imaging–preliminary experience. Radiology 234:256–264

    Article  PubMed  Google Scholar 

  15. Stehling C, Bachmann R, Langer M, Nassenstein I, Heindel W, Vieth V (2009) High Resolution MR Imaging of TFCC lesions in acute wrist trauma: Image quality at different field strengths. J Comput Assist Tomogr (in press)

    Google Scholar 

  16. Stehling C, Vieth V, Bachmann R, Nassenstein I, Kugel H, Kooijman H, Heindel W, Fischbach R (2007) High-resolution magnetic resonance imaging of the temporomandibular Joint: Image quality at 1.5 and 3.0 Tesla in volunteers. Invest Radiol 42:428–434

    Article  PubMed  Google Scholar 

  17. Vickers D, Nielsen G (1992) Madelung deformity: surgical prophylaxis (physiolysis) during the late growth period by resection of the dyschondrosteosis lesion. J Hand Surg [Br] 17:401–407

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Strasse 33, 48129, Münster, Germany

    Christoph Stehling, Isabelle Nassenstein, Rainald Bachmann, Walter Heindel & Volker Vieth

  2. Department of Trauma, Hand and Reconstructive Surgery, University of Muenster, Waldeyer Strasse 1, 48149, Münster, Germany

    Martin Langer

Authors
  1. Christoph Stehling
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin Langer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Isabelle Nassenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rainald Bachmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Walter Heindel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Volker Vieth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christoph Stehling.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stehling, C., Langer, M., Nassenstein, I. et al. High resolution 3.0 Tesla MR imaging findings in patients with bilateral Madelung’s deformity. Surg Radiol Anat 31, 551–557 (2009). https://doi.org/10.1007/s00276-009-0476-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-009-0476-0

Keywords

Search

Navigation