A 40-year-old woman came to the Primary Care clinic for pain in both wrists, loss of strength in the hands and paresthesia in all fingers, with greater frequency and intensity in the right hand.
The patient had a chronic pain of five months of evolution of mechanical characteristics and progressive worsening, associating a deformity of the wrists.
There has been no previous trauma to justify the presence of the referred clinic.
There was no relevant pathological history.
She's right-handed and works caring for the elderly.
The physical examination of both wrists highlights the presence of a deformity in the dorsal face at the cubital styloid level, associated with a ulnar deviation.
In addition, increased sweating and redness of the hands were observed.
The wrist joint balance (BA) was symmetrical: dorsal flexion: 40o.
Palm flexion: 55o.
Radial deviation: 20o.
Ulnar deviation: 30o.
Supination: the last grades are missing.
Pronation: complete.
Symptoms include pain at the site of the distal radio-iliac joint and discomfort at palpation of the radial head.
Show a complete elbow BA.
The muscle balance (BM) of the wrists is 4/5.
On the other hand, the pin-point is complete.
The thumb opposition is preserved.
Metastasis, proximal interphalangeal and distal interphalangeal are free.
You have a negative median Tinnel sign and a dubious median Phalen sign.
Having described clinical findings, an anteroposterior and lateral radiograph of both wrists was requested.
1.
After objectifying the presence of deformity in the X-ray, the patient was referred to the traumatology outpatient clinic for evaluation, where the diagnosis of Madelung's deformity and bilateral distal ulnar dislocation were made.
Surgical treatment is proposed for the reconstruction of the defect, but the patient rejects it, so consultation to Rehabilitation is performed.
Bilateral nocturnal splint and physiotherapy (intrinsic hand muscle tone and analgesic electrotherapy) were prescribed.
