Written by Mr Tim Cresswell BM FRCS. Ed (Trauma and Orth.) Dip.Orth.Eng exclusively for Madelungs Awareness.
Madelung’s is a wrist condition that usually occurs in females and starts during the growth and development of the wrist.
During the development of the forearm, a fibrous band can impede growth of part of the radius bone leading to the tethering of the ulnar-volar side of the radius. As the rest of the wrist grows, the small wrist bones sublux and can become mis=shaped. Madelung’s can be associated with various genetic conditions which are best looked into by a genetics specialist.
The treatment depends on when it is first picked up. Rest, splints, and analgesics can be tried. In the growing years, it can be possible to release the fibrous tether (the so called Vickers Ligament). It is sometimes necessary to remove a part of the growth plate if that corner has already fused. Obviously, operating on a growth plate itself has the risk of stopping growth. Once growing has stopped, treatment can include a cutting of the bone to try and improve the shape, a resection of pain nerves, fusion of the wrist or replacement of the wrist or part of it..
Sometimes shortening of the ulna can be performed. Resection of the ulna head or the Sauve-Kapandji operation do not give good outcomes usually and are best avoided.
About Tim Cresswell
Tim Cresswell was appointed to Derby to work within the Pulvertaft Hand Centre and the Trauma and Orthopaedic Unit as an Upper Limb and Hand Surgeon. Tim trained in Sheffield and did Fellowships in Cape Town, South Africa, in Derby at the Pulvertaft Hand Centre and in the USA, where he did an Upper Limb AO Trauma Fellowship.
Tim has an interest in wrist and hand trauma as well as shoulder instability and elbow replacement.
He has lectured on the local Derby courses and teaches widely in Europe on shoulder and elbow surgery.
Mr Cresswell’s publications and presentations include carpal tunnel revision, wrist fractures, total elbow replacement, shoulder instability with bone loss, the Latarjet Procedure, upper limb climbing injuries, AC joint dislocation and others.