[Wrist_01] Madelung deformity, carpal instability adaptive, Vicker’s ligament

 

 

The commonly used Mayo classification divides carpal instability into four major categories.

 

1. Carpal instability dissociative (CID), where there is dissociation of the bones in a single carpal row. The proximal carpal row is most commonly affected (i.e., SL instability; lunotriquetral instability). Distal carpal row dissociation is rare.

2. Carpal instability nondissociative includes instability at the radiocarpal and/or midcarpal joints.

3. Carpal instability complex is a combination of patterns 1 and 2.

4. Adaptive carpus refers to carpal instability secondary to congenital or acquired abnormalities in the distal radius and/or distal ulna.

 

Carpal dysfunction is not always the consequence of intracarpal pathology, but it can also result from extracarpal pathology.

A typical example of CIA is malunion of a distal radial fracture that has induced a postural adaption of the proximal carpal row to conform to the abnormal radial tilt.

 Another example may result from a Madelung's deformity, where there is volar tilt of the distal radius and an elongated, dorsally subluxed ulna, with adaptive changes of the bones of the proximal carpal row.

Madelung and Madelung-type deformities are caused by premature closure of the medial volar distal radial physis. This closure leads to increased volar tilt and increased inclination of the radio-carpal articular surface, proximal migration of the lunate, and progressive dorsal displacement of the elongating distal ulna. Congenital Madelung deformity is defined by the presence of a characteristic anomalous, hypertrophic volar radiolunate “Vickers” ligament (arising from the radial metaphysis rather than epiphysis) or less commonly an anomalous radiotriquetral ligament

 

• dorsal and radial bowing of the radius
• increased interosseous space
• exaggerated palmar (up to 35°) and ulnar tilt (up to 60°) of the radiocarpal articulation 3
• failure of ossification of the ulnar side of the distal radial epiphysis
• radial inclination >25° 8
• carpal angle <124°
• carpal subluxation in a palmar and ulnar direction
• lunate is gradually forced to the apex of the V-shaped radio-ulno-carpal joint
• “V-shaped” proximal carpal row: herniated proximal carpal row
• dorsal subluxation of the distal radioulnar joint
• positive ulnar variance
• wedging of the carpus between the radius and ulna

https://radiopaedia.org/articles/madelung-deformity

 

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#WristMRI, #FingerMRI, 

#MSKMRI_WRIST

#madelung, #Vickersligament, #Vicker, #TFCC, #Volarradioulnarligament, #Carpalinstability, #CIA,

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