I’ve been putting off having surgery for a wrist problem known as Madelung deformity. How long do you think I can wait before it’s too late with something like this?

Madelung deformity of the wrist is a congenital (present at birth) deformity that can cause wrist pain, stiffness, and loss of motion. But the cosmetic appearance is what most often brings the person in to see a surgeon. The natural history (what happens over time) of untreated Madelung deformity is relatively unknown. There hasn’t been much written about this problem.

We do know that people can be free of any symptoms up until late adult life. You didn’t mention your age but it sounds like you aren’t an older adult. Over time, the deformity can get worse resulting in break down of the joint and instability. Tendon rupture is possible in advanced cases. Usually, the affected person will develop symptoms long before that happens.

The best way to treat this problem is also unknown with many surgeons in disagreement, conflicting opinions, and a general lack of consensus. Younger patients are followed annually with examination, evaluation, and X-rays to document what’s happening.

Experts in this area suggest surgery should be done when there are limiting symptoms rather than just for cosmetic purposes. A growing child who has no symptoms should be watched and re-checked each year as suggested. Only when the deformity is getting worse, the wrist is unstable, and/or the wrist is jammed together should surgery be planned.

Type of surgery is still under debate and study. Factors that must be considered when planning a surgical procedure include age (whether the patient is still growing), the presence of a difference in bone length between the two bones of the forearm, and severity of the radial bone bowing.

Because there just isn’t enough evidence to guide management of this rare condition, more studies are needed to identify the best treatment approach. Finding successful nonsurgical ways to treat the problem is always preferred in the growing child. Early joint replacement is not advised because of the limited time the implant will last, thus requiring additional surgery later.

Surgery that does not improve wrist motion or relieve pain may not be the best way to treat Madelung deformity. Patient preferences and dissatisfaction with the appearance of the forearm and wrist are important considerations as well. Older adults who have experienced additional complications from this condition (e.g., tendon rupture, wrist subluxation or dislocation) may require surgical reconstruction of the wrist.