Dyschondrosteosis and Madelung Wrist Deformity

This is the self-help group or support group for people with dyschondrosteosis ( DCS )and/or Madelung Wrist Deformity ( MWD ). That is a permanent broken wrist appearance for the Madelung and foreshortened arms or legs in dyschondrosteosis. It came about because of some research I did on a very obscure medical condition. One person in my family was noticeably affected but as no one else apparently affected it was not considered to be genetic.
This file updated October 2007
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Many years (1980s) ago I tried to do some medical research on another condition but was defeated as I have no medical knowledge. I spent some time at the Boldrewood Medical Library facility in Southampton but got nowhere really. The problem is you need a bit of medical knowledge to even start. This has all changed with the internet. In effect there is ,via the medical search engines such as Medline and OMIM ,what I call a reverse medical dictionary. By this I mean from starting with non medical or marginal medical terms or descriptions you can get to precise medical terminology; the reverse of a medical dictionary.
The condition of interest recently, had been diagnosed but decades ago ,when this noticeably affected person was seen by a Harley St ,London, specialist. The diagnosis was misheard/ mis-remembered by one person as Mendel something and by someone else as Mendelsohn something and by someone else as something rickets. In December 1998 putting mendel* as a keyword in Medline got nowhere. The condition affects the ulna and radius bones so putting keywords in Medline and OMIM of radius AND ulna AND rickets returned a lot of hits. Reading all the returned abstracts in conjunction with a standard medical dictionary (to understand and distinguish distal from proximal and supination from pronation etc) two medium level medical terms looked promising. These were radio-ulnar (affecting both bones) and dysplasia (disordered development ). Putting these two words back in the system returned a few dozen abstracts. About half of the original articles referred to by these abstracts were on the shelves of the medical library at Southampton General Hospital. I didn't even know this library existed till now nor whether it is exceptional in allowing access to the responsible general public. A few related, highly specific terms emerged in these articles and abstracts namely; dyschondrosteosis,mesomelia ( form of semi dwarfism) and Madelung (probably the original misheard diagnosis). Madelung wrist deformity leads to a mechanically poor joint between wrist and ulna because the wrist bones are asymmetric and cause a bunching on the ulna side of the wrist throwing the head of the ulna forwards or sometimes more rarely reverseward so it looks like a ganglion at the end of the ulna (there are alternative explanations for the development of MWD). In effect it leads to a permanent partial dislocation (subluxation) of the wrist. Putting these three terms in OMIM and Medline and checking the articles another week in the medical library confirmed that this was indeed the condition and that it was genetic and very rare, affecting only about 1 in 100,000 to 1 in 800,000 of the general population.The clincher was reference to the Madelung wrist deformity which no one in my family were aware of but with hindsight is now obvious with everyone in different generations. This internet procedure is probably applicable to other technical disciplines say geology or law if there is a suitable thematic search engine for the relevant technical journals .



I would be interested in making contact with anyone familiar with the linked medical conditions :-dyschondrosteosis,mesomelic dwarfism and Madelung wrist deformity all a sub-set of the general group of skeletal dysplasias. I could find medical references on the net but nothing about the more sociological aspects of these conditions so have placed this page into the internet realm.
On the male side there can be serious family problems concerning "questionable" paternity; how could a father 6 foot or so have a son 5 foot or a father of 5 foot 2 have a son who is 6 foot 2, a sort of perceived cuckoo in the nest syndrome.
This genetic quirk can happen spontaneously or where there is offspring of a consanguineous relationship i.e. father/daughter or brother/sister or cousins. This is the biblical "sins of the father" territory. It can cause family schisms where some of the family is aware of the family secret, others suspect and some have no idea at all, the common thread is that it is a total taboo and no one will discuss it at all within or outside the family. Some people just wish this syndrome would just disappear if they ignore it and others wish to find out what is going on. Obviously the former will not find their way to this file. It has to be remembered that the proportion of children adopted who are of incestuous origin is high and consequently proportion of adoptees with conditions like MWD or DCS is also higher than background levels. 6 of the people contacting this group have MWD or DCS stemming from people who were adopted, beyond that is unknown, just informed speculation. Higher than the general level of adoption within the population. Illegitamacy is difficult enough to handle within a family but very few families would be able to knowingly raise a child of incestuous origin - it is one taboo too far, they are likely to be placed for adoption.
So far, seven people out of the people who have contacted me, had not got a medical diagnosis before finding this file - two put "wrist deformity" and someone else "gymnasts wrist deformity " as a keyword/phrase in a search engine. All the others have had the tight medical keywords of madelung or "leri weill" or dyschondrosteosis to put in search engines. Another potential problem can be that some people would have been put on a course of growth hormone treatment after being diagnosed. In the early days this was derived from cadavers with ,unknowingly, possible contamination by prions or whatever leading to a "Sword of Damocles" of CJD hanging over them.
It was only in the 1970s it would appear that the researchers put a genetic link to these ,at first sight, unrelated effects. Other medical terms for dyschondrosteosis or similar looking or related conditions are/were manus valga, carpus curvus, congenital dislocation of the wrist, late rickets of the wrist, progressive subluxation of the wrist, progressive idiopathic curvature of the radius, adolescent club-hand, carpo-cyphose, carpo-cyfose,carpocyphose, cubitolisthesis, manus furca, gabelhand, radius brevior , dyschondroplasia of the inferior radial epiphysis, osteochondrosteosis, adolescent rickets, carpal dysmorphosis, carpal kyphosis, carpoficiosis, dyschondrosis, radius brevior, radius parvus, Leri Weill Syndrome, DCO, LWS, LWD, radiovolar bayonet deformity, chondrosteodysplasia, MD Madelung Deformity , DCS (dyschondrosteosis). It is my conjecture that MWD and DCS result from some sort of genetically controlled switch. Not a case of lack of growth hormone but something switching off the uptake in the chondrite areas of some bones. Resulting in a lack of growth in that area of one end of that particular bone but not the other ,similarly either end of the matching bone pair eg Ulna/Radius and Tibia /Fibula may grow/not grow causing curving of the longer bone while growing.
Some relevant keywords for researching Madelung are lucency, pyramidalization/pyramidalisation,triangularization/triangularisation.
For anyone of a sensitive nature all the listed references at the end of this file do not carry reference to some of the more gross deformations and fatal conditions that a keyword search on Medline and Omim medical search engines inevitably turn up. It would appear there was a flurry of publications in the 1960s and 70s and little since until the 90s when geneticists became intrigued.
Seven sets of examples of the family genetics ,first two taken from journal source 6 at the end of the file
Firstly for a patient with MWD only (no DCS) 3 generations of 21 related people were medically checked and she was the only one with MWD; her parents were without MWD and her 4 daughters showed no MWD. She was one of 11 siblings 6 male and 5 female ,none of the others with MWD. 2 of her non-affected sisters had 2 non-affected daughters each.
Secondly the family tree of 5 generations of someone diagnosed with DCS,Nf=Normal female,m=male,D=DCS,++ = union,-- = sibling, ? = not checked. Fourth generation affected male was the index patient who incidentally proved to be the first recorded case of male to male inheritance in 100 years of the literature on DCS. The 'trees' below are intended for a font with equal spaced letters if it is to be read correctly.
    Nm  Df
     |++|
Df--Df--Dm--Nm--Dm  Nf
                 |++|
            Nm  Df--Nm
             |++|
      Nf--Df--Dm--Nm
   ?++|   |++?
      Nf  Df
The above would seem to be fairly representative of how DCS propagates. It was not clear in this journal but my interpretation is that in this example anyone diagnosed with DCS would have been someone only showing MWD as well cases of DCS and cases of DCS + MWD. I have used generally in this file the interpretation of DCS as being someone showing mesomelia as the defining trait and that of MWD someone having an obvious wrist disorder but no obvious mesomelic foreshortening of forearm or lower leg.
Third example M=MWD only with no mesomelia. It is from one of this self help group with permission to publish but no identifying detail.
 
        Q    Z
        Dm  Nf
         |++|
         A  B
    Nf  Mm--Df  Nm
     |++|    |++|
    A1  A2   B1  B2
    Dm--Mf   Mf--Mf


The genetics in the above family probably show meiotic recombination between PARs (pseudoautosomal regions) ie the telomeric extremeties of both X and Y chromosomes.
There are two possible explanations for the LWD / DCS to cause LWD in all the family members male and female with either normal stature/Madelung or short/DCS.
Possibility 1:
LWD starts in mother of children A and B (and not in the father). Then there is only a recombination necessary between X and Y of A to son A2.
Possibility 2:
If LWD started in father Q of children A and B, then there are two recombinations necessary:
If the Q had SHOX mutation in X-chromosome
once from Q to A
once from A to daughter A1

or
If Q had SHOX mutation in Y-chromosome
once from Q to B
once from A to daugther A1

Fourth example in Italy from reference 4
        Nm  Df
         |++|
    Nm  Df--Df  Nm
     |++|    |++|
      Nf   Nm--Nm--Nm--Nm


Fifth example from Poland from reference 2
     Nf--Nf--Dm  Nf
              |++|
         Nm  Df--Nm--Nm--Nm
          |++|
     Nf  Nm--Dm  Nf
      |++|    |++| 
Nm--Nm--Nf    Nm--Df--Nm--Dm--Df-twins-Df


Sixth examples taken from 8 French families from reference 17
Circles - female, blocks - male,black - affected, open - unaffected
 French families
Seventh examples taken from 7 UK and Swiss families in reference 16
 UK and Swiss families
To summarise the genetics that would appear to emerge from these above medical family trees and the family histories of people contacting this site. It would appear if you have isolated MWD with no history of MWD or DCS in any other of your family then it looks as though you will not pass on MWD to any offspring. If you have MWD or DCS with another family member with MWD or DCS then there is a high probability of passing on either or both MWD or DCS to any offspring. If you are an unaffected sibling of an affected person then a low probability of passing on MWD or DCS. Unfortunately, generally speaking, in the medical-genetic studies the offspring of unaffected siblings are not studied. Whether you are an affected male or female ,with family history of the conditions, then you can pass on the genetic predisposition. I have not had medical confirmation of the above statement and have not seen it stated in any medical journal ,it is just a consensus view with no authority. Female offspring tend to be 4 times more likely than male offspring to display the condition and have a more marked version. The factor of 4 is the number repeatedly stated in the medical literature. On reading the contributory stories in these files, the proportion would appear to be much greater than 4 to 1. As far as having a serious form of the conditions then perhaps more like 30 to 1 female to male. This is probably due to oestrogens exerting a maturational effect on the skeletal tissues that are susceptible to premature fusion of growth plates in conjunction with SHOX deficiency where normal SHOX sufficiency would counteract the maturing effect of oestrogens.
The following comment I have revised in the light of the experience of people who have contacted me with MWD (see personal stories below). It was my conjecture that dyschondrosteosis is a medical curiosity with little or no requirement for surgical or other interventions and that since the eighties there has been no research money available for what may be considered a cosmetic condition. There has been renewed interest recently because genetically it has an unpredictable amount of expression ie the degree of affect in related individuals although genetically a dominant inheritance.
A practical manifestation of the Madelung wrist deformity is the following. Ask the average person to sit on an upright dining chair with their arms out-stretched with the web of the hands (between thumb and first finger) resting on the thighs and they would have their thumbs against the inner thighs. This position ,long term, would be uncomfortable for someone with the Madelung wrist and would tend to adopt a position with the thumbs to the outside with ulnas uppermost, see link to picture of Louise Robey below.
It is highly likely that Jimi Hendrix (1942-1970) the guitarist had this condition (see later note concerning his son in Sweden). His performance at Woodstock ,on film, shows the characteristic protruding ulna etc. The book Jimi Hendrix :the man, the music, the memorabilia page 3 and page 67 by Caesar Glebbeck show his wrists, page 8 has a picture as a pre-teenager with the characteristic uneven long bone development which balances up by puberty; the same picture is on p20 of Jimi Hendrix Gypsey by Henry Shapiro.Also p160 and p708 in this book shows his wrists well. The Life of Jimi Hendrix by David Henderson informs us that Jimi was 5foot 11 inches and his father Al 5foot 2inches which is consistent. There was speculation as to who his father was probably principally from this height disparity. A quote from page 28 "Jimi......much taller than his father ,although not quite six foot himself. Jimi's arms draped down almost to his knees. Sometimes his father would stop work and come and stand by his side comparing arm lengths in jest" I am not a guitarist but I can see how this wrist condition would allow Jimi to play his guitar in his inimitable fashion. He played left handed with a right handed guitar re-strung which meant the pick-up control switches and knobs were under his hand. Because of the Madelung offset angle between hand and arm he could control these switches with part of his palm while picking the strings. In the reverse set-up a right-handed ,normal wristed, player using a re-strung left hand guitar would also have the controls under his palm but he would not easily be able to manipulate them while playing.
 jimi hendrix
Close-up of Jimi Hendrix's right wrist with nobble of ulna marked with 4 red circles, his left wrist is probably more representive.
 jimi hendrix right wrist
Another close-up ,head of Radius marked R and Ulna marked U with the "pivot" point of the wrist well set back and under the Ulna-head ,in shadow under the ulna rather than distally to the ulna-head. The line (green) of the small finger along the edge of the palm should normally line up with the head of the ulna. The normal hand position relative to the wrist should be more like the red line in otherwise the same bent down angle of the hand. Looking at the back of his palm the small finger side is dropped down relative to the thumb side; this is what I have termed the Madelung offset.
 jimi hendrix right wrist 2
Unfortunately (maybe consciously like a number of people with MWD) Jimi Hendrix not only usually wore long sleeves and wide wrist-bands but sometimes frilly cuffs.. Pictures taken from the Caesar Glebbeck book mentioned above. Recently I saw a piece of film/tape of Jimi performing Voodoo Chile in 1969 on BBC tv "The Lulu Show". At the very end he does his picking with the teeth routine and showed the ulna side of his right wrist spectacularly well. I would estimate the unforced Madelung offset to be more that 30mm. His left wrist had his usual wide wrist "bracelet" marked with a red "B". I recorded onto video tape and photographed off the tv screen and scanned in . This low resolution version is the best I can do at the moment from the black and white TV image. Perhaps I could sometime arrange for an animated capture of this shot. His right elbow is at the left hand bottom corner of the TV screen and left forearm and hand at the right of the picture.
 jimi hendrix Madelung offset
The serious joggle between the overlaid red circles is the unmistakable offset. The view is taken from underneath his vertical forearm (shadow showing the ulna)and the underside of his guitar, the fingers of his right arm at the white neck of the guitar. At this angle you would normally be looking at the edge of someone's right hand and perhaps palm but because of the Madelung offset you see the top of his hand and knuckles, his thumb would be around the neck of the guitar.
The following has rather too many ifs for my liking but is an interesting exercise. If Hendrix had MWD and if the facial appearance of a broad/flat/depressed/wide nasal bridge goes with MWD/DCS then Jimi Hendrix had wide upper nose and from family photos it was his father Al who had this wide nose. Then of the paternal grandparents his grandmother Nora Rose Moore had the wide nasal bridge. She was by family legend the grand-daughter of a Cherokee princess. I find it surprising that with all the millions of people who have watched Jimi Hendrix on film I seem to be the only one to have "diagnosed" him to have MWD. I agreed to send a copy of my tape of this part of the Jimi Hendrix performance to a published medic, of international repute outside the UK, researching into MWD. There would have been no problem giving a negative diagnosis ie ,say, JH has not got MWD. All I got was a definite, repeated, no-comment. I took that as a tacit acknowledgement that JH probably had MWD. A practising medical professional could in no way give a diagnosis, remote and second hand, to a dead person especially considering that MWD is a genetic condition and there are living relatives of Jimi Hendrix.
And a comment by email to someone in this group from Prof. Peter Scambler (author to reference 15 below ), Molecular Medicine Unit, Institute of Child Health, London, after seeing this file; "I had come across the idea that the late great Jimi Hendrix had Madelung, and that accounted for some of his ability with a guitar".
Looking at film of his father, Al Hendrix, he probably had Cubitus Valgus and also, reportedly, was born with six fingers on each hand. Looking at film of his purported brother, Leon Hendrix, I saw no semblance of DCS or MWD (as part of a decades long inheritance legal dispute there was a DNA profile check concerning whether they were brothers, but the results were withheld) .
It would be interesting to see if Jimi's son James Henrik Daniel Sundquist Hendrix shows any symptoms. Assuming this is a genuine profile at 1.81m then MWD but not DCS it would seem
Myspace profile by/of Jimi Hendrix's son
" Anyone who has ever met me in person had no doubt that I am his real son. (I even have a rare http://www.divdev.fsnet.co.uk/dysch.htm joint condition the same) "
Is this a world first, remote diagnosis of a very rare medical condition via picture evidence 30 years after death ? Of all the strange coincidences one of the people with MWD who has contacted this group had lived next door to Al Hendrix, neither knowing they may have had the same syndrome because of its different manifestations. JH invalided out of the military , according to which story you read, homosexual tendencies, parachute jump ankle or back injury not injuries to wrists.
Another possible "diagnosis" of someone else in the public eye. In 1999 the Earl of Burford caused a rumpus in the House of Lords in London. In an interview at that time in passing he mentioned his wife had odd wrists. He had noticed it on first seeing her "porcelain wrists" as there was apparently the same sort of wonky wrists in his own family. Or as reported in the Daily Telegraph newspaper on 28 Oct 1999
Note - You have to now subscribe to the archive of this newspaper
" The couple met in Beverly Hills at a lecture by Lord Burford on his pet theory that Edward de Vere, the 17th Earl of Oxford, was actually the author of the plays attributed to William Shakespeare. She said: "After we met, he started writing me 16-page letters that were just beautiful. I fell in love with his writing and he fell in love with my wrists, or so he says." "
His wife was an actress called Louise Robey. According to the Canadian Screen Guild she has appeared in 3 movies and a TV series.
1. Raw Deal with Arnold Schwarzenegger in 1986 (a small role).
2. The Money Pit with Tom Hanks in 1986 (named in the credits as title music composer rather than the non-speaking role).
3. Play Nice, in 1992.
4. Micki Foster in the TV version of Friday the 13th series in 1987 in which she was the leading lady.
I hired a copy of Raw Deal. Louise Robey (in the credits as Robey playing part "Lamanski's girl" ) has a one minute role playing a gangster's moll. She is robbed of jewelry in a stretch limo by Arnold Schwarzenegger 26 minutes, about 1/3 way, into the film. A close up shows Louise removing an earring. Her right wrist shows the protruding knobble of the ulna bone at the wrist that is a characteristic appearance of Madelung. Even if her wrist is the result of trauma rather than congenital Madelung Wrist Deformity or other anomaly it is useful to have moving film showing someone with the appearance of this deformity rather than medical research still photographs. The following is a picture of her with a posture adopted that would be typical of someone with MWD, rather a photogenic pic of the countess rather than a pic of me adopting the same pose.

 Loise Robey

or here, Picture of Louise Robey a less cluttered but mirror image version.

One of the most subtley enigmatic pics on the net. This picture shows someone in a pose that looks unnatural or uncomfortable or even impossible but is quite comfortable for someone with the non-painful form of MWD (see above reference to sitting on a dining chair). Note the forward prominence of her right ulna. I have asked friends with normal wrists if they notice anything odd about this picture and then asked them to strike-up this pose. Almost all of them thought there was something odd about her hands, that is right hand with fingers and palm touching thigh, fingers straight across, not at an angle, and arm straight at the elbow, two thought it was a computer manipulated image. They either could not adopt this pose or it was very uncomfortable and a strain. This otherwise awkward looking posture is very familiar to me in my own family and may even be another pointer or signature of MWD.
From ref 34 below
For people with LWD but not MWD it would seem there is a high probability of the following short 4th metacarpal and disappearing knuckles. 1) For the right hand to start with. Turn tips of all fingers under so that looking down at the hand you see back of hand and the first segments only of the fingers. The first metacarpal is your thumb and 5th is the small finger. The following is called Albright's sign. With a ruler join the farthest point of the observed 5th to similar point of the 4th .Then if normal fingers the ruler would pass outside of remaining fingers. With small 4th metacarpal the ruler would cross over the 3rd metacarpal. 2) curl round fingers further to make a fist. Again observing now just the back of the hand normally the knuckles would have a sinusoidal up and down profile. With Leri-Weill this ripple is often absent or much reduced.
As for rarity of Madelung Wrist Deformity or DCS may remain undiagnosed because it is often misdiagnosed as arthritis, Carpal Tunnel Syndrome, etc or just not diagnosed . From a clinical geneticist working on the SHOX gene associated with DCS and MWD I contacted via one of her journal articles: "I agree that it is difficult to find the incidence of dyschondrosteosis in any references- there is one of 3-7 per million (Atlas of Skeletal Dysplasias) but in my opinion it is likely to be more common than this as it can be mild and so is not always diagnosed maybe 1/100,000- but this is only an estimate".
Confirmed the following from the British Library copy of this book :- According to Adrian E. Flatt, The Care of Congenital Hand Anomalies (St Louis: The C. V. Mosby Co.,1977;page 50) 37 cases of congenital MWD in 1,476 patients with congenital hand malformations (1.7 per cent of general hand malformations) and 1 to 2 per cent of live births with hand malformations so about 1 in 4,000 of the general population of Iowa USA of the 1970s.
For comparison purposes the population in 1997 of USA was 260 million, Canada 29m,UK 58m,Holland 16m, Sweden 9m, Italy 57m, Australia 18m, New Zealand 4m. Tasmania 0.47m,Northern Ireland 1.6m,Norway 4.3m ,Chile 14m,Peru 23m,Israel 5.5m, Denmark 5.3m, Brazil 156m, Poland 39m ,Mexico 93m.
The following is not rigorous statistically but gives a flavour of the rarity. From replies (up to the revision date at the head of this file) to this group (principally), concerning just numbers of DCS and/or MWD affected and/or diagnosed persons including affected family members is :
Holland (21 people) would indicate less rare than 1 in 800,000.
N. Ireland (2 people) the rarity in the general population probably less than 1 in 750,000.
The most valid assessment due to the large proportion of internet users must be the USA, 157 people referred to on these files so rarity less than 1 in 1.8 million. Another possible interpretation for the USA rarity is it is a nation of much more ethnic diversity ie less inbred.
In the UK 83 people, so rarity less than 1 in 700,000 of the population
In Australia 21 people (plus the Sydney 12 ? ) so rarity less than 1 in 900,000 ( or perhaps 1 in 500,000 )
Canada 26 people, so rarity less than 1 in 1.2 million
New Zealand 4 people, so less than 1 in 1 million
12 people in Sweden so less than 1 in 800,000
8 in Denmark, so <1 in 650,000
3 in Israel so 1 in 1.8 million
1 in Norway
2 people in Chile
1 in Peru
1 in Poland
1 in Brazil
3 in Mexico
1 in Spain
NB the Dutch and N. Ireland figures include numbers from medical sources so there is perhaps justification for saying these are more valid figures. Then include the number of people totally unaware of the diagnosis and a figure of 1 in 100,000 looks likely. A point to be aware of ; of all the people making contact via this site not a single case of anyone ,knowingly, being related to anyone else in this group.

A few personal stories

The following personal stories would not have been possible but for the internet and global "whole text" search engines putting everyone in contact. About 132 people ( as of end of 2005 ), some isolated, and some with a familial genetic history so perhaps 400 or so people in total via family links. If anyone would like to contact the group please e-mail me ,my contact details are after the personal histories. No spam gets past me, the email addresses stay within the group and no names or email addresses released to the internet other than my own.



But first a few easy to perform tests for Madelung Wrist Deformity. I know from reading the medical research papers that it is very difficult to understand the terminology relating to these tests so I have put them in simple language. First test I will call for convenience N1 plus R for right and L for left. A simple test for Madelung wrist deformity (but not necessarily unique to MWD and I hasten to add I've not had qualified medical opinion on the following). For inspecting right wrist (N1R) place the thumb of the left hand on the wrist end of the right ulna. Place the first finger of the left hand against the section of the right palm nearest to the ulna. Then with a "squeezing" action (with firmness that would probably break a hen's egg if applied to the weakest diameter of an egg) the misalignment should substantially reduce but immediately spring back on releasing the pressure. Make an estimate in mm how much misalignment there is. Repeat for the other hand (N1L). MWD is usually bilateral ie both wrists but maybe more pronounced in one wrist than the other. See person C below who has the "bayonet" form of MWD and my N tests do not apply with this variant of MWD. I've put 3 photos of this description in the following. This is not the "bayonet" form although a relative of mine does have the "bayonet form" .I've not seen such a sequence in any of the medical research literature and gives something nearer a "dynamic" view of what is going on. Overlaid on the first photo is a rough idea of where the ulna lies. The first image is of hand and forearm resting on a flat surface in a natural state. The displacement between the two blue markers is about 21mm. The ruler is marked in centimetres.
 wrist - natural state
The blue markers remain in the same position for the next two images. It is not possible to conduct the N test as described above and photograph at the same time so have approximated by placing a small block under the ulna side of the palm and pushed the forearm down. This gives a minimum displacement of about 7mm
 wrist - minimum displacement
For the maximum displacement holding the fingers down on the flat surface and forcing the forearm upwards.
 wrist - maximum displacement
This shows a displacement of about 23mm. So from minimum to maximum a movement of 16mm. Actually doing the N test applying force directly over the displacement is more like 20mm.
The following 2 tests have been verified by a practising orthopedic specialist but for convenience I have called P1 and P2
Test P1
For testing right wrist (P1R) you must hold your elbow with your left hand. Turn you right thumb from facing right to facing left. Somebody with madelung can't make a 180 degree turn.
Test P2
Next you can test the upward movement by moving your hand, palm up,(and holding your arm still) up and down. Someone with a healthy wrist has a range of about 180 degrees (from down to up). Someone with Madelung hasn't, they have less than 180 degrees.

Of course proper medical diagnosis requires X-rays being taken and analysed by a physician familiar with the condition or at least familiar with reading X-rays for which the wrist is naturally rather variable from person to person.


In the following list of people those marked [ CL ] are in the e-mail circulation list. I am the moderator / gatekeeper so no spam etc gets passed on. This is a closed group with no one's full name or e-mail address released except my own.

Myself,Nigel,England [ CL ] MWD
I am in 40s and can't honestly say my wrists are a problem and only doing this research did I realise I had a medically discernible condition. Although someone in my family was diagnosed in the 1960s with the more obvious DCS there was nothing to suggest then it was hereditary and no family genetic counselling . I never realised my wonkey wrists had the same genetic origin and being benign there was no need to seek medical advice . Writing wordy essays at school meant my wrists ached after a while perhaps this a contributory reason for me preferring maths and physics. As long as I lift heavy weights in an appropriate manner (lifting with the end of the forearm rather than my hand under the object) and don't subject them to shock loading ( eg not competing in tug-of-war and not pushing a car with stopped engine to bump start etc) .I have not had any problem in adulthood only once totally dislocating my wrist but jumping straight back again, when I was about 25. This was unloading a 50 Kg bag of fertilizer from a lorry, the plastic bag slipped and instead of letting it drop I tried grabbing it with one wrist at an awkward angle. As a teenager I broke my wrists on 3 separate occasions but it was dismissed as boys will be boys falling off things and an inherent weakness was never diagnosed. The 3 occasions were falling off a bike, getting forearm wedged under a child's playground swing and while crank starting an agricultural engine that backfired. All situations where anyone could have broken a wrist. The perplexed radiographer tryig to understand why my good wrist looked as broken in the x-rays as my broken wrist. I never broke a leg or arm it was only ever wrists. I have only self-diagnosed in the last few years (1998-1999). My GP (doctor) was most impressed he actually jumped out of his seat to manipulate my wrists: he had never seen or heard of the condition - I demonstrated MWD to him as I was about to leave his surgery having visited on another matter. Walking through doorways I often knocked this exposed area of the ulna against the door-frame also wearing a watch it had to lie on forearm above this knobble. If I get the angles and pressures just right using the other hand I can make the radius side of my right wrist sublux into the "bayonet " form. It springs back after releasing the pressure unlike the permanent bayonet form . I have always been cautious of handshakes. The origins for handshaking is as a sign of non-hostility because originally it meant your hand could not be on the hilt of your sword if it was clasping someone else's hand. Unfortunately too many people go to exaggerated shaking etc which for someone with MWD is aggravating. [Incidentally chinking of glasses has a similar origin. As a check against poison in someone's glass - the chinking in pewter type vessels guaranteed the contents of one cup would slurp into the other cup.]
 pre-adolescent self
Fifth digit clinodactyly to a minor degree. It is just possible that hearing anomalies are associated with DCS and MWD there are references to this in the journal articles eg ref. (50 below ). Someone else in my family had reduced hearing capacity from early middle age. I went the other way in teens and twenties I was susceptible to high frequency noise well above the normal hearing range ie technically between 15 KHertz and 40KHertz. In those days a lot of shops etc had ultrasonic intruder detector systems on their premises now superseded with PIR detectors. For technical reasons those ultrasonic systems had the transmitters active all the time and only the receivers switched off day time so I had to duck and dive to avoid them as they were usually placed at head height. MWD/DCS is an irregularity in bone development; hearing relies on the smallest bones in the body so there could well be a connection. Someone else in this group has separately experienced this phenomenom. Routine hospital hearing tests would seem to only go up to 8KHz which is nowhere near the ultrasonic range, so presumably the reference here is the only reference to it in association with DCS/LWD/MWD.
I would appear to have a fibula/knee anamoly, with either leg but right most prominent. Bend leg at knee then angle upwards the foot and twist the foot to direction of centre of body. The top of the fibula bone on the outside side of the body protrudes outwards. Another trait that seems to go along parallel with DCS is facial characteristic of wide nasal bridge ,ie the bony part of the nose rather than the fleshy part being wider than normal.
Demonstrating MWD half-broken wrists in a social environment is quite some party-trick - it can make some people come over quite nauseous. On the development history. Here is a photograph of me as a pre-teen that except for the trite observation that I am white and Jimi was black could be the same as this preteen picture of Jimi Hendrix taken Seattle 1946 and appeared on a 1993, vol 7, No 4, cover of the Japan version of Esquire magazine.
Pre-teen Jimi Hendrix
Both pictures show someone in short trousers with knees at different heights with one leg angled and each arm maybe different in length. The shoulders are canted perhaps 20 degrees off horizontal, twisted and bent limb bones and splayed feet all very rickets like. In all we look like we were assembled, cobbled together, on the Friday afternoon shift while drunk. By age 15 these asymmetric growth rates had balanced up to give an evenly balanced stance of 6ft 3in. There was just one long term effect - poor foot angle when walking, leading to fast wear of the outer rear edge of the heels of shoes. Test results for myself:- N1L a displacement of about 8mm and N1R about 20mm P1L 150 degrees P1R 150 degrees P2L 80 degrees P2R 90 degrees

P in Holland (in email contact with) [ CL ] DCS
Well I've got dyschondrosteosis. It's also called Leri Weill syndrome. I'm in my 20s (in 2000, female)and one of my wrists has been operated. They've put a piece of my hipbone in it with a piece of metal on top with 7 screws in order to keep my wrist from moving cause it hurt to much. I live in Holland and there are 4 other families in Holland (each with 2 patients, I'm the only one in my family). I'm the first person with dyschondrosteosis in my family. . The dyschondrosteosis is most visible in my arms (wrists) and mildly in my legs. My left wrist is the worst and gave me a lot of pain. The pain was caused by the fact that my wrist was permanently dislocated and my muscles had to work very hard to keep everything together. Test results P1R 90 degrees P1L 20 degrees The doctors are very quick in diagnosing Madelung but they're not looking further. Madelung itself is not heriditary and it's easy to determine if someone has dyschondrosteosis with Madelung or that the Madelung is a birthdefect or caused by a accident. In most cases a simple X-ray of the legs is conclusive. If "A" wants to I can give her information, especially because we're practically the same age and I've had my wrist stiffened (arthrodeses).
Update Oct, 2005
Just a quick update on my own situation: they're going to remove the metal fusion plate from my left wrist on December 20th because it is causing zwelling and such and such.

From I in Canada (in email contact with) [ CL ] MWD
This year (2000) I just discovered that I (female) have Madelung's Deformity. I have had trouble with both wrists ever since I can remember and I am anxious to write to someone with the same deformity. I am also in my forties. When I was a young child my wrists would become painful especially writeing, playing piano, knitting or typing. My mum just thought that I was saying that because I didn't want to do these things. I always had protruding wrists (outside area) so I knew then that my wrists were different than any one else. About twenty-six years ago when I was pregnant with my first child I starting experiencing numbness and tingling in both hands especially in bed at night or when I would hold something for a period of time (my left hand was the worst). I was told that this was common with some pregnancies with the extra water retention in my system. I had four children and had the same ailment throughout. Five years ago my Family doctor sent me to see a RHEUMATOLOGIST who said that I had Carpal Tunnel Syndrome and I had various tests done, was on different medications and had to wear wrist braces going to bed at night . Last year (1999) I experienced a lot of pain in my right wrist and the bone was protruding more than usual. I'm right-handed but I couldn't use my right hand as it was so painful and the pain shot down to my little finger and up to my elbow. I had to go to the hospital for some extensive testing and the doctor there told me that I didn't have Carpal Tunnel but he never told me what was wrong. I went back to the Rheumatologist and he told me that I had some kind of birth defect and left it at that. Meanwhile, I was in agony and sometimes cried with the pain so I went back to my Family doctor and he referred me to a ORTHOPAEDIC SURGEON. This Surgeon did a full history and testings before he would let me leave his office and was able to tell me straight away that I had Madelung's Deformity. He told me that it was very RARE and GENETIC and that he would only operate as the last resort as it was quite a big operation. He was more interested in getting the pain under control so I had a Cortisone shot which took a few weeks to take affect and also put me on an anti-inflammatory and pain killer called CELEBREX (what is mainly for arthritis which I don't have). The deformity affects the Ulna and Volar in both of my wrists although the deformity is now worse in my right wrist as the outer bone seems to have moved more towards the middle of the wrist and my hand tends to turn more to the right now. Test results P1L 110 degrees P1R 150 degrees

K in Tasmania (in e-mail contact) [ CL ] MWD
A couple of weeks ago (in 2000,female) I too was diagnoed with Madalung's deformity (aged 21). I was at the specialist at my local hospital when I found out. Luckly there were student doctors there so i was told a bit about the condition. But the only treatment i was told about was an operation which they won't do unless it gets much worse. so i went looking on the internet for some not medical treatments for the pain in my wrists and for some more information when i found your site. So what i am asking is, can you pass on any information that you recieve. and do you know of any treatments or things that i can do to make my live easier. All the information i have found on the net went over my head, there were lots of technical stuff that i didn't understand. The main thing that irritates me about madelung's is that my family doctor had never heard of it, let alone knew how to treat it. and the medical books she has had very little info in them. I was told I had MWD in July this year, I found out because the pain in my left wrist had never really left since spraining it aroud 4 years ago and then it proceeded to get worst since the begining of the year. The Dr at the local youth health center sent me for xrays basicly to make me happy because he couldn't see anything wrong but could see that I was in pain. After the xrays came back with a V dispalacement, he decided that I too would need to see an Ortho Dr. The younger doctors in the Ortho Department at the Hospital told me that there was no reason they could see for the pain and it was one of those things that I will have to live with. But they thought they would check with the old!!! Dr to see what he thought. The young Dr briefed the old one and as soon as he walked in said that I had this MWD. Because my local hospital is a teaching hospital, he went and explined it to me and the Student Doctors. He said the people with MWD are prone to sprains. To explain the way the deformity affects the wrist, He also said that I can play on the monkey bars, But never to do a hand stand, because this will make it worse. Now if i even knock my wrist I bandage it up over night or for a couple of days for protection so that it doesn't get any worse. Basically why go to the doctor and pay them to tell you to wrap it up and go easy on it.

C in the USA (in e-mail contact)
I have Madelung's Deformity. I'm 46 years old and 5ft 10in I read some info and letters on your website. I've had trouble all my life with wrist pain, the worst in my late teens and early 20s and now again just recently in the last 6 months. I've used moist heat (hydroculator) , ice, anti-inflammatories and since April of 2000 I go to a massage therapist at least twice a month. The massage therapy has given me the most relief. I've played piano since age 8, concert organ and pipe organ since age 11, crochet, needle point, and do secretarial work for the last 13 years (writing this in 2000). I was tested for Carpal Tunnel in April 2000, which results were negative. The wrists braces the doctor gave me to wear while waiting for the test date actually made my wrists weaker. I wanted to write in case someone can benefit from my input. I was diagnosed with Madelung's Deformity only this last April. When I was growing up my parents and I just figured that I had weak wrists. My symptoms have included weakness in the wrists all my life, this last year - dropping things like jars of jelly, milk cartons etc. (have to use both hands to lift anything) , I've also had numerous wrist sprains since I was about 18 years old and a real bad spell where my wrists hurt non stop for about 2 years about age 19 - 20. I wear ace wraps off and on and when I played tennis even as a child, wore ace wraps. My wrists bones on both wrists stick way out.... thru my life many people have asked me, "Wow, did you break your wrist or something?" ------(by e-m i mentioned she probably had the "bayonet wrist" variant If someone looks at you side on when your standing up and arms down and palms facing backwards. The hands are stepped backwards from the line of the forearm (joggled) like the way a bayonet is fixed to a rifle off centre so the blade does not interfere with the path of a bullet.)------- Yes! That's exactly it. And I also can not straighten my arm at the elbow if my palm is flat against a wall at shoulder level {probably Cubitus Valgus}. I didn't mention that the hand specialist who diagnosed me in April wanted to do surgery. I told him that i'd rather live with it. I do go to a Massage Therapist every other week and she works my neck, upper back, arms and wrist real well. I've been taking Glucosamine Complex and I'll let you know if it helps. Was suggested to me by a friend who went to a holistic doctor. Also doing an exercise where you squeeze your thumb to fore finger and count to five and then squeeze your other fingers the same and then stretch out the whole hand and do the other hand the same. So far the theraputic massages every other week have helped the most and I can go for days now without any pain at all in one or both wrists.

R in the USA
While browsing the web I found your web page and I must say that its quite nice to see. I have Madelung's deformity and it can be quite painful, especially with repetitive movement such as writing, typing, etc. I would really like to get in contact with other people with the same condition. I have been to a wrist specialist who diagnosed my condition. Unfortunately, the treatment is basically "do whatever doesn't hurt." So I would really like to be in contact with other people with the same condition.

T in the UK
just found your address on web, what is your interest in madelung as i have suffered as long as i can remember with said deformity. i am female and i am 45

From D in the USA in e-mail contact with. [ CL ] DCS+MWD
I (female) was happy to have found your website! I have two daughters and one son. My daughters are 11 and 12 1/2, they have both recently been diagnosed with Madelung's Deformity. They will be participating in a research study on Madelung's here close to home. Have you found anything else that is typically found to be wrong in someone with Madelung's Deformity? The Dr. believes the girls also have Leri-Weill Dyschondrosteosis, and that my husband has Leri-Weill also, although he doesn't have Madelung's Deformity. I would like to find out how rare this is, but they can't seem to give an answer. The Dr. doing the research said he believes it's much more common than people origially thought, but not able to give me any real numbers. Are you also short statured? My daughters are very short statured. Do you know if you have radial head displasia (RHD)? Both of my daughters have it. The Doctor said that all people with the radial head displasia typically have Madelung's Deformity, but not everyone with Madelung's has the RHD. I would love to hear from you. Followup Nov 2000
We were at the hospital again today, from E's fall a couple of weeks ago, for her to be checked again. Today they checked her legs, they said it is common for girls with this to have very big calves. E does, but my oldest, S, does not. They made a special brace for E as she has very large forearms and a normal brace off the shelf does not fit her right. I asked the Dr. what the chances are, if she has pain now at 11, what the odds are that she will have pain the rest of her life, he says no, but that doesn't seem to be the case from most of the others on the mailing list, I've met through your website. I don't want my girls to have to suffer with pain their whole life! I believe I already told you, but we are participating in two studies on MWD. Followup Sept 2001
Just thought I would update you all on my daughters and their Madelungs. S is doing well, not due to see the Dr. again till next year. She is starting to have pain when she does to much writing, she is 13. This scares me, as she has never had pain before and it is just now "developing". The doctors won't do anything for her, as she has what they call a "mild" or "less severe" case of Madelungs. E, had surgery on her left wrist in April. It is much more severe case of Madelungs. She had such severe pain before the surgery, and after had no pain whatsoever. We were so thrilled.....until 2 weeks ago when she started having severe pain in the same wrist (left) she had surgery on. She is already scheduled to have surgery on the right arm in October, but now we have to consider another surgery on the left. After her surgery in April she was in a long arm cast for 6 weeks, which wasn't to bad on her left arm, as she is right handed. When we get the right arm done she is very concerned about having that long arm cast on her right arm and not being able to use it. The doctors have even mentioned doing both arms in October, but we (my husband and I) are going to let them know that we want to get the left fixed then schedule the right. It also scares me that the doctors keep telling me that when their growth plate closes there is no reason to believe they will have any pain at all, but the letters I see from most of you says that you do have pain as you get older. The growth plate should close around 15 or so. I love the hospital here in -, they have been really great, and as I have told some of you, we participated in a study, that I believe is still ongoing in Philadelphia, PA, about Madelungs. We found out that it is genetic and that it usually affects that SHOX gene, which has some mutation.

From A in the USA in e-m contact with [ CL ] MWD
Hi, My name is A. I am 24 and live in the US. I was just diagnosed (2000,female ) with Madelung's deformity and found your web site. I just wanted to tell you how informative it was, I wasn't able to find a whole lot of info online. I am a Registered Nurse and had never heard of Madelung's until I was sitting in the doctor's office with what I thought was a strained wrist. My left wrist is the most symptomatic, and it has bothered me since I can remember. I never thought anything about it though. I am dominant on my right, so left sided weakness never affected me until now. I am feeling very frustrated because my doctor told me I was going to have to live with the pain, that none of the available surgeries would benefit me. Of all things he thought wrist fusion may work later on, but for me that isn't an option. I have found most of my information from medical textbooks and professional journals, but I would be interested in any information that you may have. Thanks.

C2 in the USA in e-m contact with [ CL ] MWD
Hello, my name is C, .... i also have madelungs deformity. i had pain in my wrist since i was about 15 years old. but if i ever had pain before i think i just ignored it. but over a few years its became alot worse. im 18 now (in 2000,female), im getting surgery done on my arm/wrist. i go to the doctor in about a week to get a CT scan (cat scan) so that he can get a better look at my bones. then after that appointment i go in front of many doctors here in to see what the best kind of surgury for me would be. So i think this is actually a very good way of solving the problem. My mom also realized that she has it and so did her aunt. so it seems to be quite a problem in my family. Well i just thought that i would share my thoughts with you and my problem. i really like your website it had a lot of interesting information on there. thanks alot!!

From B in the USA in em contact with [ CL ] MWD
I have a 15 year-old daughter (2000) who was recently diagnosed with Madelung's Deformity. It is in her right wrist and she is right-handed. The doctor has advised fusing her wrist. Has anyone had this done and do they have any regrets? I worry about the loss of motion in her wrist, but she is really wanting the surgery. I would feel better if I could hear from others who have had this done.

From A in Holland (father) in e-mail contact with [ CL ] DCS+MWD
This morning (2000) we searched the web for information about Madelung's Deformity. We're very glad we've found your notes. Our daughter "A" (15 years old) is known to have Madelung's Deformity for about 1 year.The last few months the pain has become worse,for example at school she has trouble with carrying and lifting her books. Both wrists have the deformity,left gives most of the problems. Last year we visited a doctor(who made the diagnosis) and he told us that there were only 5 other people in Holland with the same problem. We have no idea how to go further and are looking for information that can help us along. Reading your pages we saw that you have (email) contact with " P in Holland". If possible we would like to make contact with him to gain information about the possibilities about treatment in Holland etc.So maybe you can give us his email address But also your other contacts have our attention. We feel free(if it's oke) to contact you again.Thank you for your attention,hope to hear from you soon. "A" is the only one known with the Madelung's Deformity in our family. About a year ago she started complaining about her wrists. We consulted a doctor(orthopaedist) in our local hospital. He made some X-rays and told us he'd never saw anything like it before. Unfortunately he only made X-rays of both wrists,so he didn't notice the curving of the radius.The next morning he called us and told us he'd found similar photo's in his book known as Madelung's deformity.He made an appointment for us with a professor called Mr. D. I think this will be the same professor P visited! He X-rayed the whole skeleton and gave us the diagnosis Dyschondrosteosis and Madelung wrist deformity."A" is only 1.55 meters tall. Her legs (tibia/fibula) are short in comparison with the rest of the body. He told us that no treatment was necessary at that point.At that time she had no pain and it lasted well for a whole time.At the moment the pain is becoming worse and she has difficulties at school carrying her bag as we already wrote. So we're looking for more information about possibilities and treatment.

End of year 2000


This file was getting unwieldy so the following section, that was on this file, is moved sideways to

Continuation of Personal Stories submitted in year 2001

Continuation of Personal Stories submitted in year 2002

Continuation of Personal Stories submitted in year 2003

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Continuation of Personal Stories submitted in year 2006


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Start of year 2007



From C4 in the UK, Scotland, (in e-mail contact) [ CL ] MWD
I found your website when I searched for "wrist deformity". I couldn't believe what I saw - pictures of people with the exact same wrists as me! I'm 25, female, and have been having pain in my wrists, on and off, since I was about 14/15. as far as I remember, the weird shape of my wrists was first pointed out to me by a friends father when I was around 10 years old. the deformity has gradually increased since then. I've not been diagnosed. I only ever sought treatment once, when I was about 16 and I went to a nurse who just put a bandage on it, not knowing what it could be. Since then the pain has come and gone and it's got to be "just the way it is" so I suppose that's why I never got further medical help... until now. I went to my doctor first with pain in one of my thumbs and my little finger. He said to just get a stress ball to strengthen my joints. The pain started to spread throughout both of my hands. Sometimes my wrists would be sore but at the moment I am experiencing most pain in my knuckles and finger joints. Can this be caused by Madelung's or could it be arthritis? I'm really worried that its rheumatoid arthritis! I went to my doctor again 2 weeks ago and showed him my wrists. I never thought to show him the first time! He immediately suggested I go for an x-ray. So I got the x-ray done on friday and I am now waiting for the results - should be 10-14 days. I'm just wondering if Madelungs can cause pain in finger joints? I keep getting needle-like pain in my fingers and knuckles. Sometimes they feel a bit hot and swollen. I'm really worried because I'm only 25 and don't want to be crippled from arthritis - or anything! Anyway, I just wanted to thank you so much for your website. I really can't believe I now know what's wrong with my wrists! I'm 100% sure I have Madelung's, with or without proper diagnosis. If you want I can send you photos. Oh, as far as I know there is no history of it in my family - but I have no contact with my dad's side of the family so there may be there. I think my arms are shorter than they should be - maybe my legs too but not by much. I'm 5ft2 so I'm small but not abnormally so. Do you know what measurements your forearms should be in length compared to your upper arms? I did the N and P tests and in all of them I have the movements of madelung deformity. Like I say, I'm 100% certain I have it. It's amazing. All this time I just thought I had weird looking wrists. I had no idea it was an actual condition that other people had! Well, yeah, thanks for the website! The pain in my hands kept me awake last night. Today in uni (it was my first day back after xmas) I realised I am having trouble gripping a pen properly to write.

From J3 in the UK, (in e-mail contact) [ CL ] MWD
I am writing about my daughter who is 10 years old. She was diagnosed with madelungs about 6 months ago. She came home from scholl one day complaining of a sore wrist but couldn't remember hurting it, we took her to a and e where she had an x ray, we sat in the waiting room for hours whilst the staff tried to work out what was wrong with her wrist... no one there had seen wrist x rays like hers before. To cut a long story short we were refered to a specialist at the childrens hospital who diagnosed madelungs. As she suffers from a lot of pain and has limited movement in both arms she is awaiting surgery on both wrists... Kapanje procedure? I wondered if any one has experience of this procedure and its outcome.

From J4 in the UK, (in e-mail contact) [ CL ] MWD
Hi my name is J and my daughters name is _ I would be grateful for any information you can give us about the follwing: My daughter was diagnosed with this condition at 14 at the time I was told it is also linked to Turners Syndrome which thankfully she hasn't got. She has a two year old boy and had a normal pregnancy until the end when she developed pre eclampsia and had to deliver six weeks early. She is now pregnant again but this time is suffering with all sorts, she has tightening in her chest making it difficult to breathe, her heart races for no apparent reason, she has developed back pain in the upper part of her back and then the normal problems, morning sickness for the first twelve weeks, passing out due to anaemia, low blood sugar, urine infections the list goes on. She is 23 weeks pregnant at the moment. The thing that is worrying me the most is the breathing difficulties and the upper back pain, do you think either of these could be caused by her deformity? She is quite small around 4 foot 11 inches and she is 20 years old. Please could you let me know if you have heard from others who have had difficulty during pregnancy due to the deformity. We live in _ in the West Midlands. When my daughter was a baby she was quite small in stature and I remember getting most upset when my mother in law suggested she may have dwarfism as a relative on their side of the family was a dwarf, obviously after _ was diagnosed with madelungs and I have now been looking into it I think maybe this does have some relevance. I'm sure my daughter would also be interested in joining the site so that she can talk to others.

From M7 in the USA, (in e-mail contact) MWD
Hello,I am a 34 yr old female with bilateral madelung's deformity and am also 4"11 Thank you for the article I have read on the internet.It is one of the more concise articles I have found.It has taken doctors 20 yrs to diagnose this defomity.I suffer form terrible pain due to degenerative changes that have occured due to the deformity. Are there newer surgery options for the severe form that i have? Thank you, M_ Ga. U.S.A

From M2 in UK in e-mail contact with [ CL ] MWD
Came across your web page and thought I would let you know I think I have Madelung's wrist deformity. I had my right wrist operated on when I was 17 (now 38). I think they broke one of my bones to shorten it and "shaved" a bit off the one that sticks up. The left wrist was never as bad, but it is very obviously misshapen. I didn't realise that this had a name or that anyone else suffered from it. I don't have any pain or weakness, just the hassle of always covering my arms. Is there anything corrective that can be done? Are there other people to contact? No one else in my family suffers from it to my knowledge. I have not been officially diagnosed, but an old GP of mine expressed interest a few years ago that she had 2 patients on her books with this deformity. I could not remember what she called it. Then a couple of years ago at a music festival I spotted a lady with the same wrists as me. I have no other symptoms or pain and I would like to join your support group. I originally looked up "wrist deformity" on google to try and find out what I had and to see if surgery had improved over the years. Clearly it hasn't.

From V in Spain in e-mail contact with MWD
Hola! Mi nombre es V....... soy una mujer de 25 años y me han diagnosticado la deformidad de Madelung (discondrosteosis) en ambas muñecas esta deformidad la he tenido dese que nací pero el pediatra nunca llego a fijarse... lo que pasa es que hasta hace poco tiempo no he tenido dolor pero si que esteticamente nunca me han gustado porque llaman la atención. Resulta que fui a mi medico y le pedí que me hiciera unas placas de las muñecas y me las hice. Resulta que cuando me las hice al cabo de un rato me llamaron porque el radiologo me queria ver las muñecas y yo no sabia el motivo, la sorpresa fue cuando fui a recoger los resultados y me dijeron que tenia una deformidad en las muñecas y que no sabian lo que era... Las placas las ha visto un médico traumatólogo y no me ha dado ningun tipo de explicación y ahora estoy a la espera de ir a otro médico. ¿Quisiera que me mandaras información sobre esta deformidad? y con el paso del tiempo que problemas puedo tener... También decir que soy la única de la familia. ¿Qué pruebas deben realizarme?

From L4 in the USA, (in e-mail contact) MWD
My name is L_, I am 39 and live in Ohio. I decided to search for some more info out of complete frustration and found your site - it brought me to tears to find out that there are others who have similar stories like mine. You are also wonderful for putting this site together - THANK YOU. When I was around 13 or so, my mother told my father she noticed my hand/wrist looked a little different. After a trip to the family doctor my family and I were sent to the next largest city to visit a specialist. He then referred me to another specialist, a hand/wrist surgeon. This doctor told us that this condition (whatever it was) had stunted my growth (I am 5'2") because growth begins to slow down when bones begin to close in wrists and ankles. He figured I would have been more like 5'6" or so. Anyway, he felt I would have substantial pain eventually and because of limited mobility (not being able to turn to look at a watch, etc.), prescribed surgery to fix the problem. (My wrists/arms look exactly like your bayonet picture). He wanted me to wait until 16 years of age or so, to make sure growth was done. So, I got my driver's license one day and went in for surgery the next. Pinned together and casted for the next couple months proved to be painful and tricky during high school (I'm right-handed). They offered no physical therapy and I have multiple scars and puffiness (probably from tissue?) I opted not to do my left arm. Then of then of course you get the kids or parents that begin to notice the scars, smaller forearms, etc. As long as I keep my weight done, it seems to be less noticeable. After two kids, and a little more weight it is more noticeable. Some say they don't notice, but I've always been self-conscious of them, especially during summer months (tanks tops, etc.) My 20's & 30's weren't too bad as far as pain goes, but now as I am approaching 40 I am experiencing high levels of pain everywhere on certain days and I seem to be taking more and more ibuprofen/pain killers to try to get rid of it. I was recently sent to a local orthopedic surgeon by my family physician after experiencing unbearable aches and pains in my arms (he also thinks I have carpel tunnel). I was diagnosed having DCS and/or MWD by this bewildered surgeon. After multiple x-rays he pulled me into his office with large medical textbooks and all and gave me his best guess. He suggested taking an inflammatory drug - but didn't know if it would work. Not knowing if this was a hereditary condition, he agreed with me to send both my children to pediatric orthos to get x-rayed. So far, my 9 year old daughter appears to be fine (her arms are longer than mine!) and seems to be taking after my 6'4" husband. My 7 year old son is built well, but does look a little smaller in stature - which makes me worry some. I pray that because I have read so much about the fact that men are less likely, he will be spared this condition. The reason I began searching for information is that there are days when I hurt and am stiff everywhere. Neck, back, shoulders, elbows, wrists, hands, knees, legs, ankles - you name it, it hurts. I wonder all the time, is this part of it? Or something else? I am by nature an active person and some days (when it's bad) it is hard to cope. Sometimes the pain brings me to tears. In my mind, I'm still 20, but on the "bad days" I feel like I'm an old lady. Does anyone have any ideas? Things that work? Will this get worse? I HAVE to find a way to deal with this - I'm too young to feel this old....

From C8 in the USA, (in e-mail contact) MWD
Hi, I recently came across your website on dyschondrosteosis and madelung's deformity. I am waiting to go to genetic testing as it appears that it is very possible that I (as well as members of my family) have one or both of these conditions. There is at least 1 case of dyschondrosteosis and 3 cases of madelung's in my extended family. I don't really want to have my "story" on your page (especially as I think members of my family have/will study your pages to find out more about this) but I was wondering if I could tell/ask you about my situation since you seem to know much about the subject.

From J5 in the UK, (in e-mail contact) [ CL ] MWD
I was diagnosed as having Madelungs in 1963 at the age of 13 after suffering for many years with painful shoulders and upper arms. Both arms are affected and look exactly the same as the `bayonet’ later in this article. I have since had both heads of the ulna removed which has proved slightly successful. I have two children both of whom have very mild forms of Madelungs. For many years I have felt quite alone and have found this web site very helpful.

From V in the USA, (in e-mail contact) MWD
I am so happy to have found website on Madelung's. I have leri-Weil dyschondrosteosis and until the last 4-5 years have had no problems. I am now 55 years old, in a profession requiring a lot of use of my right arm, 30+ years as an anesthetist. I am now experiencing changes in my dominant arm. Range of motion has markedly decreased, with much more bony prominence on underside of my arm. I often have dull aching in the whole joint, something new for me. Occasionally I experience a very quick sharp pain, but it is so fleeting I cannot really describe exactly what it is. Writing has become more difficult, as is using the computer mouse for any length of time. Fatigue sets in very quickly. X-rays deny presence of arthritis, EMGs deny carpal tunnel and other nerve compression syndromes. A local orthopedic "hand man" was unable to share any info with me, just telling me that I had Madelung's and had no appreciation of slow progressive changes in past few years. I have pretty much ignored the Madelungs all my life, but there is definitely something going on now and I cannot find any info about changes past the age of maturity.... I have never had anybody outside of my family to discuss this with, (except doctors who mostly knew less than I) and it is not open for discussion in my family . I do have other family members with the syndrome. My mother has always felt shame for passing along imperfection. My mother was the first to show up with "crooked arms"...Her family was very poor and rural and were told she had rickets. (Boy, was that wrong!) As I approached adolescence,(earlt 60's) the appearance of my arms began to change and I was rushed off to doctor. Had a workup at local world class Children's Hospital and was told my family had Madelung's Deformity and it ran in girls. My mother, sister and I all had it and had same body build, however my maternal grandmother was much taller, leaner and didn't look like us at all, with no wrist deformity. Short stature syndromes were not mentioned at that time. One of my daughters at a very young age began having terrible growing pains in her knees and appeared to have the thicker build in her legs and knees. I took both of my daughters to the Children's Hospital, where it was determined that we all had Leri-Weil Dyschondrosteosis, which also includes Madelung's deformity. A wonderful geneticist spent time with me and cleared up so many questions. Finally everything made sense. We are all about 4"9" tall, normal torsos, short thick legs and Madelung wrists. Our wrists all appear slightly different from the others'. So..in my family, there was my mother, my sister and I, my 2 daughters. My sister did not pass it on. The gene is autosomal dominant, meaning if the gene is passed on, you get Leri-Weil. Every pregnancy for myself or my daughters presents a 50% chance of passing on Leri-Weil. Interestingly enough, the gene was probably passed down through my maternal grandfather. He had same short, thick legs, etc build as we, but did not appear to have any wrist abnormalities. His family history very splintered, but their were rumors of distant relatives with "crooked arms" I am happy to share information Although having some problems with my Madelung's now, has never been problem in past for any of us, except 1 daughter had a lot of pain in adolescence. Both daughters athletic and healthy.

For anyone in this circulation list, after reading this current file, and realise they have not been circulated. If they re-contact me stating their old email address and their [ CL ] code letter/number/country I can re-instate them. People with aol.com email addresses will have to contact someone else (non AOL ) in the list to get them to relay these circulated emails as AOL bounce Bcc , probably due to them falsely interpretting as spam and rejecting. Maybe this problem: Title "Mailings blocked" on http://technology.guardian.co.uk/weekly/story/0,,1580155,00.html
As of Oct 2005 all 14 AOL addresses removed from circulation/update emails. The properly constituted anti-spam/virus system would pass them through with tagging of the title with *** SPAM *** , *** VIRUS *** or whatever then the recipients can simply set a filter to divert into a probable-spam folder and periodically check the titles themselves for false inclusions, due to too many non-dictionary technical words or whatever, before deleting the lot. UK based NTL / ntlworld contacts are likely to be the next subgroup to be so excluded.

The wrist condition was recognised and then published by Herr Madelung in 1878 ( 17 years before X-ray images were invented) and later was named after him.

********************

Otto Wilhelm Madelung - Die spontane Subluxation der Hand nach vorne. Verhandlungen d. deutschen Gesellschaft fur Chirurgie 7:259-276,1878 ( The Spontaneous Forward Subluxation of the Hand- Proceedings of the German Association of Surgeons 1878 ) . Also in Arch.Klin. Chir 1878;23:395-412
I tried getting a copy of this journal article from a medical archive institute in Freiburg, Germany but their series of this journal go back to 1879. May 2002 I contacted Prof Dr Gudrun Rappold at Heidelberg and she forwarded on a copy of his article to me. The following is a rough transcript of that article . There are errors especially confusion between "e" and "c" as almost indistinguishable in the printed typeface plus usual mis-keyings. It not only contains archaic medical terms but is written in the German of one and a quarter centuries ago.

O W Madelung 1878 Journal Article ( <> German )

This 1878 article ,for the moment ,crudely translated into something resembling English but not as she is spoke. The gist of the paper is there. When both myself ,and a German speaking friend ,can find time, we will tidy up the translation. I am not a medic and know no German so it is surprising there is anything intelligible in this translation. I find sections of the technical medical journals on these topics to be fairly impenetrable even in English. It is an amalgam of a few online machine translations and use of a large German to English dictionary and a German medical dictionary at Boldrewood Medical Library. Untranslated words are in italics.
O W Madelung 1878 Journal Article ( <> English )
A recent return to OW Madelung and his work.
Part of article Journal of Hand Surgery (American) / Vol 31A, No 2, February 2006
*********************
And now the first publication of what later became known as Leri-Weill Syndrome. Just 4 weeks to get a copy of this 1929 French journal presumably from France via the British Library and that despite my journal reference to this article had Vol 53 not Vol 35.
Note may still be some uncorrected mistranscribed letters c / e / : i / l : t / f
Text only , the pictures were too indistinct to copy

Leri & Weill Journal Article,1929 ( <> French )

Bulletins et Memoires de la Societe Medicale des Hopitaux de Paris.
Une Affection Congenitale et Symetrique de Developpement Osseux: la Dyschondrosteosa
By Leri, A And Weill,J
Vol 35, 20 Dec 1929, pp 1491 to 1494
Later citations refer to this article, same page numbers and year, as Vol 53
Journal name abbreviated to Bull. Soc. Med. Hop. Paris
The following is my translation ,NB I have no knowledge of French or Medicine so read with that proviso. It is result of machine translation and use of a number of French Medical dictionaries. Should anyone, with knowledge of French, spot any errors distorting the meaning, please contact me
Leri & Weill Journal Article,1929 ( <> English )

*************************

After reading the German article I find it quite remarkable that knowledge and treatment of MWD for the next century after 1878 had hardly changed. To mollify any medics reading this file ; it was not until the 1970s that a more complete view of these syndromes began to emerge and from the 1990s an understanding of the background genetics emerged. These are very rare syndromes and it is to be appreciated that the ordinary family doctor would never in all likelihood come across anyone in his practise with these symptoms so to expect him to be aware of them is somewhat unreasonable. Even a regional skeletal specialist consultant may only come across a few such index cases in his working life. Of course he will probably see more followup related people with these conditions.
If any medics reading this file are aware of any pain management techniques for the painful versions of these sort of conditions your input would be appreciated.
A couple of non-drug regime possible pain relief techniques. 1) T.E.N.S Transcutaneous Electrical Nerve Stimulator for alleviating pain. They are battery powered pocket sized units costing in UK about 80 pounds (130 USD). Produces electrical pulses to stick-on electrodes placed on the skin. Quote from an instruction manual " TENS devices are used for the relief and management of chronic (long term) intractable pain, post surgical and post traumatic pain problems".
2) Years ago I made a "kummerbund" out of some space-blanket material that completely nullified the pain of a bout of shingles around the waist. My doctor did not believe me when I made a followup visit and I said I had had no need for the prescription of heavy duty pain killers he had made out 2 weeks earlier and wasn't needed either. Someone told me heat was useful against shingles but I had no hot-water bottle but I did have some of this mylar ,aluminised plastic, space blanket. Space blanket material is found in camping/outdoor pursuit shops costing just a few dollars. It is the material seen wrapped around marathon runners at the end of a race - sweaty bodies I would have thought was the worst possible case for use but never mind. Don't place immediately to the skin is it conducts heat out and radiates rather than the intended radiating heat back into the body. For wrists cut a piece of space blanket about 12 inches by 18 inches and fold 6 times down to 12x3 inches. Wrap a strip of thin cloth around to enclose and seal the edges by sewing. Stick a pad of hook velcro at one end and a strip of felt velcro where the overlap is when wrapped around the wrist. It does rustle a bit.
3) For anyone finding typing difficult including people with RSI then computer voice to text /speech recognition software has improved a lot recently. Once trained to your own voice and in an otherwise quiet environment produces very few errors in transcription these days. A useful test phrase for any such software is if it can pick up the difference between spoken "recognise speech" and "wreck a nice beach" each spoken in some sort of context to make it more realistic.
4) Saw Jerry Lewis promoting this pain management device http://my.webmd.com/content/article/54/65247.htm?z=3064_00000_2010_00_05 for chronic back pain ( Medtronic / Tame the Pain / Pain Pacemaker , keywords ). Don't know if it is relevant to MWD if anyone wishes to research.
5) Some tips that may as well be in the general domain for sufferers of arthritis or anyone else with weak or painful wrists.
Techniques for opening "vacuum" sealed pickle or jam jars.
1) Puncture lid with an awl/ brad-awl and cover hole with a gummed label. or 2) Invert lid into a pan of just boiled hot water then turn upright and unscrew or 3) Bash the lid (on the edge) with a sharp tap from a piece of wood about 2-3 inches square and 9 inches long

e-mail

diverse9@onetel.co.....m  email address ( for anti-spamming reasons please remove all 5 dots ..... between co and m ) Plain text only (see below)

If these email addresses fail then replace fastmail.fm or onetel.com with divdev.fsnet.co.uk part of the address and remove the 9 . Please make emails plain text only , no more than 5KByte or 500 words. Anyone sending larger texts or attachments such as digital signatures, pictures etc will have them automatically deleted on the server. I will be totally unaware of this, all your email will be deleted - sorry, again blame the spammers. If you suspect problems emailing me then please try using my fsnet.co.uk account.

Contact details are:- Nigel Cook, address is my business address (not related to the subject of this page in any way ). postal address:-
66 Ivy Rd
St Denys
Southampton
Hampshire
SO17 2JN
ENGLAND

I have no structure for corresponding to anyone by telephone or letter. My original email address used to be diverse@tcp.co.... but got spammed out of existance, later diverse2 and diverse9 before the commercial at @
Telephone number - the same number as it has been since 1988 but email is now the preferred method of contact so number deliberately not placed here. Far too many junk calls.
I devote a block of time each day to replying to emails.

Some DCS/MWD UK contact numbers / addresses

This file is recognised by NHS Direct with annual snailmail validation, under "D" on here
http://www.prodigy.nhs.uk/PILs/pilAlpha.asp?stylesheet=4

Also "The following high quality evidence-based resources have been selected by our UK professional medical authors to answer your query on 'dyschondrosteosis and madelung wrist deformity' Patient Support Dyschondrosteosis and Madelung Wrist Deformity, 6 star rating " For Dutch speakers and For Dutch speakers Wanneer u per email met Nederlandse lotgenoten in contact wil komen, mail dan naar Paula (met als onderwerp Madelung, Lerie-Weill of dyschondrosteosis) op mailto:PK_1976@hotmail.co.....m (verwijder de 5 puntjes tussen "co" en "m")

An MSN group set up by someone mentioned in these files MSN group - LWS/MWD
As it says in the URL One person's site "Kids with Madelungs "
or Archived "Kids with Madelung "

Bill Newman ,Manchester Dysplasias Research Group 0161 276 6506
Great Ormond St,Department of Clinical Genetics (SHOX Gene research)
30 Guilford Street,London,WC1N 1EH

Simon Thomas, WRGL Genetics, Salisbury District Hospital, Salisbury ,Wiltshire, SP2 8B , England

Details of one of the surgical corrective procedures
Another keyword for similar procedures is "orthofix"

Some DCS/MWD USA contact details
Dr. Pia Marttilla 1-800-444-9111 X 3078,Esoterix Endocrinology,LA, California.
Human SHOX gene database
SHOX Gene and DCS/MWD/LWS
Trial of growth hormone treatment for those with SHOX gene anomaly
A general collection of self-help groups for rare conditions
GeNeSIS - The Genetics and Neuroendocrinology of Short Stature International Study
A general site for dwarfism
A more technical article about MWD (registration is quick and straightforward as "general public" to obtain the full article )
Perhaps in the future everyone will look like this J Exp Zoolog B Mol Dev Evol. 2004 Mar 15;302(2):111-20. by Reinhard Stindl, Vienna
"In the absence of telomerase activity, telomeric DNA has been shown to shorten every time a cell divides. The concept of a mitotic clock based on the gradual erosion of telomeres is now generally accepted and has been confirmed in numerous plants and animals."


The origins genetically is probably a balanced reciprocal translocation of 2 genes technically 2;8(q32;p13) from American Journal of Medical Genetics 16:p589,1983. [That is the 32 section on the long, q, arm of the number 2 chromosome swapped with the 13 section of the short,p, arm of the number 8 chromosome. After derivation of the karyotype (separated and stained set of all the chromosomes) the long arm of chr 2 was obviously shortened and the short arm of chr 8 was obviously longer.] More recently located to part of the SHOX gene - Nature Genetics,p70,V19,May 1998. The SHOX gene is found in the Pseudo-autosomal regions (PAR1) of the sex chromosomes ,these PAR1 are adjacent to the ends (telomeres) of the p arms of the X and Y chromosomes. Although lying on the sex chromosomes they have a lot of similarity to genes that would appear on the non-sex, autosomal ,chromosomes hence pseudoautosomal. Suitable markers for the XY genes would seem to be DXYS6814,DXYS233,DXYS228 and DXYS234. Areas of interest are single C to T transition R195X,XY translocations p22,q12 and gene Xp22.3 or Yq11. From reference 17 "........haploinsufficiency of SHOX (Short stature homeobox- containing gene) is responsible for DCS,as affected families carried either large scale deletions (7 of 8 families) or a truncating mutation (1 family) of the gene..........
(haploinsuficiency relates to gene dosage ,if there is insufficient for the normal full transcription process). The absence of Madelung deformity in some short stature patients with SHOX mutations/ deletions (while others demonstrate both signs )remains an unexplained paradox. The variable expression of DCS features in individuals carrying terminal Xp deletions and XY unbalanced translocations similarly remains unexplained and might be due to either sex-chromosome- specific regulation or involvement of modifier genes".
From personal correspondence with a UK based researcher "....at present we do not identify the genetic cause in LWD (Leri-Weill Deformity) in a proportion of cases, but I know that other groups such as those of Gudrun Rappold in Heidelberg and Judith Ross in America are continuing to research this. When the gene for a condition is first discovered it is often the case that although it provides a genetic explanation for a proportion of people, it does not do so for everyone. As time goes by, different and more unusual genetic changes affecting the same gene are discovered. It is even possible that the condition could be caused by changes in genes other than SHOX. If some of the families who contact you are interested in research, I would suggest that they are first seen by their local Genetics department, and from here they can be put in touch with the centres who are continuing research into SHOX/ LWD."
Communication from Gudrun Rappold March 2006
Besides SHOX, there is evidence that a second gene is present in the human genome that, in its mutated form, causes an identical/ undistinguishable phenotype of Léri-Weill dyschondrosteosis. We are presently collecting families with Léri-Weill dyschondrosteosis that are not showing a SHOX defect in the coding or regulatory region in order to carry out a whole genome linkage analysis to pinpoint down this novel gene. Maybe you have a well established clinical/radiological diagnosis of "Léri-Weill dyschondrosteosis" but a SHOX mutation could not be confirmed and maybe there are also several affected members in your family. In this case I would be extremely interested in collaborating with you and I would be glad if you could contact us (.......@med.uni-heidelberg.de).
SHOX Human Short Stature Gene -Summary of Mutations
Exon Amino acid
change/stop position
Nuclear change Mutation type Phenotype
2
N77X
197-198delCG
Frameshift
LWS
2
E61X
G272T
Nonsense
LWS
2
V75X
272delG
Frameshift
LWS
2
X
GT-IVS-AG
Frameshift
LWS
3
Q112X
G425T
Nonsense
LWS
3
L132V
C485G
Missense
LWS
3
E149X
G536T
Nonsense
LWS
3
R153L
G549T
Missense
LWS
3
K181X
572insGT
Frameshift
LWS
4
R173C
C608T
Missense
LWS
5
R195X
C674T
Nonsense
ISS
5
R195X
C674T
Nonsense
LWS
5
Y199X
C688G
Nonsense
LWS
6
A224T
G761A
Missense
ISS
6
delH229-L232
776-787delC¥4aa
Deletion
ISS
Notes LWS - Leri-Weill Syndrome,ISS - Ideopathic Short Stature
Source reference [ 44 ] March 2002
Nothing so simple as one mutation leading to one clinical manifestation. The above recorded mutations occur in a region of less than 200 Kbases at the telomeric end of the short arm which is about 10 Mbases from telomere to centromere .

Some Pictures/Graphics from the following journal sources


But first an internet site with a rarity a non-medical picture of someone with MWD (Shelby's Corner, Stretch Magazine )
 MWD developement a
Graphics drawn from Xrays of developement of MWD from ages 2 years,4 years and 6 years compared to normal (on left) from reference 32
 MWD developement b
Graphics drawn from Xrays of developement of MWD from ages 8 years,10 years and 12 years compared to normal (on left) from reference 32
 MWD developement c
The above sequence of images show MWD of someone's right arm from age 3 to 60 taken from family snap shots. The image ,age 10 , shows radial curvature. The last 2 images are after successful surgery.
 MWD (non-bayonet)

Picture of the prominent ulna that the medics call "necropsy appearance" of MWD that didn't carry through the copying and scanning process very well from reference 6
 MWD (bayonet)
"Bayonet" form of MWD of someone in this group

 MWD (bayonet)
Close-up of the above

 MWD 2 cases
Two cases of differing MWD from reference 5 below

 MWD 7

A severe case of MWD before quasi-successful corrective surgery, post operation on corresponding right arm shown in family album sequence above.
 MWD
Case of MWD from 1938 reference 12 below also showing the foreshortening of forearms and "muscle-bound" or "popeye-arms" appearance.
 MWD bayonet type
"Bayonet Wrist" and Xrays in 2 perpendicular views showing the curved forearm bones and exaggerated space between leading to the "Popeye arm" or "muscle-bound" appearance from reference 16
 MWD bayonet type
Similar views with more pronounced curvature (hence muscular appearance) from reference 17

 mesomelia

A picture of someone with mesomelia and MWD from ref 11. Unless you know what you are looking for the difference between F forearm length and U upper arm length are not immediately obvious. She also (from the X rays but not too apparent in this picture ) has the curved bones of the forearm that give the "muscle-bound" or "popeye" appearance. Note also (which was not referred to in the article) the wide nasal bridge.
 mesomelia 2
Someone showing the effect in the lower leg from reference Journal of Bone and Joint Surgery, Vol 64B,No 3,p377,1982


Pictures of the mesomelia foreshortening in forearms and lower legs does not show too well but measuring of the bones does. The following is from 13 patients in one study, units are percentages compared to normal for that person's height in metres and age, not all data taken All are female except the last case.
height  |         ratio Radius/Humerus      |           ratio tibia/femur
and age | Right       Normal        Left    |     Right       Normal      Left
1.5,54  | 69            75          72.6    |      63           83
1.36,11 | 71.7          74          73.2    |      71           85
1.5,20  |                                   |      67           83          69
1.52,26 | 73.3          75          71.4    |     71.2          83
1.35,12 | 57.1          74          52.2    |     74            85          74
1.35,12 | 59.2          74          58.3    |     74            85          74
1.57,11 |               74          68.2    |                   85          77
1.57,14 | 70            73          72.5    |     76            83
1.55,13 |               73          72      |
1.47,36 | 70.2          75          69.5    |     84            83
 ?  ?   | 67.7          75          62.5    |
?  ,?   | 60.3          75          61.6    |
1.7 ,11 | 76.8          75                  |
from reference 8 below
From the Rappold book (ref 34 below) Anthropometric techniques
Upper Arm Length - Starting from the shoulder blade ,run finger laterally along ridge of scapula to tip of acromion (acromiale), and mark this point. Identify head of radius (caput radii or radiale) by paplpating space betwen humerus and radius at elbow,until you feel the head of radius, and mark this point. (when measuring make sure the marked points overlay the relevent bony part)
Forearm (lower arm ) length - With arm hanging loosely and palm facing forward, find styloid process of radius (processus styloideus or radial stylion ) - most prominent bony landmark at lateral wrist. Mark this point. Use previous upper arm mark .
Lower leg length (upper absent in this book) - Subject should be seated , with right ankle crossed over left knee. Find upper medial border of tibia (tibiale or condylus medialis),by running finger down patella until you reach tibial plateau,then move medially to edge of tibial plateau, and mark this spot. Find sphyrion tibiale (most distal point of tibia) by running finger upward from heel to point where tibia ends, a little distal to most prominent point of malleolus medialis (medial malleolus) and mark this point.

Medical Published Research in the Public Domain



1 American Journ. Dis Child. 132,1978,p1037 Xrays of an affected individual at age 12 and 45
2 Acta Radiol. Diag. 11,1971,p459 -4 generations with DCS
3 Clinical Pediatrics 1972,p281 -2 case studies,rather technical description
4 Italian J. Orth. Trauma. 1975,p141 3 generations,includes a tibial surgical intervention
5 Am. J. Roent. 1965,Vol 95/1,p178 -tabulated data focus on knee Xrays
6 J. Bone Joint Surgery V58B,p350 Aug 1976-Good overview with fairly simple terminology even if the title is wrong (Madelung Disease is a completely different condition).
7 J. Med. Genet. 1980,17,p41 -2 generations of family 4 affected out of 6 people
8 Radiology 93,1969,p1037 -Technical but clear X-rays and tabulated physiological data
9 Am. J. Dis.Child 120,1970,p329 -tabulated data of 8 patients
10 J. Pediatr. 68,No3,1966,p432 -Tabulated dimensional data and good differential comparison with related syndromes
11 Am. J. Dis .Child. November 1971-Representative photos of wrist and forearm appearance
12 Annals of Surgery 1938,p421 -17 pages lot of history,some graphics and good picture of bayonet wrists
13 Clin. Orthop 1976,May,No116,p24 -3 families also first published record of male to male transmission
14 Brit. J. Radiol. 47,1974,p634 -picture of male with "muscle-bound" forearm appearance
15 Nature Genetics V19,May 1998 p70-73 - Shox and DCS genetical analysis of 15 families up to 5 generations including a family of 82 over 5 generations with 43 affected individuals !
16 Nature Genetics V19,May 1998 p67-69 - Shox mutations in dyschondrosteosis, pictures and Xrays of "bayonet" MWD
17 American Journal of Medical Genetics 16:p589,1983 - 2;8(q32;p13) balanced reciprocal chromosome translocation and pictures of 4 family members showing Madelung wrists,mesomelia and cubitus valgas.
18 J. Med. Genetics 2001;38 :323 SHOX point mutations in dyschondrosteosis
The above periodicals were on the shelves of the teaching library of Southampton General Hospital with open public access.Similar collections of medical research periodicals are probably at other teaching hospitals in the UK. Holland and Tasmania has an open access policy for medical libraries but I don't know about other countries.
Two archaeological cases:
30 Nature vol 330,5 Nov 1987 Dwarfism in an adolescent from the Italian late Upper Palaeolithic (Age) - Mesomelic dwarfism, relative shortening of forearms and lower legs and also restricted elbow movement. Radio-carbon date 11,150 +/- 150 years, age at death about 17 years and accorded special funereal treatment. "one of the few caves in Italy with parietal art. Thus, the site was an important social and/or ritual centre, and it is clear from the limited number of burials in the cave that only certain members of the population were of the status necessary to be buried there."
31 Journal of Medical Genetics October 2000, 37(10)E27 A Case of Dyschondrosteosis from Roman Britain
32 Text book : Congenital Deformities of the Hand and Forearm by H. Kelikian ,1974,chapter22 -18 pages including very clear drawings derived from Xrays showing developement of Madelung wrists every 2 years from 2 yearold to 12 yearold and description of surgical procedure to correct wrist deformity
34 In July 2002 Prof Dr Gudrun Rappold sent me a complimentary copy of her book published 2002
Understanding SHOX deficiency and its role in growth disorders: a reference guide
by Gudrun A Rappold,Judith L Ross,Rüdiger J Blaschke and Werner F Blum
Publisher TMG Healthcare Communications Ltd,62 Stert St,Abingdon,Oxfordshire OX14 3UQ,UK
ISBN 1 85113 265 1
A summary of the 130 page book :
Background to SHOX involvement in a number of stature syndromes - Leri-Weill,Madelung,Langer,Turner,Ideopathic Short and triple x (XXX).
Introduction to molecular genetics zeroing-in specifically to the SHOX gene. Introduction means introduction to practising endocrinologists and other physicians, for anyone else it would need further study to comprehend this sort of material. It covers the complex area going from details of the SHOX gene through transcription into biochemistry and on to the clinical expression.
There are two useful glossaries: clinical terms and molecular biology terms ,colour-code referenced throughout the book.
Appendices of genetic codes,codes for amino acids,pedigree analysis symbols, anthropometric techniques (to measure limb proportions etc) and anthropometric tables for ages 3 to 19 years for all the pertinent limb segments and list of abbreviations ( acronyms ).
40 Genome Research 1997 p1114 Man to Mouse-Lessons learned from the distal end of the Human X Chromosome
41 J Med Genet 1992 29 p455 Short Stature in a girl with a terminal Xp deletion distal to DXYS15...
42 J Med Genet 1999 36 p711 Loss of the SHOX gene associated with Leri-Weil ....
43 J of Clinical Endoc & Meta 2000 p245 Identification of Short Stature caused by SHOX defects and therapeutic effect of Recombinant Human Growth Hormone
44 J of Clinical Endoc & Metab 2002 p1402 Deletions of the Homeobox Gene SHOX are an important cause of growth failure in children with short stature.
45 Proc Nat Ac Sc March 1998 p2406 SHOT,a SHOX related homeobox gene...
46 Proc Nat Acad Sc Oct 1996 p10691 Cloning and characterization of four murine homeobox genes
47 J Med Genet 1995 32 p831 Short stature in a girl with partial monosomy of the pseudoautosomal region distal to DXYS15....
48 J of Clinical Endoc & Met 2001 p5674 Phenotypes associated with SHOX deficiency
49 J Med Genet 2001p323 SHOX point mutations in Dyschondrosteosis
50 Ann. Otol. Rhinol. Laryngol 112 (2003 ) p153 Congenital Conductive Hearing Loss in Dyschondrosteosis
51 J. Clin Endoc. Metab. ,Oct 2003, 88 (10) p4891 Auxology is a valuable instrument for the clinical diagnosis of SHOX Haploinsufficiency in school-age children with unexplained short stature.
52 Brit J. of Haematology 121, p375 Pseudosomal linkage of familial Hodkins Lymphoma : Molecular analysis of a unique family with Leri-Weill Dyschondrosteosis and H L.
A few useful sites are:-
An overview of the Medline accessible references
OMIM site
Medline Site
Medical Journals (abstracts only for us non-medics)
Background to a ,discontinued , court case where the mother was lying about her husband being the biological father to her daughter who had the appearance of MWD and her son who had the appearance of DCS. The husband had no family history of MWD or DCS but someone else did have such a family history.
MWD raised in a court case relating to a works injury
Newspaper story concerning DCS and growth hormone
I've grown 1cm since January Mar 9 2007 By Peter Henn A GIRL who suffers from a genetic disorder has won the right to NHS drugs that will help her grow. ... He added: “It’s good the PCT changed its mind after the YA’s campaign, but it was wrong to not give her treatment, especially when it has proven so effective.” South East Essex Primary Care Trust confirmed Chloe’s circumstances had changed, but said it could not speak about the case as it was a confidential matter. FACTBOX: *Leri-Weill Dyschondrosteosis (LWD) was first diagnosed by French neurologists Andre Leri and Jacques Weill. *It is a form of dwarfism marked by forearm and wrist deformities. *Sufferers of the syndrome are only expected to reach a maximum height of 140 cm. *Genotropin is a drug used to fight growth defects, and helps people with the problems reach a more normal height. A course of the drug costs the taxpayer between £122 and £278, but individual shots can range from £4.64 to £46.37.

For anyone interested this is the original of this file put on the internet in June 1999

There follows a summary of the above file in different languages

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A summary of this file
The method I used for doing medical research into MWD (Madelung Wrist Deformity) and DCS (Dyschondrosteosis). The technique is probably applicable to other rare medical conditions. Some other names for these conditions and associated medical terms. Genetic background to MWD and DCS Two recognizable people who may have the appearance of these conditions. Two simple tests that in conjunction with X-rays etc could lead to a diagnosis of MWD. Numerous (anonymized) personal stories of people with MWD or DCS who have contacted me. For anyone who would like to join this, closed group, mailing list my contact details are at the end of these personal stories. Some of the published research articles in the medical periodicals on MWD and DCS.

Un sommaire de ce dossier
La méthode que j'ai employée pour faire la recherche médicale dans MWD (défaut de forme de poignet de Madelung) et DCS (Dyschondrosteosis). La technique est probablement applicable à d'autres conditions médicales rares. Quelques autres noms pour ces conditions et limites médicales associées. Fond génétique à MWD et à DCS. Deux personnes fameuses qui pourrait avoir l'aspect / fond de ces conditions. Deux essais simples qu'en même temps que des rayons X etc.. pourrait developer à un diagnostic des histoires personnelles (anonymes) de MWD. Numerous des personnes avec MWD ou DCS qui m'ont contacté. N'importe qui voudrait joindre ceci, groupe fermé, expédiant la liste mes détails de contact sont à la fin de ces histoires personnelles. Certains des articles édités de recherches dans les périodiques médicaux sur MWD et DCS..

Een samenvatting van deze pagina
De methode, die ik gebruikte voor medisch onderzoek in MWD (Madelung Pols Afwijking) en DCS (Dyschondrosteosis). De techniek is vermoedelijk toepasbaar op andere ongewone medische aandoeningen. Sommige andere namen voor deze aandoeningen en geassocieerde medische termen. Genetische achtergrond bij Mwd en DCS. Twee mensen in het openbaar, die misschien de karakteristieken / achtergrond van deze aandoening bezitten. Twee eenvoudige testen die samen met RÖNTGENFOTO'S enz. zouden kunnen leiden tot een diagnose van MWD. Talrijke (geanonimiseerde) persoonlijke verhalen van mensen met MWD of DCS, die met mij contact op hebben genomen. Wie zich aan zou willen sluiten bij deze (gesloten) groep-emaillijst, kan contact met mij opnemen (zie aan het einde van deze persoonlijke verhalen voor contactgegevens). Sommige van de gepubliceerde onderzoeksartikelen in de medische tijdschriften over MWD en DCS.
Wanneer u per email met Nederlandse lotgenoten in contact wil komen, mail dan naar Paula (met als onderwerp Madelung, Lerie-Weill of dyschondrosteosis) op mailto:PK_1976@hotmail.co.....m (verwijder de 5 puntjes tussen "co" en "m")

Eine Zusammenfassung dieser Datei
Die Methode, die ich für das Tun der medizinischen Forschung in MWD (Handgelenkmißbildung Madelung) und in DCS (Dyschondrosteosis) verwendete. Die Technik ist vermutlich auf andere seltene medizinische Bedingungen anwendbar. Einige andere Namen für diese Bedingungen und dazugehörigen medizinischen Bezeichnungen. Genetischer Hintergrund zu MWD und zu DCS. Zwei Leute im allgemeinen Auge, das das Aussehen / den Hintergrund dieser Bedingungen haben konnte. Zwei einfache Tests, die in Verbindung mit Röntgenstrahlen usw. zu einer Diagnose (der anonymised) persönlichen Geschichten MWD. Numerous der Leute mit MWD oder DCS führen könnte, die mit mir in Verbindung getreten haben. Jedermann, das dieses verbinden möchte, geschlossene Gruppe, Liste sendend meine Kontaktdetails sind am Ende dieser persönlichen Geschichten. Einige der erschienenen Forschungsartikel in den medizinischen Zeitschriften auf MWD und DCS..

Un resumen de este fichero
El método que utilicé para hacer la investigación médica en MWD (deformidad de la muñeca de Madelung) y DCS (Dyschondrosteosis). La técnica es probablemente aplicable a otras condiciones médicas raras. Algunos otros nombres para estas condiciones y términos médicos asociados. Fondo genético a MWD y a DCS. Dos personas en el ojo público que pudo tener el aspecto / el fondo de estas condiciones. Dos pruebas simples que conjuntamente con radiografías el etc podría conducir a una diagnosis de las historias personales (anonymised) de MWD. Numerous de la gente con MWD o DCS que me han entrado en contacto con. Cualquier persona que quisiera ensamblar esto, grupo cerrado, enviando la lista mis detalles del contacto están en el final de estas historias personales. Algunos de los artículos publicados de la investigación en los periódicos médicos en MWD y DCS..

Um sumário desta lima
O método que eu me usei fazendo a pesquisa médica em MWD (deformity do pulso de Madelung) e em DCS (Dyschondrosteosis). A técnica é provavelmente aplicável a outras circunstâncias médicas raras. Alguns outros nomes para estes circunstâncias e termos médicos associados. Fundo genetic a MWD e a DCS. Dois povos no olho público que pôde ter a aparência / fundo destas circunstâncias. Dois testes simples a que conjuntamente com raios X etc. poderia conduzir a um diagnóstico de histórias pessoais (anonymised) de MWD. Numeroso dos povos com MWD ou DCS que me contataram. Qualquer um que gostaria de juntar este, grupo closed, enviando a lista meus detalhes do contato estão no fim destas histórias pessoais. Alguns dos artigos publicados da pesquisa nos periodicals médicos em MWD e em DCS..

Sammanfattning
Metoden som har använts för att söka efter medicinsk information om om Madelungs deformitet (MWD) samt Dyschondrosteos (DCS även kallat Leri-Weils syndrom), kan användas för att söka efter information om andra sjukdomar. (Vet du inte hur man lättast söker efter information i databaser kan du vända dig till närmaste bibliotek - de brukar ordna kurser i informationssökning som ofta är gratis.) Här nämns två offentliga personer som eventuellt kan tänkas ha dessa sjukdomar. Det beskrivs vidare två enkla tester som kan komplettera röntgenundersökning för att fastställa en diagnos av Madelungs deformitet. Genetisk bakgrund för Madelungs deformitet och dyskondrosteos. Personliga berättelser från personer som har kontaktat gruppen finns även publicerade på den här sidan, liksom referenser till publicerat material samt länkar till sajter/databaser där man kan söka efter mer information. De som vill komma i kontakt med den här slutna gruppen kan nå mig via adressen längst ner på sidan.

Un sommario di questo documento
Il metodo che ho usato per fare la ricerca medica su MWD (deformità del polso di Madelung) e su DCS (Dyschondrosteosis). La tecnica è probabilmente applicabile ad altre malattie rare. Altri nomi per queste malattie e termini medici associati. Priorità bassa genetica a MWD ed a DCS. Due persone famose che sembrano avere queste malattie. Due prove semplici che insieme con i raggi X ecc potrebbero condurre ad una diagnosi del MWD. Numerose storie anomine di persone con MWD o DCS che si sono messe in contatto con me. Chiunque voglia unirsi a questo gruppo chiuso, alla mailing list. I miei recapiti sono alla conclusione di queste storie personali. Alcuni degli articoli di ricerca pubblicati nei periodici medici su MWD e su DCS..

 Hebrew 

סיכום של הקובץ הזה בעברית השיטה שהשתמשתי בשביל לעשות מחקר רפואי בעניין MWD ( Madelung Wrist Deformity שורש היד של מאדאלאנג ) ו DCS ( דיסצ'ונדרוסטאוסיס ) היא טכניקה שקרוב לוודאי ניתן ליישם גם עבור ליקויים בריאותיים נדירים אחרים. ישנם כמה שמות נוספים לליקויים ולמונחים הרפואיים האלה. רקע גנטי לגבי MWD ו DCS : שתי אוכלוסיות שבעיני הציבור אולי יהיו בעלי ההופעה/ רקע של התנאים האלה. שני מבחנים פשוטים שביחד עם רנטגנים וכו' יכלו להוביל לדיאגנוזה של MWD . סיפורים אישיים של אנשים (בעילום שם) עם MWD או DCS שפנו אלי. לכל אחד שרוצה להצטרף לקבוצה הסגורה של רשימת הנמענים שברשותי, ישנם פרטי התקשרות אלי בסוף הסיפורים האישיים האלה. כמה מהמאמרים של המחקר על MWD וDCS שהתפרסמו בכתבי העת הרפואיים.

or Summary in Hebrew


Et resume af denne fil/tekst
Den metode jeg har brugt til at lave den medicinske studie i Madelungs deformitet og Leri - Weill dyschondrosteose.
Teknikken er sikkert brugbar for søgning på andre sjældne medicinske tilstande/sygdomme.
Andre navne for disse sygdomme/tilstande og associerede medicinske benævnelser. Genetisk baggrund for Madelungs deformitet og Leri-Weill dyschondrosterose. To kendte mennesker som måske har disse tilstande og baggrunden for denne observation.
To simple test, som sammen med røntgenbilleder kan lede til en diagnose på Madelungs deformitet.
Flere anonyme personlige historier fra personer med Madelungs deformitet og Leri-Weill-dyschondrosterose, som har kontaktet mig. For alle som ønsker at blive medlem af denne lukkede gruppe, mailings-liste og mine kontaktdetaljer er efter disse personlige historier.
Nogle af de udgivede forskningsartikler fra tidsskrifter omhandlende Madelungs deformitet og Leri-Weill dyschondrosterose.




Apologies, ignore the following ridiculous situation. Because of SEO, searchengines now only index text appearing in browsers, it should properly be hidden from browsers. It is mainly keywords condensed out of the previous year sub-files to this file.

Unicode problems with foreign script Use XVI32 Hex editor to remove BOM characters [ Zero Width Non-Breaking Space (ZWNBSP) ] 255,256 / FEFF from the top of file and 00 intercharacter spaces. Convert Hex character codes to &#....; decimal codes that both browsers and Google Cached seem happy with. Copy text from Notepad or whatever to the text side of the XVI32 0D 0A is hex code for end of line. Thereafter for English updates save file as ANSI , not Unicode. To convert Hex text to decimal change line breaks to * and with no line wrap form single lines of text about 100 characters long, submit to Google search which returns then as &=....; code. Change * to 0D 0A madalin madaling discondrostis discondrosteosis madalins medalin medellin madellin medaling medalins madalin madalins madelin madeling madelins medelin medeling medelins medalin medalins madilin madiling madilins medilin mediling medilins madilin madilins medalin medaling medalins medalin medaling medalins medalin medalins medelin medeling medelins medelin medeling medelins medalin medalins medilin mediling medilins medilin mediling medilins medilin medilins midalin midaling midalins midalin midaling midalins midalin midalins midelin mideling midelins midelin mideling midelins midalin midalins midilin midiling midilins midilin midiling midilins midilin midilins mandalin mandaling mandalins mendalin mendaling mendalins mandalin mandalins mandelin mandeling mandelins mendelin mendeling mendelins mendalin mendalins mandilin mandiling mandilins mendilin mendiling mendilins mandilin mandilins mendalin mendaling mendalins mendalin mendaling mendalins mendalin mendalins mendelin mendeling mendelins mendelin mendeling mendelins mendalin mendalins mendilin mendiling mendilins mendilin mendiling mendilins mendilin mendilins mindalin mindaling mindalins mindalin mindaling mindalins mindalin mindalins mindelin mindeling mindelins mindelin mindeling mindelins mindalin mindalins mindilin mindiling mindilins mindilin mindiling mindilins mindilin mindilins mandolins mandolin mandoling madalungs madolin madoling madolins medolin medoling medolins madolin madolins madolin madoling madolins medolin medoling medolins medolin medolins madolin madoling madolins medolin medoling medolins madolin madolins medolin medoling medolins medolin medoling medolins medolin medolins medolin medoling medolins medolin medoling medolins medolin medolins medolin medoling medolins medolin medoling medolins medolin medolins midolin midoling midolins midolin midoling midolins midolin midolins midolin midoling midolins midolin midoling midolins midolin midolins midolin midoling midolins midolin midoling midolins midolin midolins mandolin mandoling mandolins mendolin mendoling mendolins mandolin mandolins mendolin mendoling mendolins mendolin mendoling mendolins mendolin mendolins mindolin mindoling mindolins mindolin mindoling mindolins mindolin mindolins mandolins
 Louise Robey fash5.jpg 200 x 270 pixels - 19k www.hotgossip.co.uk/ 99july/fash.html/fash5.jpg http://www.hotgossip.co.uk/99july/fash.html http://web.archive.org/web/20030125122359/http://hotgossip.co.uk/99july/images2/fash5.jpg ANYONE FINDING KEYWORDS HIGHLIGHTED IN THIS LIST between comment tags - they are condensed keywords from the year files dysch2001.htm dysch2002.htm dysch2003.htm dysch2004.htm dysch2005.htm 2001, 29 contacts plus 12 previously ^L in Sweden ^R in UK ^M in the UK ^M in Holland ^ R2 in the UK ^ T in Canada ^ L in Canada ^ D2 in e-m contact ^ C3 in the USA ^ S in the UK ^ D2 in the USA ^ S2 in the USA ^ K in the USA ^ B in New Zealand ^ J in the USA ^ R2 in the USA ^ M in Canada ^ C in Australia ^ L in Northern Ireland ^ A2 in the USA ^ M in Australia ^ M2 in Canada ^ W in the USA ^ L2 in Canada ^ H in the USA ^ S2 in the UK ^ S in New Zealand ^ J2 in the USA ^ S3 in the USA 2002, 23 contacts From V in the UK by contac