Medical Analysis Report

1. Radiological Findings

Based on the provided forearm X-ray, the following findings are observed:

• Significant cortical thickening: The thickening is longitudinal, distributed along one side of the diaphysis, resembling a “dripping wax” appearance, as though melted wax is flowing along the bone surface.
• The area of thickening is primarily confined to one side of the bone, with relatively well-defined borders.
• No obvious involvement of the joint surface is currently noted; however, the sclerotic region may extend toward the joint area.
• No clear fracture lines or definite imaging evidence of soft tissue swelling are observed.

Overall radiological characteristics suggest a localized sclerotic bone change, accompanied by unilateral enlarged cortical overgrowth. In conjunction with clinical presentations, rare bone diseases should be considered.

2. Differential Diagnosis

Considering the patient is a 21-year-old male with prolonged forearm swelling and chronic pain, and radiographic findings of unilateral cortical thickening, the following conditions should be taken into account:

1. Melorheostosis (Unilateral Bone Sclerosis): The typical presentation is “dripping wax” sclerosis, often exhibiting irregular thickening on one side of the bone, potentially affecting surrounding soft tissues and causing restricted joint movement or tendon contractures.
2. Osteoma: Commonly found in the skull or jaw bones. If occurring in a long bone, it can manifest as localized cortical thickening, yet it typically does not show the “dripping wax” pattern seen in Melorheostosis.
3. Osteopoikilosis and Osteopathia Striata: Often presenting as multiple small patchy or linear sclerotic changes spread over a broader distribution, usually discovered incidentally, and commonly in symmetrical patterns.
4. Others (e.g., metaphyseal chondroma, periosteal reactive thickening): These require differentiation based on local lesion characteristics, clinical symptoms, and disease onset patterns.

From both the radiological features and the clinical correlation, the “dripping wax” cortical thickening is most indicative of Melorheostosis. In instances of significant unilateral cortical thickening, this diagnosis should be prioritized.

3. Final Diagnosis

Based on:

• The patient is young, with no special family history or past medical history.
• The forearm exhibits unilateral cortical thickening with a characteristic “dripping wax” appearance.
• Clinical manifestations primarily include local chronic pain and swelling, with a notable risk of soft tissue contractures.

A comprehensive judgment suggests that the most likely diagnosis is: Melorheostosis (Unilateral Bone Sclerosis).

If further confirmation is needed, CT 3D reconstruction or MRI (to identify soft tissue changes) can be performed, and a bone biopsy may be considered to exclude other rare bone disorders.

4. Treatment Plan and Rehabilitation

4.1 Treatment Strategy

• Conservative Treatment:
  • Symptomatic analgesia: Nonsteroidal anti-inflammatory drugs (NSAIDs) can be considered to relieve pain and inflammation.
  • Rehabilitation exercises: Physical therapy and range-of-motion exercises to prevent or reduce joint contractures and muscle atrophy.
• Surgical Treatment: For severe joint dysfunction, deformity, or significant soft tissue restriction, surgery (e.g., soft tissue release or bone remodeling) may be considered to improve function.
• Regular Follow-up: Monitor disease progression, changes in soft tissues, and any continuing bone thickening or deformity.

4.2 Rehabilitation/Exercise Prescription

In planning rehabilitation, it is essential to ensure the safety of bones and joints while gradually restoring and maintaining normal function. The FITT-VP principle may serve as a guideline:

• Frequency: It is recommended to engage in rehabilitation exercises 3–5 times per week, with rest or low-intensity days in between to allow adequate recovery.
• Intensity: Adjust according to the patient’s current pain level and functional capacity, starting with low intensity and minimal resistance. If significant pain arises, reduce the intensity or pause the relevant activity.
• Time: Each session may start at 15–30 minutes and gradually increase to 30–45 minutes. It can be broken into sets to avoid prolonged loading.
• Type: Focus on range-of-motion and light resistance exercises, supplemented with flexibility and core stability training. High-impact or vigorous activities should be avoided.
• Progression: As symptoms stabilize and joint range-of-motion improves, progressively increase resistance (e.g., advancing to higher-resistance elastic bands) while also enhancing proprioception and muscle endurance.

Example training routine (adjust as needed for individual conditions):

1. Warm-up: Use warm compresses or massage to promote local blood circulation (about 5 minutes).
2. Range-of-motion exercises: Such as wrist flexion/extension and forearm pronation/supination, 10–15 repetitions each time, rest 30 seconds, repeat 2–3 sets.
3. Light resistance training: For example, using a hand gripper or elastic band, 8–12 repetitions, rest 30 seconds, repeat 2–3 sets. Decrease intensity if severe pain occurs.
4. Flexibility stretching: Gently stretch the forearm extensor and flexor muscles, holding each stretch for 15–20 seconds, avoiding excessive pulling.
5. Cool-down: Gradually relax and perform gentle joint mobilizations. Finish with cold therapy or elevate the forearm to reduce inflammatory responses.

Disclaimer

This report is based on available data and general medical knowledge, provided for reference only. It does not replace in-person consultation or professional medical advice. In case of any doubts or worsening symptoms, please seek prompt evaluation by a specialist and consider further examinations for accurate diagnosis and treatment.