1. Radiological Findings

Based on the provided X-ray and MRI images, the following main characteristics are noted:

• The distal radius and ulna of the forearm show curvature or angular changes. There is obvious growth restriction on the medial aspect of the distal radius, leading to dorsal and radial bowing.
• Disrupted relationship between the distal radius and the lunate: the lunate is displaced toward the palmar and ulnar sides (“lunate subsidence”), and there is an excessive palmar tilt of the radiocarpal joint (increased palmar tilt).
• On the anteroposterior (AP) radiograph, a “V” shape is seen between the distal radius and the proximal row of carpal bones; MRI shows thickening or an abnormal Vickers ligament.
• Clinical photographs suggest forearm segment shortening (indirectly corroborated by the imaging), joint deformities, and a mismatch in the proportions between the proximal and distal segments.

2. Potential Diagnoses

Based on the patient’s presentation and imaging changes, the possible diagnoses include:

1. Madelung Deformity
   Features: Primarily characterized by abnormal growth of the distal radius, wrist joint deformities, and lunate displacement. It commonly presents in adolescents or young adults and is often associated with forearm shortening, wrist pain, and decreased grip strength.
2. Leri–Weill Dyschondrosteosis
   Features: An autosomal dominant disorder marked by mesomelic (middle-segment) shortening of the forearms and lower legs. It is frequently accompanied by Madelung deformity, resulting in wrist joint deformities and functional impairment. Patients often demonstrate relatively short stature, particularly due to shortening of the mid-limb segments.

3. Final Diagnosis

Considering this patient is female, has short stature, segmental shortening of the forearm, and imaging findings indicative of Madelung deformity, aligned with literature review and clinical experience, the most likely diagnosis is:

Leri–Weill Dyschondrosteosis (with Madelung Deformity)

To further clarify any genetic components, it is advisable to perform genetic testing to confirm potential defects in the SHOX gene. If symptoms worsen or if other joint problems occur, additional CT or functional imaging studies may be warranted.

4. Treatment Plan and Rehabilitation

4.1 Treatment Strategies

• Conservative Treatment:
  • For pain management, non-steroidal anti-inflammatory drugs (NSAIDs) or local physical therapy may be tried, though the effect can be limited.
  • If there is notable wrist joint laxity or discomfort due to deformity, a wrist brace can be considered to reduce joint stress.
• Surgical Treatment:
  • If the deformity significantly affects wrist function or causes persistent pain, corrective osteotomy, radial lengthening, or other reconstructive surgeries may be considered to correct the deformity, alleviate pain, and potentially restore function.
  • In cases of markedly thickened Vickers ligament, partial release or reconstruction may slow the progression of long-term deformities.

4.2 Rehabilitation and Exercise Prescription

A rehabilitation plan should be implemented under the guidance of a specialist physician or physical therapist, especially when taking into account lower-limb and cardiopulmonary function to ensure safety.

• Exercise Goals:
  • Enhance wrist and forearm muscle strength and stability, reduce pain.
  • Improve joint range of motion, and maintain or increase daily living and work capabilities.
• Principle of Progression (FITT-VP):
  1. Frequency (F): 3–5 sessions per week focusing on wrist and forearm rehabilitation.
  2. Intensity (I): Begin with low resistance or elastic bands, gradually advancing to moderate resistance while avoiding significant pain.
  3. Time (T): About 15–30 minutes per session, including warm-up, main exercises, and cool-down.
  4. Type (T): Primarily include active wrist flexion/extension, forearm pronation/supination, grip strengthening, and flexibility stretches; functional exercises (e.g., using light dumbbells or resistance bands for wrist curls, forearm curls, and pronation/supination) can be incorporated.
  5. Progression (P): As symptoms ease and strength increases, resistance or repetitions can be gradually increased.
  6. Volume/Planning (VP): Perform 2–3 sets of 10–15 repetitions per exercise. Adjust sets and resistance progressively.
• Special Considerations:
  • If significant pain or discomfort arises during exercises, reduce intensity or discontinue and consult a physician.
  • If there are other underlying skeletal conditions, assess bone health to avoid excessive loading during rehabilitation.

Disclaimer: This report provides a reference analysis and does not substitute for an in-person consultation or the direct guidance of a professional physician. Patients should base their treatment on actual circumstances, follow medical advice, or consult professional guidance for diagnosis and rehabilitation.