Medical Imaging Analysis Report

I. Imaging Findings

The patient is a 20-year-old male with no significant health complaints. He was found to have his left forearm fixed at approximately 30° of pronation with limited supination during a routine physical examination before enlisting. Based on the provided X-ray images (Figure 1 and Figure 2):

• There is a bony connection in the proximal radial-ulnar adjacent area, and the boundary between the proximal radius and ulna is not clearly visible.
• The radial head does not appear to be separately identified, suggesting the possibility of congenital fusion or partial bony bridging in the proximal region.
• No significant soft tissue swelling around the elbow joint is observed, and there are no clear indications of a fracture line or traumatic changes.

Overall observation shows signs of fusion between the proximal radius and ulna, consistent with common imaging findings of congenital proximal radioulnar joint abnormalities.

II. Potential Diagnoses

Combining clinical symptoms with the imaging findings, possible diagnoses or differential diagnoses include:

1. Congenital Proximal Radioulnar Synostosis (CPRUS)
   Reasoning: This disease is a rare congenital malformation in which there can be bony fusion near the proximal radioulnar region, leading to restricted forearm rotation. The imaging findings of this case are consistent with characteristics of proximal radioulnar synostosis.
2. Physeal or Developmental Abnormalities
   Reasoning: During childhood or growth periods, focal physeal abnormalities or developmental disorders can occur, often accompanied by other related signs or deformities. In this case, other idiopathic developmental abnormalities have been ruled out, so CPRUS should be considered first.
3. Post-Traumatic Osseous Healing
   Reasoning: Trauma or poor fracture healing can eventually lead to fusion at the radioulnar junction. However, this patient has no history of trauma, and imaging shows no evidence of old fractures, making this less likely.

III. Final Diagnosis

Considering the patient’s age, absence of trauma history, imaging findings, and clinical presentation of the left forearm fixed in pronation with impaired supination, the most likely diagnosis is:

Congenital Proximal Radioulnar Synostosis (CPRUS)

-> If further clarification of the bony structure details is required, CT scans or other three-dimensional reconstruction imaging can be considered to evaluate the bony trabeculae and the exact position of the radial head.

IV. Treatment Plan and Rehabilitation

4.1 Treatment Strategy

Based on the characteristics of this condition and the patient's daily functional status, management can include conservative and surgical approaches:

• Conservative Treatment: If the degree of forearm functional impairment is mild, compensatory strategies (e.g., using shoulder and wrist joints) in daily life can help maintain function. Occupational therapy (OT) and physical therapy may be implemented to address or alleviate excessive workload on the shoulder and wrist due to compensation.
• Surgical Treatment: If the forearm cannot fulfill daily functional requirements, the patient reports significant functional impairment, or the deformity is pronounced, a derotational osteotomy of the proximal radius and ulna may be considered. However, the outcome in restoring forearm rotation function after surgery can be limited, and the risks and potential benefits need to be thoroughly evaluated.

4.2 Rehabilitation/Exercise Prescription Recommendations

Rehabilitation training should be individualized and gradual (following the FITT-VP principle). Recommendations include:

1. Frequency: Conduct targeted rehabilitation training 3-5 times per week.
2. Intensity: Exercise without causing significant pain or excessive fatigue. Emphasize strengthening activities for the shoulder joint, wrist joint, and fine motor skills of the fingers.
3. Time: About 15-30 minutes per session. The duration can be gradually increased according to the patient’s tolerance.
4. Type:
   • Joint Range of Motion Exercises: Focus on shoulder internal and external rotation, flexion and extension, as well as wrist extension and flexion to enhance compensatory ability.
   • Muscle Strengthening: Use mild resistance exercises or resistance bands, avoiding excessive forceful supination that may cause discomfort.
   • Functional Training: Simulate daily tasks, such as picking up objects, writing, computer operations, etc.
5. Progression: As joint flexibility and muscle strength improve, gradually increase the resistance level or training duration. If significant discomfort or pain occurs, adjust or suspend training accordingly.
6. Precautions: Monitor usage of the shoulder and wrist joints to prevent overuse injuries caused by excessive compensation. After surgical intervention, rehabilitation should be performed under medical supervision, avoiding high-intensity activities prematurely.

In addition, regular follow-up visits are recommended. Consultation with a rehabilitation therapist or orthopedic surgeon is advised to assess joint range of motion, muscle strength, and pain control, in order to adjust the rehabilitation plan as needed.

Disclaimer

This report is based on limited imaging and clinical information and serves as a reference analysis. It cannot replace an in-person consultation or professional medical advice. Specific diagnoses and treatment plans should be developed according to the patient’s actual condition and guided by specialist physicians.