Gymnast wrist is a term that used to describe variety of chronic overuse injuries of the wrist in gymnasts with immature skeleton. Gymnast wrist is combined of osseous and ligamentous injury and usually manifests as a chronic Salter-Harris type I fracture of the distal radial physis on radiography 1.
Distal radial physeal injury is common in gymnasts, and occasionally occurs in other sports 2. The distal radius mostly involved because it bears the primary stressful forces in the wrist joint 1.
Gymnast wrist results from repetitive compressive forces applied to distal radial physeal plate during participation in sports like gymnastics and weight-lifting that place a great tension on the physis and adjacent structures 1.
Pain with gradual onset and exaggeration by weight-bearing activities while the wrist in extension position. Often, range of motion is normal on physical examination, and frequently swelling and tenderness over the distal radius presents 2.
- physeal plate widening
- physeal plate irregularity
- metaphyseal and less commonly epiphyseal sclerosis and irregularity 1,4
- physeal plate bridging/fusion in late stage of the disease 1
Most of the above-mentioned physeal, metaphyseal and epiphyseal changes are usually evident on radiography 1-3.
MRI may be used when radiographs are inconclusive. MRI can demonstrate the same findings as radiographs with more details about the physeal cartilage and edema in the adjacent bones before these changes become visible on radiographs 4.
It is worth mentioning that MRI is crucial in high-risk patients with chronic wrist pain because early detection is essential in preventing further damaging of the radial physis 1.
Complications of untreated fracture include:
early physeal closure of the distal radius leading to positive ulnar variance and Madelung-type deformity in cases of lack proper treatment or prolonged healing process 1,3,4
Treatment and prognosis
As with most similar injuries, the mainstay of treatment is rest with ice and anti-inflammatory agents might be used.
The prognosis is dependent on the stage of the injury and radiographic findings at the time of diagnosis, with splint/cast immobilization, can extend from 4 weeks to 6 months 2.
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- 3. DiFiori JP, Puffer JC, Mandelbaum BR, Dorey F. Distal radial growth plate injury and positive ulnar variance in nonelite gymnasts. (1997) The American journal of sports medicine. 25 (6): 763-8. doi:10.1177/036354659702500607 - Pubmed
- 4. Jerry R. Dwek, Fabiano Cardoso, Christine B. Chung. MR imaging of overuse injuries in the skeletally immature gymnast: spectrum of soft-tissue and osseous lesions in the hand and wrist. Pediatric Radiology. 39 (12): 1310. doi:10.1007/s00247-009-1428-x
- 5. Steven P. Kerssemakers, Anastasia N. Fotiadou, Milko C. de Jonge, Apostolos H. Karantanas, Mario Maas. Sport injuries in the paediatric and adolescent patient: a growing problem. (2009) Pediatric Radiology. 39 (5): 471. doi:10.1007/s00247-009-1191-z - Pubmed
- 6. Todd J. Frush, Thomas N. Lindenfeld. Peri-epiphyseal and Overuse Injuries in Adolescent Athletes:. (2009) Sports Health. 1 (3): 201-11. doi:10.1177/1941738109334214 - Pubmed
- 7. Jason T. Little, Nina B. Klionsky, Abhishek Chaturvedi, Aditya Soral, Apeksha Chaturvedi. Pediatric Distal Forearm and Wrist Injury: An Imaging Review. (2014) RadioGraphics. 34 (2): 472-90. doi:10.1148/rg.342135073 - Pubmed