Updated: 5/20/2021

Gymnast's Wrist (Distal Radial Physeal Stress Syndrome)

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https://upload.orthobullets.com/topic/6052/images/mri wrist 3.jpg
https://upload.orthobullets.com/topic/6052/images/ap ulnar variance.jpg
https://upload.orthobullets.com/topic/6052/images/ap and lateral wrist2.jpg
  • Summary
    • Gymnast's wrist is a distal radius physeal injury most commonly due to overuse of the wrist primarily affecting young gymnasts.
    • Diagnosis is made clinically with tenderness at the distal radius with radiographs showing widened distal radial growth plate with ill-defined borders.
    • Treatment involves rest, NSAIDs and immobilization for 3-6 weeks. Rarely, in the case of premature physeal closure, surgical treatment is indicated.
  • Epidemiology
    • Incidence
      • up to 25% of non-elite gymnasts
  • Etiology
    • Pathophysiology
      • wrist undergoes supraphysiological loads due to use as a weight bearing joint.
      • repetitive stress causes inflammation at growth plate of distal radius.
      • microtrauma can lead to premature closure of distal radial physis resulting in secondary overgrowth of ulna.
    • Associated conditions
      • orthopaedic
        • distal ulnar overgrowth
        • positive ulnar variance
  • Presentation
    • Symptoms
      • wrist pain
        • usually radial sided
        • may be chronic in nature
    • Physical exam
      • inspection
        • swelling may be present at wrist
        • tenderness to palpation at distal radius
      • motion
        • decreased wrist flexion or extension may be present
  • Imaging
    • Radiographs
      • recommended views
        • AP and lateral of the wrist
      • findings
        • widened distal radial growth plate with ill-defined borders
        • positive ulnar variance with chronic cases
    • MRI
      • indications
        • chronic or cases non-responsive to treatment
      • findings
        • paraphyseal edema
        • early physeal bridging
        • bruising of radius
  • Diagnosis
    • Radiographic
      • diagnosis confirmed by history, physical exam, and radiographs
  • Treatment
    • Nonoperative
      • NSAIDS, rest, immobilization for 3-6 weeks
        • indications
          • first line of treatment
    • Operative
      • resection of physeal bridge
        • indications
          • small physeal closures
      • ulnar epiphysiodesis and shortening with radial osteotomy as needed
        • indications
          • large physeal closures (roughly 50% of physis)
  • Prognosis
    • Good outcomes associated with early treatment.
    • May lead to premature closure of distal radial physis.
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Questions (1)

(SBQ04PE.13) Figure A is the radiograph of an 8-year-old female who presents with complaints of right shoulder pain for the past 3 weeks. She has been unable to perform gymnastics during this time. She is treated conservatively for a proximal humeral stress fracture. In gymnasts, which upper extremity stress fracture is most likely to lead to growth arrest?

QID: 2198
FIGURES:
1

Scaphoid

3%

(43/1579)

2

Distal humerus

23%

(359/1579)

3

Clavicle

1%

(12/1579)

4

Shoulder

19%

(293/1579)

5

Distal radius

55%

(868/1579)

L 4 D

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