Updated: 11/30/2019

Gymnast's Wrist (Distal Radial Physeal Stress Syndrome)

Review Topic
1 1
https://upload.orthobullets.com/topic/6052/images/mri wrist 3.jpg
https://upload.orthobullets.com/topic/6052/images/ap ulnar variance.jpg
  • Overuse syndrome of the wrist primarily affecting young gymnasts
    • may lead to premature closure of distal radial physis 
  • Epidemiology
    • up to 25% of non-elite gymnasts 
  • 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
  • Prognosis
    • good outcomes associated with early treatment
  • 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  
  • 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 
  • 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)

Please rate topic.

Average 3.3 of 19 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Evidences (2)
Topic COMMENTS (4)
Private Note