Updated: 11/12/2019

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
Introduction
  • 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
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 
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)
 

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