Updated: 11/30/2019

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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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? Tested Concept

QID: 2198
FIGURES:
1

Scaphoid

3%

(40/1403)

2

Distal humerus

23%

(317/1403)

3

Clavicle

1%

(12/1403)

4

Shoulder

19%

(265/1403)

5

Distal radius

55%

(765/1403)

L 4 D

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Evidence (5)
EXPERT COMMENTS (4)
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