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 months 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)