Gymnast wrist is a term that is used to describe a variety of chronic overuse injuries of the wrist in gymnasts with an immature skeleton. Gymnast wrist comprises a combination of osseous and ligamentous injuries and usually manifests as a chronic Salter-Harris type I fracture of the distal radial physis on radiography 1.
Distal radial physeal injury is common in gymnasts, and occasionally occurs in other sports 2. The distal radius is mostly involved because it bears the primary stressful forces in the wrist joint 1.
Pain with gradual onset and exaggeration by weight-bearing activities while the wrist in extension position. Often, range of motion is normal on physical examination, and frequently swelling and tenderness over the distal radius presents 2.
Gymnast wrist results from repetitive compressive forces applied to the distal radial physeal plate during participation in sports like gymnastics and weight-lifting that place a great tension on the physis and adjacent structures 1.
- physeal plate widening
- physeal plate irregularity
- metaphyseal and less commonly epiphyseal sclerosis and irregularity 1,4
- physeal plate bridging/fusion in late stage of the disease 1
Most of the above-mentioned physeal, metaphyseal and epiphyseal changes are usually evident on radiography 1-3.
MRI may be used when radiographs are inconclusive. MRI can demonstrate the greater detail about the physeal cartilage and edema in the adjacent bones before these changes become visible on radiographs 4.
It is worth mentioning that MRI is crucial in high-risk patients with chronic wrist pain because early detection is essential in preventing further damage to the distal radial physis 1.
Treatment and prognosis
As with similar injuries, the mainstay of treatment is rest with ice packs and anti-inflammatory agents as required.
The prognosis is dependent on the stage of the injury and radiographic findings at the time of diagnosis, with splint/cast immobilization, recovery may take anywhere from one to six months 2.
Complications of untreated fracture include:
- 1.Dobyns JH, Gabel GT. Gymnast's wrist. (1990) Hand clinics. 6 (3): 493-505. Pubmed
- 2. C Shih, C Y Chang, I W Penn, C M Tiu, T Chang, J J Wu. Chronically stressed wrists in adolescent gymnasts: MR imaging appearance. (1995) Radiology. 195 (3): 855-9. doi:10.1148/radiology.195.3.7754021 - Pubmed
- 3. DiFiori JP, Puffer JC, Mandelbaum BR, Dorey F. Distal radial growth plate injury and positive ulnar variance in nonelite gymnasts. (1997) The American journal of sports medicine. 25 (6): 763-8. doi:10.1177/036354659702500607 - Pubmed
- 4. Jerry R. Dwek, Fabiano Cardoso, Christine B. Chung. MR imaging of overuse injuries in the skeletally immature gymnast: spectrum of soft-tissue and osseous lesions in the hand and wrist. Pediatric Radiology. 39 (12): 1310. doi:10.1007/s00247-009-1428-x
- 5. Steven P. Kerssemakers, Anastasia N. Fotiadou, Milko C. de Jonge, Apostolos H. Karantanas, Mario Maas. Sport injuries in the paediatric and adolescent patient: a growing problem. (2009) Pediatric Radiology. 39 (5): 471. doi:10.1007/s00247-009-1191-z - Pubmed
- 6. Todd J. Frush, Thomas N. Lindenfeld. Peri-epiphyseal and Overuse Injuries in Adolescent Athletes:. (2009) Sports Health. 1 (3): 201-11. doi:10.1177/1941738109334214 - Pubmed
- 7. Jason T. Little, Nina B. Klionsky, Abhishek Chaturvedi, Aditya Soral, Apeksha Chaturvedi. Pediatric Distal Forearm and Wrist Injury: An Imaging Review. (2014) RadioGraphics. 34 (2): 472-90. doi:10.1148/rg.342135073 - Pubmed
Related Radiopaedia articles
- wrist fractures and dislocations
- distal radial fracture
- carpal bones
- carpal instability
- triangular fibrocartilaginous complex (TFCC) injuries
- ulnar-sided wrist impaction and impingement syndromes
- soft tissue and tendons