Gymnast wrist

Case contributed by Yuan Ling

Presentation

Gymnast with wrist pain.

Patient Data

Age: 13 years
Gender: Male
x-ray

Marked widening of the distal radial growth plate across its entire area, with metaphyseal irregularity and cystic change.

Band of metaphyseal sclerosis with no osseous destruction beyond this.

Minimal displacement of the pronator fat pad.

Case Discussion

Metaphyseal erosion and widening with a sclerotic border at the distal radial growth plate is compatible with gymnast wrist. This is a chronic stress injury due to axial overload of the physis, most often seen in elite gymnasts.

Complications include early physeal closure of the distal radius leading to positive ulnar variance and Madelung-type deformity.

Given the mechanism of injury, the TFCC is also at risk. If pain does not settle with rest and behavior modification, MRI may be helpful for further soft tissue assessment.

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