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Gymnast Wrist

 
ICD-9 Classification / Treatment
Etiology / Natural History Associated Injuries / DDx
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms:pseudorickets

Gymnast Wrist ICD-9

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Gymnast Wrist Etiology / Epidemiology / Natural History

  • Nonspecific pain in the wrist of a gymnast; and most often refers to injury of the distal radial physis
  • Caused by chronic compressive impact forces, torsional forces, and distraction
  • Gymnastic (floor exercise and balance beam) place high forces on the unfused distal radial metaphyses which can lead to physeal widening, cystic changes, and metaphyseal fragmentation. 
  • May be considered a Salter-Harris type I stress fracture.
  • Natural history:  depending on severity, injury to the distal radial physis may cause premature physeal closure and radial shortening.  This may lead to postive ulnar varience -> TFCC Tear -> Ulnocarpal Impaction Syndrome.

Gymnast Wrist Anatomy

  • Wrist ligaments and joint capsule are 2 to 5 times stronger than the open physis, making the physis more susceptible to trauma in adolescent gymnast. (Liebling MS, Am J Roentgenol. 1995; 164(1):157)
  • Stress fractures usually involve the hypertrophic zone of the physis, with resultant growth plate widening.

Gymnast Wrist Clinical Evaluation

  • Wrist pain +/- wrist swelling. 

Gymnast Wrist Xray / Diagnositc Tests

  • PA. lateral and Oblique views of the wrist indicated.  May be normal or demonstrate suble widening of the physis and soft tissue swelling, physeal irregularity, cystic changes, and fragmentation of the metaphysis (pseudorickets).  Compare distal radial physeal width to the normal physeal width of the uninvolved distal ulnar physis.
  • Advanced cases may demonstrate premature closure of the distal radial physis and ulnar positive variance.
  • MRI: Salter-Harris I fractures demonstrate irregularity of the growth plate with increased T2 signal intensity, and bone marrow edema-like signal changes are often identified within the adjacent epiphysis and metaphysis.  Physeal closure will demonstrate osseous bridging of the physis.

Gymnast Wrist Classification / Treatment

  •  Discontinue the offending activity until the wrist is pain free, followed by gradual return to activity.

Gymnast Wrist Associated Injuries / Differential Diagnosis

Gymnast Wrist Complications

  • Premature physeal closure
  • TFCC tear
  • Ulnar impaction syndrome

Gymnast Wrist Follow-up Care

  • Mild cases may return to sports when wrist is pain free. 
  • Depending on severity, injury to the distal radial physis may cause premature physeal closure, angular deformity and radial shortening.  This may lead to postive ulnar varience -> TFCC Tear -> Ulnocarpal Impaction Syndrome. and long term disability.

Gymnast Wrist Review References

  • Webb BG, Rettig LA. Gymnastic wrist injuries. Curr Sports Med Rep. 2008; 7(5):289–295.
  • Liebling MS, Berdon WE, Ruzal-Shapiro C, Levin TL, Roye D Jr, Wilkinson R. Gymnast wrist (pseudorickets growth plate abnormality) in adolescent athletes: findings on plain films and MR imaging. AJR Am J Roentgenol. 1995; 164(1):157–159.
  • DiFiori JP, Puffer JC, Aish B, Dorey F. Wrist pain in young gymnasts: Frequency and effects upon training over 1 Year. Clin J Sport Med. 2002; 12:348–353

 

 

 

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