Case 19: A 12-year-old level 8 gymnast has had right wrist pain for the past three months. The pain began with tumbling activity and now occurs with all weight bearing activity including conditioning. He says the wrist occasionally swells. He has pain along the distal radial physis and discomfort with forced dorsiflexion. He has a normal neurologic examination.
Gymnasts are unique in that they bear up to four times their body weight on their arms when they tumble and perform their sport. Many will experience wrist pain and swelling with repetitive weight bearing activity. A differential diagnosis of wrist pain in this group consists of a chronic Salter Harris I fracture of the distal radius, wrist tendonitis, stress injury or fracture, ganglion cyst, compartment syndrome, or nerve entrapment.
Chronic Salter Harris I fractures are common in both elite and nonelite gymnasts with open physes. Pain at the distal radius occurs with weight bearing dorsiflexion. Athletes may lack full wrist extension or have pain with passive and active extension or radial and ulnar deviation. These athletes typically have weak scapular stabilizers which may be partly to blame for this injury. Radiographs (AP, lateral, and oblique) show widening, sclerosis and cystic changes of the distal radius (Fig. 17). Contralateral views may be necessary to appreciate all changes.
Treatment consists of rest and ice along with daily rehabilitation focused on the scapular stabilizers, upper back muscles, and core body. A wrist splint may be useful for relief of symptoms during the day and while
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