Gymnast's Wrist

A 15-year-old male adolescent presenting with right wrist pain and swelling for short duration. The patient is physically active and part of gymnast team. X-ray of both wrists and MRI exam of the right wrist were requested.

The X-ray revealed widening of the right distal ulnar and both distal radial physeal plates with irregularity and sclerotic changes more pronounced along the left distal radial metaphysis (Fig.1).

MRI showed widening of the right ulnar distal physis and mildly elevated signal pattern associated with mild irregularity of the distal metaphysis and minimal sub-periosteal fluid.  Minimal irregularities of the distal radius metaphysis with no significant diastases of its physeal plate or related manifest marrow oedema were also noted (Fig.2).

Gymnast’s Wrist comprises a spectrum of chronic overuse injuries afflicting the skeletally immature wrist secondary to physeal plates repetitive compressive insults applied in stressing sports like gymnastics -hence the etymology- and manifesting as chronic Salter-Harris type I injury [1].

The distal radius is mostly involved because it bears the primary stressful forces at wrist joint, with less frequent distal ulnar involvement. Patients usually present with pain of gradual onset exaggerated by weight-bearing/compressive activities while the wrist is in extension position [2].

The characteristic radiographic diagnostic criteria include widening of the physis, especially volary and radially, with peri-physeal pseudo cystic as well as sclerotic changes. On MRI, the physeal changes can also be appreciated with peri-physeal marrow oedema depicted in some cases [3].

Clinically there are three stages; an early stage characterized by chronic wrist pain (no radiographic abnormalities), decreased range of motion in the middle stage (radiographic features start to ensue) and osseous deformity in the form of disrupted radial growth with relatively lengthened ulna (positive ulnar variance and related morbidities such as TFCC tears and ulnar impaction) in the late stage [4]. The radiologic features along with typical history are sufficient to make the diagnosis.

The treatment depends on the affliction stage. Rest with ice packs and anti-inflammatory drugs are the mainstay at early stage. Application of splint/cast immobilization is sometimes required, with surgical reduction of the ulna reserved for the late stages. Recovery also is variable and takes anywhere from one to six months according to the stage [2].

Written informed patient’s guardian consent for publication has been obtained.