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Distal Radial Epiphysitis
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Contents
Other Names
- Gymnast's Wrist
- Distal Radial Physeal Stress Syndrome
- Radial Epiphysitis
Background
- This page refers to distal radius epiphysitis, often termed 'Gymnast's Wrist'
History
Epidemiology
- Affects up to 25% of gymnasts (need citation)
Pathophysiology
- General
- Can be considered a chronic type 1 Salter Harris Fracture
Pathophysiology
- Wrist experiences excessive loads due using wrist as a weight bearing joint
- The repetitive stress leads to inflammation of the physis
- Microtrauma can lead to premature fusion of physis and excessive overgrowth of Ulna
- Traction vs stress injury
Risk Factors
- Sports
- Gymnastics
- Especially in uneven parallel bars, vault, balance beam and floor exercises[1]
- Weight-Lifting
- Rock Climbing
- Gymnastics
Differential Diagnosis
- Fractures
- Dislocations
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
Clinical Features
- History
- Age 10 to 14
- Gradual onset
- Dorsal radial sided wrist pain, worse in extension
- Worse with axial stress loading (vaulting, hand-walking)
- Physical Exam: Physical Exam Wrist
- Tenderness, swelling to distal radius
- Loss of range of motion may be present
- Pain with hyperextension and axial loading
Evaluation
Radiographs
- Standard Radiographs Wrist
- 3 view radiographs initial imaging modality of choice
- Findings
- May see widened, irregular growth plate
- Metaphyseal and epiphjyseal sclerosis, irregularity
- In more chronic patients, positive ulnar variance
MRI
- Indicated in refractory or chronic patients
- Findings
- Paraphyseal edema
- Bridging
- Bone edema
Classification
- N/A
Management
Nonoperative
- Indications
- Most athletes
- Rest from offending activity
- While in cast
- Gradual RTP
- Immobilization for at least 6-8 weeks, sometimes 3-6 months
- Consider Short Arm Cast, Radial Gutter Cast
- Prevention
- Manage load and volume
- Strength and flexibility exercises
- Proper technique
Operative
- Indications
- Refractory conservative management
- Late presentation
- Procedures
- Resection of physeal bridge
- Ulnar epiphysiodesis, shortening with radial osteotomy
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play
- Depends on rate of recovery, some athletes can be immobilized for 6 months
Complications & Prognosis
Prognosis
- Prognosis is favorable if treated early
- Can take up to 4-5 months if late to care
Complications
- Microtrauma can lead to premature fusion of physis and excessive overgrowth of Ulna
- Positive ulnar variance
- Radial Shortening
- TFCC Injury
See Also
- Pediatric Fractures (Main)
- Apophyseal And Epiphyseal Injuries (Main)
- Hand and Wrist Anatomy (Main)
- Wrist Pain (Main)
- Physical Exam Wrist
References
- ↑ Poletto, Erica D., and Avrum N. Pollock. "Radial epiphysitis (aka gymnast wrist)." Pediatric emergency care 28.5 (2012): 484-485.
Created by:
John Kiel on 30 June 2019 20:30:31
Authors:
Last edited:
26 January 2022 10:33:25
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