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Distal Radial Epiphysitis

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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

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

Differential Diagnosis


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
  • 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


References

  1. 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