1. Gymnast Wrist Dr. Kris Buedts, Dr Yo Baeten
Europa Ziekenhuis Site Sint Michiel, Brussel
Dr. Briffoz, Marc Walraeven lic.
Medical Staff Topsportschool Gent
Dr Nick Baelde
MRI Unit AZ Jan Palfijn Gent

2. Wrist pain Introduction General considerations Case Reports
Outline of a prospective study protocol in elite gymnasts

3. General considerations
More gymnasts
Immature skeleton
Higher training levels in elite and non-elite gymnasts

4. Wrist pain Is common among both sexes
The wrist is converted into a weight bearing structure
Loading in dorsiflexion
As much as 16X body weight
Prevalence : 46% to 79%, Difiori et al, Clinical sports medicine update 2006

5. Wrist pain
Floor Exercises

6. Wrist pain
Balance Beam

7. Wrist pain
Pommel Horse

8. Wrist pain
Vaulting

9. Wrist pain Wrist pain for several months is common
up to 45%, Mandelbaum Br et al, Am J Sportsmedecine, 1996
In direct correlation with
1) Training intensity (= level of competition X training hours
2) Age
3) Age of initiation

10. Wrist pain
Distribution in function of training intensity

11. Wrist pain Side of pain, DiFiori et all, Am J of Sportsmedicine, 1996
Dorsal : 61,5 %
Ulnar : 12,3 %
Palmar : 7,7 %
Radial : 6,2 %
Non localized : 14 %

12. Wrist pain
Distribution, Garron et all, Clinics in sportsmedicine, 1992
More ulnar sided pain in female
More dorsal sided pain in male
Age
More ulnar sided pain in mature wrist
More dorsal sided pain in immature wrist

13. Wrist Pain
Distal Radius Physeal stress reaction

14. Wrist pain
Stress fracture of the scaphoid

15. Wrist pain
Scaphoid impaction syndrome and scapholunate area injury

16. Wrist pain
Ulnar Impaction syndrome

17. Wrist pain
Avascular necrosis of the capitate

18. Wrist pain
Distal Radius Physeal arrest

19. Wrist pain
Triquetrolunate impingement

20. Wrist pain Chronic Soft tissue capsulitis Wrist Impingement
Wrists splint
Ganglia
TFCC complex tears

21. Point of interest The Immature wrist :
Distal Radius Physeal stress reaction
Why ?
Protection for future
Prevention for wrist degeneration
Repetitive injury and compression of the wrist leads to a premature closure of the distal radials growth plate resulting in secondary ulnar overgrowth, L De Smet et al, Am J of Sports medicine, 1994

22. Difference between boys and girls
Short Statue
Leanness
More proprioceptif training
More ulnar sided wrist pain
Boys
Power training
More repetition
Less proprioceptif training
More dorsal sided wrist pain

23. Wrist degeneration Ulnar wrist pain Madelung like deformity
Ulna + with Ulnar impingement syndrome
And/or TFCC problems,
L. De Smet et al, Act Orthop Belg, 1993,

24. Prevention Prevention measures : cut down of wrist pain
Training equipment
Cleaning of bars
Bracing
Nutritional advice
Coaching

25. One Exception Puberal Boys and girls Age Group 12- 15 years
Initiation to training : <5.6Y>
High training intensity
Fysionomy
Small stature
Delayed puberty
Out of Control

26. Case Report HT, 15y, Dorsal sided wrist pain, elite
Started training at 5Y

27. Case Report

28. Distal Radial Physeal Injury
Biomechanics
- 80% of load is borne by the radius in the extended wrist, Palmer et al, J Hand Surg 1982
- Shortening of the ulna increases the load borne by the radius
- open physis : <mean ulnar variance>
- 2 mm
Hafner et al, Skeletal rad, 1989

29. Distal Radial Physeal Injury
Histology
Dynamic compression can stimulate bone growth
Loading can exceed adaptive capacity of the growth plate
Growth plate more vulnerable during puberal growth spurt
Flachsmann et al, Clin Orthop rel res, 2000

30. Distal Radial Physeal Injury
Compromise of blood supply
Disrupts mineralization
Prolonging the life of the chondrocytes
Widening of the growth plate
“Logjam” of chondrocytes
Jaramillo et al, Radiology 1993

31. Distal Radial Physeal Injury
Radiology
Widening of the distal radial physis
Beaking of the epiphysis
Cystic changes and irregularity of the methaphyseal margin

32. Distal Radial Physeal Injury

33. Distal Radial Physeal Injury

34. Introduction to a prospective study protocol in elite gymnast
Purpose
To determinate mean velocity age of onset
To determinate wrist side involvement
To determinate <Ulna -> in open physis
To determinate correlation between ulna + and Distal Radial Physeal Injury
To protect our young athletes for chronic injury

35. Introduction to a prospective study protocol in elite gymnast
Questionnaire
Physical examination
Training volume, Training intensity
Rate of growth, endocrinal follow up
Standard RX
Screening with MRI
Control group

36. Distal Radial Physeal Injury
Thank you