Gymnast’s Wrist - An Insight

Introduction

The wrist is made up of eight small bones that connect the arm to the hand. These bones connect to form a joint with two bones in the forearm, called the radius and ulna, and the bones in the hand, called the metacarpals. Ligaments, tendons, and muscles surround the bones in the wrist. These help the wrist move and stay stable.

What Is a Gymnast’s Wrist?

Gymnast's wrist happens when the end part of the forearm bone (distal radius) gets stressed due to repetitive pressure and sliding forces when the wrist is extended. Since most of the weight on the extended wrist is carried by the distal radius, it becomes more susceptible to this condition. The gymnast's wrist primarily affects the growth plate located in the radius bone.

This growth plate is vulnerable to injury, particularly in young gymnasts, as it is still developing. The repetitive and forceful movements required in gymnastics can lead to overuse injuries in the gymnast's wrist.

In a study of gymnast's wrist in young gymnasts:

• Most patients were girls, but 5% were boys, usually older.

• Even lower-level gymnasts can develop the condition.

• Many (75%) practiced despite pain for over three months.

• It was usually diagnosed using X-rays (71%).

• Recurrence, growth issues, and surgery were common.

• Early diagnosis and rest are crucial to prevent lasting problems in young athletes.

What Are the Causes of Gymnast’s Wrist?

Overuse and Repetitive Stress

One of the primary causes of gymnast's wrists is overuse and repetitive stress. Gymnasts frequently engage in high-impact and repetitive activities, subjecting their wrists to constant strain. This can lead to microtrauma and stress fractures in the still-developing bones of younger athletes.

Sport-related risk factors:

Improper technique during gymnastics routines can put excessive pressure on the wrists. Incorrect hand placement, previous injuries, uneven weight distribution, improper equipment, and improper landing techniques can all contribute to developing a gymnast's wrist. Other risk factors include more numbers of impact repetitions and sudden increase in intensity of the training.

Growth Plate Vulnerability:

The growth plates of young gymnasts are still developing and are more susceptible to distal radial physeal stress syndrome. The growth plate in the radius bone is particularly at risk. Injuries to the growth plate can lead to long-term problems if not addressed promptly.

What Are the Symptoms of a Gymnast’s Wrist?

Gymnast's wrist manifests through various symptoms in varying intensity. When the gymnasts, coaches, and parents know these signs, it becomes easier to seek early intervention.

• Persistent pain in the wrist is the most common symptom of a gymnast's wrist. Pain is often felt on the side facing the thumb (radial side). This pain is often sharp, throbbing, or aching and may worsen during and after gymnastics.

• Swelling around the wrist is another common symptom. It may be visible and accompanied by redness. Swelling can make it difficult to grip and perform gymnastic maneuvers effectively.

• A gymnast's wrist can lead to wrist weakness. It may be challenging to bear weight on the hands during activities like handstands, cartwheels, or weight-bearing stunts.

• Limited wrist mobility can occur due to pain, swelling, and weakness. This can hinder a gymnast's ability to perform certain movements and poses required.

How Is a Gymnast’s Wrist Diagnosed?

• During a physical examination, tenderness can be observed when gently pressing along the distal radial physis. There can be pain when the wrist is hyperextended or subjected to axial loading.

• The condition is typically diagnosed using X-ray images, which may reveal irregularities in the distal radius, such as the widening of the distal radial physis.

• An MRI (magnetic resonance imaging) is recommended in cases of chronic pain or when the condition does not respond well to treatment. The MRI results may show:

  • Paraphyseal edema, which indicates swelling around the growth plate.

  • Bruising of the radius bone can signify damage and stress-related injuries.

  • Early physeal bridging, suggests the beginning of bone growth disturbances.

How Is the Gymnast’s Wrist Treated?

Non-operative treatment

• The first step in treating a gymnast's wrist is rest, ranging from a few weeks to a few months, based on the injury's severity.

• Nonoperative treatment involves using nonsteroidal anti-inflammatory drugs (NSAIDs), rest, and immobilization for 3 to 6 weeks.

• During this rest period, physical therapy may be recommended to maintain mobility and strength in the upper body to prevent compensation in other areas, muscle weakness, abnormal movements, or loss of joint flexibility.

• As the patient recovers mobility and strength, physical therapy progresses to controlled weight-bearing exercises on the affected hand and wrist, such as wall pushups. These activities do not harm the injured area.

• When the physician approves, the physical therapist introduces full-body, weight-bearing exercises to prepare for returning to sports, focusing on maintaining stability and preventing symptom recurrence.

Operative treatment

In cases where nonoperative treatment is not effective, surgical options may be considered, such as

• Resection of physeal bridge for small physeal closures.

• Ulnar epiphysiodesis and shortening with radial osteotomy for large physeal closures involve roughly 50% of the growth plate.

How Can a Gymnast’s Wrist Be Prevented?

Preventing gymnast's wrists is needed for maintaining long-term wrist health and performance in gymnastics. Here are some strategies to reduce the risk of this injury:

• Proper Technique - Ensure that qualified coaches teach gymnasts the correct techniques. Proper hand placement, weight distribution, and landing techniques can significantly reduce the strain on the wrist.

• Gradual Progression - Implement a gradual progression in training routines. Avoid pushing young gymnasts too hard or too quickly, as their growth plates are still developing. Gradually increase the intensity and complexity of exercises to allow their bodies to adapt.

• Rest and Recovery - Include rest days in the training schedule to give the wrists and the body time to recover. Adequate sleep, nutrition, and hydration should be met.

• Wrist Strengthening Exercises - Incorporate specific wrist-strengthening exercises into the training regimen. Exercises that improve wrist strength and flexibility can help protect gymnast's wrists. Wrist curls, wrist extensions, and wrist stretches are beneficial.

• Equipment Maintenance - Ensure that gymnastic equipment, such as mats and bars, is in good condition and provides proper support. Faulty equipment can lead to injuries.

• Regular Check-ups - These are essential, especially for young gymnasts. A physician can monitor growth plate development and guide on preventing injuries.

Conclusion

Other orthopedic conditions associated with the gymnast’s wrist include distal ulnar overgrowth and instability in the distal radioulnar joint. Gymnast's wrists can affect young athletes, but early diagnosis and treatment are key to a positive prognosis. Most gymnasts can recover fully and continue their athletic journey with adequate rest and intervention.