Transcript Gymnast Wrist - Belgian Hand group

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
Wrist pain
• Introduction
• General
•
considerations
Case Reports
Outline of a
prospective study
protocol in elite
gymnasts
General considerations
• More gymnasts
• Immature skeleton
• Higher training levels in elite and non-elite
gymnasts
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
Wrist pain
• Floor Exercises
Wrist pain
• Balance Beam
Wrist pain
• Pommel Horse
Wrist pain
• Vaulting
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
2) Age
3) Age of initiation
(= level of competition
X training hours
Wrist pain
• Distribution in function of training intensity
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 %
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
Wrist Pain
• Distal Radius Physeal stress reaction
Wrist pain
• Stress fracture of the scaphoid
Wrist pain
• Scaphoid impaction syndrome and
scapholunate area injury
Wrist pain
• Ulnar Impaction syndrome
Wrist pain
• Avascular necrosis of the capitate
Wrist pain
• Distal Radius Physeal arrest
Wrist pain
• Triquetrolunate impingement
Wrist pain
• Chronic Soft tissue capsulitis
• Wrist Impingement
• Wrists splint
• Ganglia
• TFCC complex tears
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
Difference between boys and girls
• 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

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,
Prevention
• Prevention measures : cut down of wrist
pain
• Training equipment
• Cleaning of bars
• Bracing
• Nutritional advice
• Coaching
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
Case Report
• HT, 15y, Dorsal sided wrist pain, elite
• Started training at 5Y
Case Report
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
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
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
Distal Radial Physeal Injury
• Radiology
– Widening of the distal
radial physis
– Beaking of the
epiphysis
– Cystic changes and
irregularity of the
methaphyseal margin
Distal Radial Physeal Injury
Distal Radial Physeal Injury
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
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
Distal Radial Physeal Injury
Thank you