Epidemiology: Gymnasts with open growth plates (meaning they are still growing and have not yet finished going through puberty) are at risk for Gymnast wrist.
Mechanism of Injury/Description: Gymnast Wrist occurs from repetitive weight-bearing/pounding on the hands (ex: back handspring, vaulting, etc…) which leads to injury/inflammation to the radial growth plate (thumb side) of the wrist.
Signs/Symptoms: On exam, gymnasts may have tenderness to palpation (touch) on the wrist at the growth plates, decreased wrist motion (specifically with wrist extension), and pain with weight bearing on the hands (a positive L hold or seated lift-off test).
Diagnosis: Gymnast Wrist is diagnosed by physical exam (ex: pain with palpation, decreased wrist extension, positive L hold test), x-rays (ex: distal radial physeal widening or early closure, parrot beaked appearance, and sometimes positive ulnar variance), and sometimes an MRI is used in the diagnosis of Gymnast wrist.
Treatment: Rest from impact/pounding, immobilization in a brace or cast, and physical therapy are important in treating Gymnast Wrist. Severe cases may require surgery.
Prevention: To prevent Gymnast Wrist decrease repetitive impact/pounding, strengthen your wrist, shoulder, and periscapular muscles, and use proper technique when performing upper extremity weight bearing gymnastics skills.
Gymnastics Medical Provider PEARLS: When considering Gymnast Wrist as a diagnosis, consider doing bilateral AP x-ray films of the wrist with the elbow at 90 degrees and shoulder abducted to 90 degrees to compare and assess the stage of Gymnast Wrist. There are “3 stages” of gymnast wrist. Grade 1 pain with weight bearing but no radiographic changes, Grade IIa widening at the distal radial physis, Grade IIb early closure of the distal radial physis, and Grade III complete closure of the radial physis and ulnar positive variance.
Gymnast, Parent, and Coach PEARLS: Do NOT ignore wrist pain. If your gymnast is having wrist pain do not put wrist guards on to decrease the pain; instead see a medical provider for a diagnosis/cause of the pain.