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Gymnast Wrist

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

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Gymnast Wrist

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  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 • 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

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