Wrist pain syndrome in the gymnast. Pathogenetic, diagnostic, and therapeutic considerations

Abstract

Gymnast wrist pain syndrome presents a difficult diagnostic and therapeutic challenge. It is common and debilitating among gymnasts, resulting in a reduction in training and performance, and may be the result of a response to repetitive trauma during the period of growth and development. This study was undertaken to define and characterize factors contributing to the causes and development of gymnast wrist pain and to establish an effective means of systematic and comprehensive evaluation and treatment. Thirty-eight collegiate gymnasts (20 UCLA: 9 female, 11 male; 18 NCAA: all male) were evaluated by radiograph and questionnaire. Seventy-five percent (22) of the males and 33% (3) of the females had had wrist pain for at least 4 months. The UCLA males averaged 2.82 +/- 1.94 mm positive ulnar variance; this was significantly greater than that of the NCAA males, who averaged 1.28 +/- 1.02 mm (P less than 0.02). The UCLA females averaged 1.44 +/- 1.88 mm positive ulnar variance. All of the gymnasts had significantly greater variance than had the controls, who averaged -0.52 mm (P less than 0.0001). The pommel horse routine was consistently responsible for wrist pain among the males. Anatomical and histological correlation of cryosections with magnetic resonance imaging (MRI) was performed to establish the usefulness of MRI in the diagnosis of wrist pain. MRI was able to differentiate the complex transitions between cortical and trabecular bone, articular surfaces, the ligaments, and the triangular fibrocartilage (TFC) complex of the wrist joint. A therapeutic algorithm was established to facilitate the evaluation and management of gymnast wrist pain. Arthroscopic surgery was successful, and arthroscopic findings correlated well with those of MRI and arthrography. Prospective studies are now underway in the pediatric and adolescent population to define further the causes and development of wrist pain problems in gymnasts.