CASE 14323 Published on 25.01.2017

Gymnast wrist


Musculoskeletal system

Case Type

Clinical Cases


Apeksha Chaturvedi, MD

Strong Memorial Hospital,University of Rochester Medical Center; 601 Elmwood Ave 14642 Rochester, United States of America;

13 years, female

Area of Interest Bones, Musculoskeletal bone ; Imaging Technique MR
Clinical History
A 13-year-old competitive gymnast presented with pain in both wrists; the left wrist was more painful.
Imaging Findings
Frontal and slightly oblique radiographs of the wrist showed widening and irregularity at the distal radial physis. There was sclerosis of the adjacent metaphysis.
A spectrum of inter-related osseous and ligamentous injuries can result from repetitive compressive forces to the wrist sustained over long periods of time- these are collectively referred to as gymnast wrist [1, 2]. There is typically a history of participation in high-impact sports including gymnastics and weight-lifting [1]. Patients present with wrist pain aggravated by participation in the inciting activity. On plain film radiographs, fraying, widening and irregularity of the distal radial physis is seen. On MR, an abnormally high T2 signal intensity with widening of the distal radial physis is noted. This appearance is typical of gymnast wrist [2].

A prolonged healing response occurs after chronic overuse injury to the distal radial physis. This can lead to physeal bridging, premature fusion of the radius and resultant ulnar overgrowth/positive ulnar variance. Tears to the triangular fibrocartilage complex (TFCC), focal chondral injury to the lunate and articular cartilage degeneration can ultimately result [1].

Until pain subsides, the inciting activity should be ceased. Surgical management including distal ulnar epiphyseodesis or ulnar shortening osteotomy is reserved for cases demonstrating complete distal radial growth arrest.
Differential Diagnosis List
Physeal injury of distal radius due to repetitive stress-gymnast wrist.
Salter-Harris-4 fracture
Final Diagnosis
Physeal injury of distal radius due to repetitive stress-gymnast wrist.
Case information
DOI: 10.1594/EURORAD/CASE.14323
ISSN: 1563-4086