Distal Radius Epiphysitis

Aka: Distal Radius Epiphysitis, Gymnast's Wrist

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II. Epidemiology

  1. Age: 8 to 15 years old
  2. Gender: Females predominate (esp. gymnasts)
  3. Associated Sports
    1. Gymnastics (most common)
    2. Diving
    3. Rock Climbing
    4. Weight Lifting

III. Pathophysiology

  1. Overuse injury
  2. Repetitive compression and shearing of the extended wrist (esp. when weight bearing high axial loads)

IV. Symptoms

  1. Chronic Wrist Pain (esp. lateral wrist at radial aspect)
  2. Initially primarily with axial loading
    1. Later occurs at rest

V. Signs

  1. Mild wrist swelling
  2. Decreased Wrist Range of Motion
  3. Decreased grip strength
  4. Focal tenderness over the lateral, distal radius at the Epiphyseal Plate
  5. Provocative maneuvers
    1. Wrist hyperextension
    2. Axial wrist loading

VI. Imaging

  1. Wrist XRay (AP and Lateral)
    1. Distal radius apiphysis widening
    2. Metaphyseal palmar spurring
    3. Cystic or sclerotic changes at the apiphysis
    4. Positive ulnar variance
      1. Distal ulna articular surface >2.5 mm distal to the radial articular surface
  2. MRI Wrist
    1. Not typically indicated outside of unclear cases

VII. Management

  1. NSAIDs as needed
  2. Wrist Immobilization (short arm splint)
  3. Restricted activity involving the affected wrist and Forearm for 4 to 6 weeks
    1. Avoid upper body weight bearing until pain has fully resolved
    2. Full resolution may require up to 3 months of activity restriction
  4. Physical Therapy
    1. Strengthening and flexibility Exercises for the small hand and wrist Muscles
    2. Consider bracing to limit wrist hyperextension

VIII. References

  1. Lintner (2023) Am Fam Physician 108(6): 544-553 [PubMed]

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