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

Gymnast wrist pain syndrome presents a difficult diag nostic 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 compre hensive evaluation and treatment. Thirty-eight collegiate gymnasts (20 UCLA: 9 female, 11 male; 18 NCAA: all male) were evaluated by radio graph 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 sig nificantly greater than that of the NCAA males, who averaged 1.28 ± 1.02 mm (P < 0.02). The UCLA females averaged 1.44 ± 1.88 mm positive ulnar vari ance. All of the gymnasts had significantly greater variance than had the controls, who averaged -0.52 mm (P < 0.0001). The pommel horse routine was consistently responsible for wrist pain among the males. Anatomical and histological correlation of cryosec tions with magnetic resonance imaging (MRI) was per formed to establish the usefulness of MRI in the diag nosis of wrist pain. MRI was able to differentiate the complex transitions between cortical and trabecular bone, articular surfaces, the ligaments, and the trian gular 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 arthrog raphy. Prospective studies are now underway in the pediatric and adolescent population to define further the causes and development of wrist pain problems in gymnasts.