Radial Epiphyseal Stress Reaction: Difference between revisions
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== Clinically Relevant Anatomy == | |||
Radial epiphyseal stress reaction involves the distal radial physes (also called growth plates)<ref name=":0">Brukner P, Khan K, Cook J, Cools A, Crossley K, Hutchinson M, et al. EBOOK [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941124/ BRUKNER and KHAN’s CLINICAL SPORTS MEDICINE.] Sydney: McGraw-Hill Education (Australia) Pty Limited; 2016. | |||
</ref> | </ref>, which is located at the end of the long bone where secondary ossification centres for growth and development occur <ref>Gray’s Atlas Of Anatomy. S.L.: Elsevier; 2020. | ||
</ref>. The growth plates are especially susceptible to injuries in children and adolescents<ref>Kraan RBJ, Kox LS, Oostra RJ, Kuijer PPFM, Maas M. [https://doi.org/10.1080/17461391.2019.1710263 The distal radial physis: Exploring normal anatomy on MRI enables interpretation of stress related changes in young gymnasts.] European Journal of Sport Science. 2020 Jan 12;20(9):1197–205. | |||
</ref>. <br> | |||
== Mechanism of Injury / Pathological Process == | |||
Radial epiphyseal stress reaction is a common overuse injury affecting skeletally immature athletes engaged in high-impact sports<ref name=":0" />. It is particularly common among gymnasts, thus it is also known as the ‘gymnast’s wrist’. Activities that put repetitive compressive, shearing, distraction and torsional forces through the distal radial epiphysis<ref name=":1">Mauck B, Kelly D, Sheffer B, Rambo A, Calandruccio JH. [https://pubmed.ncbi.nlm.nih.gov/32950218/ Gymnast’s Wrist (Distal Radial Physeal Stress Syndrome). Orthopedic Clinics of North America]. 2020 Oct;51(4):493–7. | |||
= | </ref>, such as handstands, somersaults and handsprings, increase the risk of growth arrest in this population<ref name=":0" />. {{#ev:youtube|v=ywfE4gGgSKk&t=1s}} | ||
<br> | <br> | ||
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== Clinical Presentation == | == Clinical Presentation == | ||
Clinical presentation of the gymnast wrist often include pain, swelling, tenderness, and limited range of motion during physical examination. Palpation along the distal radius growth plate and over dorsal rim radius often reproduce pain. Patients often report symptoms being aggravated by weight-bearing activities, like gymnastics maneuvers, or impact-related movements and wrist instability may also be evident.<br> | |||
== Diagnostic Procedures == | == Diagnostic Procedures == | ||
The athlete is often referred for radiographic or MRI scan if injury to the growth plate is suspected.<br>Diagnostic criteria<ref name=":1" />: | |||
* widening of the growth plate in the palmar and radial side. | |||
* cystic changes in the metaphysis | |||
* beaked appearance of the distal palmer and radial parts of the growth plate, | |||
* blurry appearance within the growth plate | |||
== Outcome Measures == | == Outcome Measures == | ||
* [[/www.physio-pedia.com/Patient Specific Functional Scale|Patient Specific Functional Scale]] | |||
* [https://search-api.swiftype.com/api/v1/public/installs/pc/43ZVT-g2_ksiLpUX3zSj.json?_st_tracking%5Bdoc_id%5D=60ca5ef6196a67f41b5e161e&_st_tracking%5Bquery%5D%5Bq%5D=visual%20ana&_st_tracking%5Bquery%5D%5Bpage%5D=1&_st_tracking%5Bquery_type%5D=autocomplete&_st_url=https%3A%2F%2Fwww.physio-pedia.com%2FVisual_Analogue_Scale%3Futm_source%3Dphysiopedia%26utm_medium%3Dsearch%26utm_campaign%3Dongoing_internal Visual Analogue Scale] | |||
* [https://www.physio-pedia.com/Faces_Pain_Scale_-_Revised?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal Faces Pain Scale] for younger children | |||
* [[/www.physio-pedia.com/DASH Outcome Measure|DASH Outcome Measure]] | |||
== Management / Interventions == | |||
Management of the gymnast wrist often involves a multidisciplinary team approach, including orthosurgeons, peadiatricians, physiotherapists, and coaches. | |||
=== Conservative management === | |||
=== Surgical intervention === | |||
== Differential Diagnosis == | |||
== | == Reference == | ||
Revision as of 15:28, 22 May 2023
This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (22/05/2023)
Clinically Relevant Anatomy[edit | edit source]
Radial epiphyseal stress reaction involves the distal radial physes (also called growth plates)[1], which is located at the end of the long bone where secondary ossification centres for growth and development occur [2]. The growth plates are especially susceptible to injuries in children and adolescents[3].
Mechanism of Injury / Pathological Process[edit | edit source]
Radial epiphyseal stress reaction is a common overuse injury affecting skeletally immature athletes engaged in high-impact sports[1]. It is particularly common among gymnasts, thus it is also known as the ‘gymnast’s wrist’. Activities that put repetitive compressive, shearing, distraction and torsional forces through the distal radial epiphysis[4], such as handstands, somersaults and handsprings, increase the risk of growth arrest in this population[1].
Clinical Presentation[edit | edit source]
Clinical presentation of the gymnast wrist often include pain, swelling, tenderness, and limited range of motion during physical examination. Palpation along the distal radius growth plate and over dorsal rim radius often reproduce pain. Patients often report symptoms being aggravated by weight-bearing activities, like gymnastics maneuvers, or impact-related movements and wrist instability may also be evident.
Diagnostic Procedures[edit | edit source]
The athlete is often referred for radiographic or MRI scan if injury to the growth plate is suspected.
Diagnostic criteria[4]:
- widening of the growth plate in the palmar and radial side.
- cystic changes in the metaphysis
- beaked appearance of the distal palmer and radial parts of the growth plate,
- blurry appearance within the growth plate
Outcome Measures[edit | edit source]
- Patient Specific Functional Scale
- Visual Analogue Scale
- Faces Pain Scale for younger children
- DASH Outcome Measure
Management / Interventions[edit | edit source]
Management of the gymnast wrist often involves a multidisciplinary team approach, including orthosurgeons, peadiatricians, physiotherapists, and coaches.
Conservative management[edit | edit source]
Surgical intervention[edit | edit source]
Differential Diagnosis[edit | edit source]
Reference[edit | edit source]
- ↑ 1.0 1.1 1.2 Brukner P, Khan K, Cook J, Cools A, Crossley K, Hutchinson M, et al. EBOOK BRUKNER and KHAN’s CLINICAL SPORTS MEDICINE. Sydney: McGraw-Hill Education (Australia) Pty Limited; 2016.
- ↑ Gray’s Atlas Of Anatomy. S.L.: Elsevier; 2020.
- ↑ Kraan RBJ, Kox LS, Oostra RJ, Kuijer PPFM, Maas M. The distal radial physis: Exploring normal anatomy on MRI enables interpretation of stress related changes in young gymnasts. European Journal of Sport Science. 2020 Jan 12;20(9):1197–205.
- ↑ 4.0 4.1 Mauck B, Kelly D, Sheffer B, Rambo A, Calandruccio JH. Gymnast’s Wrist (Distal Radial Physeal Stress Syndrome). Orthopedic Clinics of North America. 2020 Oct;51(4):493–7.
