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Gymnast Wrist Dr. Kris Buedts, Dr Yo Baeten Europa Ziekenhuis Site Sint Michiel, Brussel Dr. Briffoz, Marc Walraeven lic. Medical Staff Topsportschool.

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Presentation on theme: "Gymnast Wrist Dr. Kris Buedts, Dr Yo Baeten Europa Ziekenhuis Site Sint Michiel, Brussel Dr. Briffoz, Marc Walraeven lic. Medical Staff Topsportschool."— Presentation transcript:

1 Gymnast Wrist Dr. Kris Buedts, Dr Yo Baeten Europa Ziekenhuis Site Sint Michiel, Brussel Dr. Briffoz, Marc Walraeven lic. Medical Staff Topsportschool Gent Dr Nick Baelde MRI Unit AZ Jan Palfijn Gent

2 Wrist pain Introduction Introduction General considerations General considerations Case Reports Case Reports Outline of a prospective study protocol in elite gymnasts

3 General considerations More gymnasts More gymnasts Immature skeleton Immature skeleton Higher training levels in elite and non-elite gymnasts Higher training levels in elite and non-elite gymnasts

4 Wrist pain Is common among both sexes Is common among both sexes The wrist is converted into a weight bearing structure The wrist is converted into a weight bearing structure Loading in dorsiflexion Loading in dorsiflexion As much as 16X body weight As much as 16X body weight Prevalence : 46% to 79%, Difiori et al, Clinical sports medicine update 2006 Prevalence : 46% to 79%, Difiori et al, Clinical sports medicine update 2006

5 Wrist pain Floor Exercises Floor Exercises

6 Wrist pain Balance Beam Balance Beam

7 Wrist pain Pommel Horse Pommel Horse

8 Wrist pain Vaulting Vaulting

9 Wrist pain Wrist pain for several months is common Wrist pain for several months is common up to 45%, Mandelbaum Br et al, Am J Sportsmedecine, 1996 up to 45%, Mandelbaum Br et al, Am J Sportsmedecine, 1996 In direct correlation with 1) Training intensity (= level of competition X training hours 2) Age 3) Age of initiation

10 Wrist pain Distribution in function of training intensity Distribution in function of training intensity

11 Wrist pain Side of pain, DiFiori et all, Am J of Sportsmedicine, 1996 Side of pain, DiFiori et all, Am J of Sportsmedicine, 1996 Dorsal : 61,5 % Dorsal : 61,5 % Ulnar : 12,3 % Ulnar : 12,3 % Palmar : 7,7 % Palmar : 7,7 % Radial : 6,2 % Radial : 6,2 % Non localized : 14 % Non localized : 14 %

12 Wrist pain Distribution, Garron et all, Clinics in sportsmedicine, 1992 Distribution, Garron et all, Clinics in sportsmedicine, 1992 More ulnar sided pain in female More ulnar sided pain in female More dorsal sided pain in male More dorsal sided pain in male Age Age More ulnar sided pain in mature wrist More ulnar sided pain in mature wrist More dorsal sided pain in immature wrist More dorsal sided pain in immature wrist

13 Wrist Pain Distal Radius Physeal stress reaction Distal Radius Physeal stress reaction

14 Wrist pain Stress fracture of the scaphoid Stress fracture of the scaphoid

15 Wrist pain Scaphoid impaction syndrome and scapholunate area injury Scaphoid impaction syndrome and scapholunate area injury

16 Wrist pain Ulnar Impaction syndrome Ulnar Impaction syndrome

17 Wrist pain Avascular necrosis of the capitate Avascular necrosis of the capitate

18 Wrist pain Distal Radius Physeal arrest Distal Radius Physeal arrest

19 Wrist pain Triquetrolunate impingement Triquetrolunate impingement

20 Wrist pain Chronic Soft tissue capsulitis Chronic Soft tissue capsulitis Wrist Impingement Wrist Impingement Wrists splint Wrists splint Ganglia Ganglia TFCC complex tears TFCC complex tears

21 Point of interest The Immature wrist : The Immature wrist : Distal Radius Physeal stress reaction Why ? Why ? –Protection for future –Prevention for wrist degeneration Repetitive injury and compression of the wrist leads to a premature closure of the distal radials growth plate resulting in secondary ulnar overgrowth, L De Smet et al, Am J of Sports medicine, 1994

22 Difference between boys and girls Girls Girls  Short Statue  Leanness  More proprioceptif training  More ulnar sided wrist pain Boys Boys  Power training  More repetition  Less proprioceptif training  More dorsal sided wrist pain

23 Wrist degeneration Ulnar wrist pain Ulnar wrist pain Madelung like deformity Madelung like deformity Ulna + with Ulnar impingement syndrome Ulna + with Ulnar impingement syndrome And/or TFCC problems, L. De Smet et al, Act Orthop Belg, 1993,

24 Prevention Prevention measures : cut down of wrist pain Prevention measures : cut down of wrist pain Training equipment Training equipment Cleaning of bars Cleaning of bars Bracing Bracing Nutritional advice Nutritional advice Coaching Coaching

25 One Exception Puberal Boys and girls Puberal Boys and girls Age Group years Age Group years Initiation to training : Initiation to training : High training intensity High training intensity Fysionomy Fysionomy Small stature Small stature Delayed puberty Delayed puberty Out of Control

26 Case Report HT, 15y, Dorsal sided wrist pain, elite HT, 15y, Dorsal sided wrist pain, elite Started training at 5Y Started training at 5Y

27 Case Report

28 Distal Radial Physeal Injury Biomechanics Biomechanics - 80% of load is borne by the radius in the extended wrist, Palmer et al, J Hand Surg Shortening of the ulna increases the load borne by the radius - open physis : - open physis : - 2 mm Hafner et al, Skeletal rad, 1989

29 Distal Radial Physeal Injury Histology Histology –Dynamic compression can stimulate bone growth –Loading can exceed adaptive capacity of the growth plate –Growth plate more vulnerable during puberal growth spurt Flachsmann et al, Clin Orthop rel res, 2000

30 Compromise of blood supply Compromise of blood supply Disrupts mineralization Disrupts mineralization Prolonging the life of the chondrocytes Prolonging the life of the chondrocytes Widening of the growth plate Widening of the growth plate “Logjam” of chondrocytes “Logjam” of chondrocytes Jaramillo et al, Radiology 1993 Distal Radial Physeal Injury

31 Radiology Radiology –Widening of the distal radial physis –Beaking of the epiphysis –Cystic changes and irregularity of the methaphyseal margin

32 Distal Radial Physeal Injury

33

34 Introduction to a prospective study protocol in elite gymnast Purpose Purpose To determinate mean velocity age of onset To determinate wrist side involvement To determinate in open physis To determinate correlation between ulna + and Distal Radial Physeal Injury To protect our young athletes for chronic injury

35 Introduction to a prospective study protocol in elite gymnast Questionnaire Questionnaire Physical examination Physical examination Training volume, Training intensity Training volume, Training intensity Rate of growth, endocrinal follow up Rate of growth, endocrinal follow up Standard RX Standard RX Screening with MRI Screening with MRI Control group Control group

36 Distal Radial Physeal Injury Thank you


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