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Gymnast Wrist Dr. Kris Buedts, Dr Yo Baeten

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Presentation on theme: "Gymnast Wrist Dr. Kris Buedts, Dr Yo Baeten"— 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 General considerations Case Reports
Outline of a prospective study protocol in elite gymnasts

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

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

5 Wrist pain Floor Exercises

6 Wrist pain Balance Beam

7 Wrist pain Pommel Horse

8 Wrist pain Vaulting

9 Wrist pain Wrist pain for several months is common
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

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

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

13 Wrist Pain Distal Radius Physeal stress reaction

14 Wrist pain Stress fracture of the scaphoid

15 Wrist pain Scaphoid impaction syndrome and scapholunate area injury

16 Wrist pain Ulnar Impaction syndrome

17 Wrist pain Avascular necrosis of the capitate

18 Wrist pain Distal Radius Physeal arrest

19 Wrist pain Triquetrolunate impingement

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

21 Point of interest The Immature wrist :
Distal Radius Physeal stress reaction 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
Short Statue Leanness More proprioceptif training More ulnar sided wrist pain Boys Power training More repetition Less proprioceptif training More dorsal sided wrist pain

23 Wrist degeneration Ulnar wrist pain Madelung like deformity
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
Training equipment Cleaning of bars Bracing Nutritional advice Coaching

25 One Exception Puberal Boys and girls Age Group 12- 15 years
Initiation to training : <5.6Y> High training intensity Fysionomy Small stature Delayed puberty Out of Control

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

27 Case Report

28 Distal Radial Physeal Injury
Biomechanics - 80% of load is borne by the radius in the extended wrist, Palmer et al, J Hand Surg 1982 - Shortening of the ulna increases the load borne by the radius - open physis : <mean ulnar variance> - 2 mm Hafner et al, Skeletal rad, 1989

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

31 Distal Radial Physeal Injury
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 Distal Radial Physeal Injury

34 Introduction to a prospective study protocol in elite gymnast
Purpose To determinate mean velocity age of onset To determinate wrist side involvement To determinate <Ulna -> 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 Physical examination Training volume, Training intensity Rate of growth, endocrinal follow up Standard RX Screening with MRI Control group

36 Distal Radial Physeal Injury
Thank you

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