Growth, loading put gymnasts' wrists at risk
NEW YORK (Reuters Health) - Young gymnasts, especially young female gymnasts, are at risk of several types of wrist injury, and a quick and accurate diagnosis is essential to prevent these injuries from worsening, two sports medicine physicians report.
"Prevention should also be an important aspect of a gymnast's training regimen," Drs. Brian G. Webb and Lance A. Rettig of the Indiana University School of Medicine in Indianapolis advise in Current Sports Medicine Reports.
This may include gradually increasing the amount of weight an athlete bears on the wrist, refraining from heavy wrist "loading" during growth spurts, and using orthotics to support the joint, they suggest.
Elite athletes who begin training in early childhood and practice for several hours a day during peak growth periods are more likely to be injured than lower-level gymnasts, Webb and Rettig say. The wrist is the most common upper extremity injury for female athletes, they add, noting that the joint must support up to 16 times an athlete's body weight during particularly stressful injuries, such as floor routines, vaulting, and balance beam routines.
According to Webb and Rettig, the most common is stress injury to the growth plate of the radius, one of the two bones of the forearm (along with the ulna). If this injury is diagnosed before changes to the growth plate visible on X-rays have occurred, rehabilitation is much easier, they note. Treatments include strengthening exercises and bracing once the athlete returns to practice and competition.
Other relatively common injuries include scaphoid impaction syndrome, in which this cashew-shaped wrist bone jams against the edge of the radius. The injury is typically treated with rest, but surgery may be required.
Another is dorsal impingement, in which the back edge of the radius impinges on the wrist bones. Treatment with rest, splinting, non-steroidal anti-inflammatory drugs and injection usually is successful, although, again, surgery may be necessary if these more conservative approaches don't help, Webb and Rettig say.
Casting had previously been the treatment of choice for fracture of the scaphoid bone, the most frequently injured wrist bone, but using screws can help the fracture heal more quickly and allow a faster return to practice, Webb and Rettig say.
The most commonly injured wrist ligament is the scapholunate interosseous ligament, and because of the relatively low level of pain it produces, athletes may have the injury for a significant amount of time before seeing a doctor, according to the investigators. Arthroscopy may be performed to evaluate the injury and determine if repair or reconstruction is needed.
"It is important to quickly and accurately diagnose the specific injury to expediently initiate the proper treatment and limit the extent of injury," Webb and Rettig conclude.
SOURCE: Current Sports Medicine Reports, September/October 2008.
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