Radial Epiphyseal Stress Reaction

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Original Editor - Trista Chan
Top Contributors - Trista Chan and Carina Therese Magtibay

Introduction

Radial epiphyseal stress reaction is a common overuse injury affecting skeletally immature athletes engaged in high-impact sports. It is particularly common among gymnasts, thus it is also known as the ‘gymnast’s wrist’.

Clinically Relevant Anatomy

 Radial epiphyseal stress reaction involves the distal radial physes (also called growth plates), which is located at the end of the long bone where secondary ossification centres for growth and development occur . The growth plates are especially susceptible to injuries in children and adolescents.

Mechanism of Injury / Pathological Process

Activities that put repetitive compressive, shearing, distraction and torsional forces through the distal radial epiphysis, such as handstands, somersaults and handsprings, increase the risk of growth arrest in this population.

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. Wrist instability may also be evident.

Diagnostic Procedures

Diagnostic procedures for gymnast wrist typically involve a combination of clinical assessment and imaging. Clinical assessment includes comprehensive medial history, reported symptoms and physical examination. The athlete is then often referred for radiographic or MRI scan if injury to the growth plate is suspected. Diagnostic criteria include:

• 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

• Patient Specific Functional Scale
• Visual Analogue Scale
• Faces Pain Scale for younger children
• DASH Outcome Measure

Management / Interventions

Management of the gymnast wrist often involves a multidisciplinary team approach, including orthosurgeons, peadiatricians, physiotherapists, and coaches.

Differential Diagnosis

• Salter Harris V stress fracture
• Distal radius fracture
• Keinbock's disease
• Joint instability