Joe A Shaw PA-C - 7/25/2008

Question
Hi. My 10 year old daughter does competitive gymnastics (10 hrs/week) and has been suffering from wrist pain, mostly when she is supporting her weight on her hands in a flexed position when tumbling and vaulting, although it seems to hurt when you push on certain areas on the side of her wrist too. She's been seeing a local ortho doctor who has done a couple of x-rays and a MRI, which he said showed some low level stress responses but no fracture or cyst. He says he's confident that she is suffering from overuse and aggravation of her growth plate. She has grown a ton in the last year and a half. He's recommended a period of rest with no weight bearing activity during which time he says the condition should return to normal. She's done over 6 weeks of rest with no improvement. I guess my question is how long does it typically take before it will start to feel better? Her doctor said we could get a 2nd opinion with a hand surgeon to see if they would pick up on something that maybe he missed, but I don't know that I want to pursue that yet. At this point, we don't have another follow-up scheduled with the current doctor. We are going to do another few weeks of rest and then call back if it's not getting better. Without seeing her, do you think this is the right course of action?

Also, I forgot to ask her doctor when we were there earlier this week if there would be any benefit of doing some wrist strengthening exercises. I've checked some out online, but it I didn't know if they would help any or whether or not they would just further aggravate things.

Answer
Leslie,
Yes, I think your ortho is correct. You probably mean that she has pain with hyperextending her wrist, like in a handstand? (not flexing) flexing the wrist is when you turn it inwards. They are confusing terms because the backside of ones hand is the dorsal side (think dorsal fin on a shark-on the topside) so sometimes hyperextension is called dorsiflexion vs palmarflexion which is bending wrist inwards (towards the palm). I just give you this so when docs throw these terms around or when you read something it will make sense.

This condition is pretty common in young girls called "gymnast's wrist" or dorsal wrist impingement syndrome. You do want to make sure that there are no joint abnormalities where the wrist bones meet the ends of the forearm bones (ulnar/radial bones) and by seeing an ortho I think he would know that. The lay-off period will vary greatly..it may take 3-6 months depending on how much stress or damage there is to the growth plates. The hand wrist exercises are a good idea, but should generally be started after the pain phase..hopefully you can find a PT who has worked w gymnasts. You may find that ice/heat wrist wraps will help and are a lot less fuss than zip lock bag and ice cubes. Ice 2-3 x day 10-15 mins followed by moist heat for 5 mins. Also since the wrist joint is so close to the surface, some patients find pain relieving creams and gels help..like biofreeze and orthogel. (just don't put on before moist heat and don't get in eyes) I will leave a few links below. Good luck

http://www.hughston.com/hha/pdf/vol15no4.pdf

http://www.carpal-tunnel-symptoms.com/carpal-tunnel-store.html