Abstract
ObjectiveTo explore the use of quantitative volume assessment to identify the presence and extent of stress-related changes of the distal radial physis in gymnasts with suspected physeal injury, asymptomatic gymnasts, and non-gymnasts.MethodsSymptomatic gymnasts with clinically suspected distal radial physeal injury, asymptomatic gymnasts, and non-gymnasts (n = 69) were included and matched on skeletal age and sex. Volume measurements were performed on coronal water selective cartilage MRI images by creating three-dimensional physeal reconstructions semi-automatically using active-contour segmentation based on image-intensity thresholding. Inter- and intra-rater reliability of the measurements were assessed using intra-class correlation coefficients (ICC) for absolute agreement.ResultsTwenty-seven symptomatic-, 18 asymptomatic-, and 24 non-gymnasts were included with a median age of 13.9 years (interquartile range (IQR) 13.0–15.0 years). Median physeal volume was significantly increased (p < 0.05) in symptomatic- (971 mm3, IQR 787–1237 mm3) and asymptomatic gymnasts (951 mm3, IQR 871–1004 mm3) compared with non-gymnasts (646 mm3, IQR 538–795 mm3). Inter-rater (ICC 0.96, 95% CI 0.92–0.98) and intra-rater (ICC 0.93, 95% CI 0.85–0.97) reliability of volume measurements were excellent. Of the 10 participants with the highest physeal volumes, nine were symptomatic gymnasts.ConclusionIncreased volume of the distal radial physis can reliably be assessed and is a sign of physeal stress that can be present in both symptomatic- and asymptomatic gymnasts, but gymnasts with suspected physeal injury showed larger volume increases. Future studies should explore if volume assessment can be used to (early) identify athletes with or at risk for physeal stress injuries of the wrist.Key Points• The volume of the distal radial physis can be reliably assessed by creating three-dimensional physeal reconstructions.• Stress-related volume increase of the distal radial physis is present in symptomatic and asymptomatic gymnasts.• Gymnasts with clinically suspected physeal injury showed larger volume increases compared with asymptomatic gymnasts and may therefore be a valuable addition in the (early) diagnostic workup of physeal stress injuries.
Highlights
Wrist overuse injuries are prevalent among gymnasts [1]
As a consequence, using the proximal physis of MC-1 as a within-patient reference physis may be beneficial to determine if an increased distal radial physeal thickness can be attributed to maturational status or stress applied to the wrist and avoid the interference of skeletal age in interpretation of distal radial physeal thickness in gymnasts [10]
We evaluated the volume of the proximal physis of MC1 using the method proposed by Kox et al in the diagnostic workup of suspected pathology of the distal radial physis, comparing distal radial physeal thickness to the thickness of the proximal physis of MC-1 [10]
Summary
Wrist overuse injuries are prevalent among gymnasts [1]. In youth gymnasts, the distal radial physis is regularly damaged as the growth cartilage is less resistant to (repetitive) stress than surrounding structures [2, 3]. In morphological assessment of radial physeal stress injury, a comparison to the patients’ proximal physis of the first metacarpal bone (MC-1) has been proposed [10]. Maturational status influences both of these physes; the proximal physis of MC-1 is less subject to axial stress during gymnastics. As a consequence, using the proximal physis of MC-1 as a within-patient reference physis may be beneficial to determine if an increased distal radial physeal thickness can be attributed to maturational status or stress applied to the wrist and avoid the interference of skeletal age in interpretation of distal radial physeal thickness in gymnasts [10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
