Wrist Injury - Tennis

Abstract

HISTORY: A 14 year old male tennis and hockey player presented to Sports Medicine with right wrist pain of 6 weeks duration located over the radial aspect of the wrist. He had fallen on an outstretched arm 7-8 weeks prior while playing doubles, but was able to complete the match and play several more matches that day and the following day with only minimal pain. About a week after the fall, his wrist pain began; he is not sure if it was the same pain he had experienced briefly after the fall. The pain was aggravated the more he played tennis and relieved by several days of rest. The pain mainly occurred as he was coming through in pronation on the follow through of his forehand. The pain gradually became more severe until the patient could hardly play any tennis due to pain. He was also unable to stick handle or shoot in hockey without pain. He had not played tennis or hockey for 2 weeks prior to presentation. PHYSICAL EXAMINATION: Examination revealed mild tenderness over the distal radius and the radial gutter. Range of motion was full without pain. He had pain with resisted pronation. Strength of the wrist was otherwise normal. There was no evidence of swelling and sensory examination was normal. DIFFERENTIAL DIAGNOSIS: Impaction fracture of the radius Scaphoid fracture Scapholunate dislocation/ligamentous sprain Tendinitis first or second dorsal compartment Interosseous membrane sprain TEST AND RESULTS: X-ray wrist - increased sclerosis of the distal radius and ulnar metaphysis adjacent to the growth plate. MRI wrist - signal abnormality and focal irregularity in the distal radial metaphysis and physis most suggestive of stress reaction. Small ganglion cyst along the radiocarpal joint in the volar aspect of the wrist. No evidence of a Salter fracture. Contents of the carpal tunnel are normal. FINAL WORKING DIAGNOSIS: Distal radial physeal stress reaction (gymnast’s wrist) TREATMENT AND OUTCOMES: Patient was placed in a short arm cast for 4 weeks. As it was hockey season when the cast came off, he was placed in a formfit wrist splint for hockey and started a gradual return to sports. So far the patient has had minimal pain with hockey, but further outcomes will be discussed at the conference. Since this is an injury which typically occurs in adolescent gymnasts, we will discuss the possible mechanism of this injury with tennis.