Jerry Raphael Dwek MD, Abstract Co-Author: Nothing to Disclose

Christine B. Chung MD, Abstract Co-Author: Nothing to Disclose

Fabiano Nassar Cardoso MD, Presenter: Nothing to Disclose

Introduction: In the pediatric athlete, stress related physeal changes and their MR imaging appearance are commonly encountered in characteristic locations that are activity specific. In the gymnast, one such injury has been well described in the distal radial physis with characteristic imaging findings. However, a spectrum of overuse injuries, some of which have been rarely reported in the radiology and orthopedic literature, can be encountered in the gymnast’s hand and wrist. Objective: To demonstrate the MR imaging appearance of a spectrum of overuse injuries in the skeletally immature wrist and hand of gymnasts ranging from those commonly encountered in the literature, to those rarely reported.

Materials and methods: A total of 125 MR exams of the hand and wrist in skeletally immature patients were performed at a single institution over a 2 year period. Clinical histories of MR imaging examinations were reviewed to determine whether patients were gymnasts. MR imaging studies of that subpopulation were reviewed for the presence of osseous or soft tissue lesions. MR imaging protocols included: T1-weighted coronal and axial, T2-weighted fat-suppressed coronal, axial and sagittal, and coronal gradient sequences. All MR imaging studies were reviewed by a pediatric radiologists with both pediatric and musculoskeletal subspecialty training.

Results: Of these 125 MR studies performed, 12 were in gymnasts who presented with chronic wrist or hand pain. Abnormalties included 2 cases of metacarpal head necrosis, bilateral focal lunate necrosis at the scapholunate ligament attachment in a single patient (arthroscopic correlation available on both sides), 4 cases of chronic physeal stress injury involving the distal radial physis, and triangular fibrocartilage tears in 4 patients.  

Conclusions: A wide variety of soft tissue and osseous lesions can be encountered in the high performance skeletally immature gymnast. Familiarity with these stress-related injuries is important for accurate diagnosis and characterization.  

MR imaging is an important modality in the analysis of a wide variety of osseous and soft tissue injuries which can occur in the skeletally immature, high performance gymanst.

Dwek, J, Chung, C, Cardoso, F, MR Imaging of Overuse Injuries in the Skeletally Immature Gymnast: Spectrum of Soft Tissue and Osseous Lesions in the Hand and Wrist.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6019493.html