Bilateral Wrist Pain In A Teenage Gymnast - Page #1

Author: Shelby Johnson, MD
Co Author #1: David B. Soma, MD
Co Author #2: Mark S. Collins, MD

Patient Presentation:
A 14 year-old female gymnast presented to clinic with nine months of progressive bilateral dorso-radial wrist pain. She denied any acute wrist injury or trauma. The pain was worse with any wrist movement and most severe with forced wrist extension. She denied swelling, weakness, or paresthesias. At the time of presentation she was training up to 20 hours per week. She did take a month off of gymnastics prior to presentation with some improvement in her symptoms however her pain worsened when she returned to sport. Of note, the patient also reported three years of left knee pain after a vaulting injury and was ultimately found to have a chronic ACL tear that required reconstruction.

No significant past medical or surgical history.

Physical Exam:
General: Short stature
Inspection: Prominence of ulnar heads. Volar displacement of the hands and carpal bones
Palpation: Tender over distal radial physes. No snuff box tenderness
ROM: Full, symmetric range of motion. Pain with passive wrist extension
MSK: Negative DRUJ ballotment test, negative fovea sign, negative Watson test
Neuro: Strength intact. Pain with resisted wrist extension and ulnar deviation. Sensation intact.
The above findings were all bilateral.

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