Author: James Sullivan, MD
Co Author #1: James Sullivan, MD
Co Author #2: Roberta Dennison, MD
Senior Editor: Marc Hilgers, MD, PhD, FAMSSM
Editor: Amy Leu, DO

Patient Presentation:
A 12-year-old female gymnast presents to the sports medicine clinic for evaluation of right wrist pain for the past 4 months.

History:
The patient is a level 4 gymnast and was on the uneven bars when she heard a pop and felt immediate pain to the dorsal aspect of her wrist. Her wrist had been gradually bothersome for a few months prior but acutely worsened at this moment. She did not develop any erythema, ecchymosis, or edema, but the pain persisted into the next couple days, so her parents brought her to the primary care clinic. There, radiographs of her wrist were negative and she happily proceeded home to rest. She returned to gymnastics a couple weeks later, but her discomfort returned immediately. She reports pain with weight-bearing activities and worries that she will not be able to compete for level 5 status.

Physical Exam:
Inspection: No skin changes, symmetric muscle tone and bulk.

Palpation: There is a 0.5cm mass on the dorsal surface of the right carpal bones that is minimally tender to palpation. No bony tenderness to palpation of her hand or her wrist, including distal radius/ulna.

ROM: Full flexion at the wrist. Lacks a couple degrees of extension of the wrist relative to the left. Noted discomfort with flexion, extension, pronation, and supination of the right wrist.

Strength: Good grip strength bilaterally. Equal and 5/5 strength with flexion, extension, pronation, and supination of bilateral wrists.

Special Tests: Negative scapholunate instability on Watson's test

Neurovascular: 1+ radial pulses bilaterally, equal sensation of radial, median, and ulnar distributions of hand. AIN, PIN intact.

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