Distal Radial Epiphysitis

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 3 min read
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Article Summary

Gymnast wrist (distal radial epiphysitis) is a term used to describe an overuse injury involving the growth plate of the radius (the forearm bone that connects to the wrist). It usually appears during a period of increased intensity of gymnastic activity, such as when a gymnast moves to a higher competitive level. Resistance band exercises include rows, shoulder extension, diagonals, and internal/external rotation. Tricep extension with...

Key Takeaways

  • This article explains Other Names in simple medical language.
  • This article explains Pathophysiology in simple medical language.
  • This article explains Risk Factors in simple medical language.
  • This article explains Differential Diagnosis in simple medical language.
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Gymnast wrist (distal radial epiphysitis) is a term used to describe an overuse injury involving the growth plate of the radius (the forearm bone that connects to the wrist). It usually appears during a period of increased intensity of gymnastic activity, such as when a gymnast moves to a higher competitive level. Resistance band exercises include rows, shoulder extension, diagonals, and internal/external rotation. Tricep extension with band or hand weight. Bicep curls with band or hand weight. Gradual return to weight-bearing exercises including push-ups, planks, and handstands can be added when the athlete is pain-free.

Gymnast’s wrist is irritation and infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation of the growth plate (epiphysis) at the end of the radius (forearm bone), where it connects to the hand to form the wrist. The growth plate is made up of cartilage, which is softer and more vulnerable to injury than mature bone.

Gymnast’s wrist is an overuse injury that occurs in up to 40 percent of young gymnasts. It usually appears during a period of increased intensity of gymnastic activity, such as when a gymnast moves to a higher competitive level. Impact activities like tumbling and vaulting put a large amount of compressive force on the growth plate in the wrist.

Other Names

  • Gymnast’s Wrist
  • Distal Radial Physeal Stress Syndrome
  • Radial Epiphysitis

Pathophysiology

  • General
    • Can be considered a chronic type 1 Salter-Harris Fracture
  • Wrist experiences excessive loads due using wrist as a weight-bearing joint
  • The repetitive stress leads to infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation of the physis
  • Microtrauma can lead to premature fusion of physis and excessive overgrowth of Ulna
  • Traction vs stress injury

Risk Factors

  • Sports
    • Gymnastics
      • Especially in uneven parallel bars, vault, balance beam, and floor exercises
    • Weight-Lifting
    • Rock Climbing

diagnosis: Differential diagnosis is a list of possible conditions that may explain symptoms. সহজ বাংলা: একই লক্ষণের সম্ভাব্য রোগের তালিকা।" data-rx-term="differential diagnosis" data-rx-definition="Differential diagnosis is a list of possible conditions that may explain symptoms. সহজ বাংলা: একই লক্ষণের সম্ভাব্য রোগের তালিকা।">Differential Diagnosis

  • Fractures
    • Distal Radius Fracture
      • Barton’s Fracture
      • Chauffer’s Fracture
      • Colles’ Fracture
      • Die-Punch Fracture
      • Radial Styloid Fracture
      • Smith’s Fracture
    • Distal Ulna Fracture
    • Carpal Fractures
      • Scaphoid Fracture
      • Lunate Fracture
      • Triquetrum Fracture
      • Pisiform Fracture
      • Trapezium Fracture
      • Trapezoid Fracture
      • Capitate Fracture
      • Hamate Fracture
    • Essex Lopresti Fracture
  • Dislocations
    • Carpometacarpal Joint Dislocation
    • Distal Radioulnar Joint Dislocation
    • Lunate Dislocation
    • Perilunate Dislocation
  • Instability & Degenerative
    • Scapholunate Instability
    • Lunotriquetral Instability
    • Scaphoid Nonunion Advanced Collapse
    • Distal Radial Ulnar Joint Instability
    • Kienbocks Disease
  • Tendinopathies & Ligaments
    • De Quervain’s Tenosynovitis
    • Intersection Syndrome
    • TFCC Injury
    • Wrist Tendinopathies
    • Extensor Carpi Ulnaris Instability
  • Neuropathies
    • Carpal Tunnel Syndrome
    • Pronator Teres Syndrome
    • Anterior Interosseus Nerve Syndrome
    • Posterior Interosseus Nerve Syndrome
    • Guyon Canal Syndrome
  • Pediatric Considerations
    • Distal Radial Epiphysitis (Gymnast’s Wrist)
    • Torus Fracture
  • Arthropathies
    • Wrist pain and stiffness. সহজ বাংলা: বয়স/ক্ষয়ের কারণে জয়েন্টের ব্যথা।" data-rx-term="osteoarthritis" data-rx-definition="Osteoarthritis is wear-and-tear joint disease causing pain and stiffness. সহজ বাংলা: বয়স/ক্ষয়ের কারণে জয়েন্টের ব্যথা।">Osteoarthritis
    • Rheumatoid Arthritis
  • Cartilage
    • Osteochondral Defect
  • Vascular
    • Hypothenar Hammer Syndrome
  • Other
    • Ganglion Cyst of Wrist
    • Ulnar Impingement Syndrome
    • Infectious Tenosynovitis

Clinical Features

  • History
    • Age 10 to 14
    • Gradual onset
    • Dorsal radial sided wrist pain, worse in extension
    • Worse with axial stress loading (vaulting, hand-walking)
  • Physical Exam: Physical Exam Wrist
    • Tenderness, swelling to the distal radius
    • Loss of range of motion may be present
    • Pain with hyperextension and axial loading

Radiographs

  • Standard Radiographs Wrist
    • 3 view radiographs initial imaging modality of choice
  • Findings
    • May see widened, irregular growth plate
    • Metaphyseal and epiphyseal sclerosis, irregularity
    • In more chronic patients, positive ulnar variance

MRI

  • Indicated in refractory or chronic patients
    • Findings
    • Paraphyseal edema
    • Bridging
    • Bone edema

Treatment

Nonoperative

  • Indications
    • Most athletes
  • Rest from the offending activity
    • While in cast
    • Gradual RTP
  • Immobilization for at least 6-8 weeks, sometimes 3-6 months
    • Consider Short Arm Cast, Radial Gutter Cast
  • Prevention
    • Manage load and volume
    • Strength and flexibility exercises
    • Proper technique

Operative

  • Indications
    • Refractory conservative management
    • Late presentation
  • Procedures
    • Resection of physical bridge
    • Ulnar epiphysiodesis, shortening with radial osteotomy
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