Rehabilitating the Pediatric Gymnast s Wrist. Justine LaPierre, MS, OTR/L March 1, 2019

Transcription

1 Rehabilitating the Pediatric Gymnast s Wrist Justine LaPierre, MS, OTR/L March 1, 2019

2 Gymnast Wrist Distal Radial Physeal Stress Syndrome Caused by repetitive loading forces Symptomatic for dorsal wrist pain, worse with loading Vague injury history DiFiori et al., 2006; Cornwall, 2010; Bednar, 2015; Kozin & Abzug, 2016

3 The World of a Gymnast Forces through a gymnast s wrist can be 2-16x their body weight (DiFiori et al, 2002) 70% of female gymnasts have wrist pain (Bednar, 2015) including 50% of beginner and midlevel young gymnasts (DiFiori et al, 2002) I just can t wait to do a handstand again.

4 Injury Prevention Regular wrist stretching and strengthening Orthotic options for sport Rigid taping to restrict wrist hyperextension Planning athletic demands over time for joint preservation Hermann Wright & Rettig 2002; Difiori et al., 2006; Kozin & Abzug 2016

5 Tiger Paws Injury Prevention EZY ProBrace ess.com/category/wristhand/

6 Evaluation Pain Sensibility Range of Motion Strength Conservative Management ADL / functional status Interview Canadian Occupational Performance Measure (COPM) Patient Rated Wrist and Hand Evaluation (PRWE) Knowledge Deficit Caregivers and patient

7 Intervention Rest Conservative Management Duration of rest period will vary May include forearm based wrist cock-up for immobilization if symptomatic in non-gymnastic activities Education Respect the pain! Activity modification Eliminate mats that are too soft Address technique Hermann Wright & Rettig 2002; Difiori, 2006; Bednar, 2015; Kozin, 2016

8 Conservative Management Intervention Gradual return to sport Pain free range of motion Reduction in training schedule Targeted strengthening Hermann Wright & Rettig 2002; Difiori, 2006; Kozin,

9 Conservative Managment Intervention Gradual return to sport Closed chain activity to promote proprioception and stability Slowly progress loading activities and forces Hermann Wright & Rettig 2002; Difiori, 2006; Kozin,

10 Conservative Management Intervention Gradual return to sport

11 Conservative Management

12 Surgical Management Therapist s role s/p ulnar shortening osteotomy, distal ulnar epiphysiodesis, or arthroscopic wafer procedure Orthosis fabrication upon cast removal Follow similar rehab progression for return to sport

13 Summary Consider early intervention via prevention education to support long term joint integrity in the wrist of the pediatric gymnast Post injury or post surgical treatment, implementing the appropriate rest period is the first priority Afterward, the hand therapist can guide gradual strengthening and loading activities in the clinic, for safe return to sport

14 References Bednar, M. S. (2015). The gymnast. In J. M. Abzug, S. H. Kozin, & D. A. Zlotolow (Eds.), The Pediatric Upper Extremity (Vol. 2, pp ). New York, NY: Springer. doi: / _75 Chawla, A., & Wiesler, E. R. (2015). Nonspecific wrist pain in gymnasts and cheerleaders. Clinics in Sports Medicine, 34(1), doi: /j.csm Cornwall R. (2010). The painful wrist in the pediatric athlete. Journal of Pediatric Orthopedics. 30, S13-S16. DiFiori, J. P., Caine, D. J., & Malina, R. M. (2006). Wrist pain, distal radial physeal injury, and ulnar variance in the young gymnast. Yearbook of Sports Medicine, 34(5), doi: /s (08)70045-x DiFiori, J.P., Puffer, J.C., Aish, B., & Dorey, F. (2002). Wrist pain in young gymnasts: Frequency and effects upon training over 1 year. Clinical Journal of Sports Medicine, 12(6):348-53

15 References Frank, S. (2016, September 7). Column: Healing wrist pain in young gymnasts. Retrieved December 22, 2016, from Grant-Ford, M., Silter, M.R., Kozin, S.H., Barbe, M.F., & Barr, A.F. (2003). Effect of a prophylactic brace on wrist and ulnocarpal joint biomechanics in a cadaveric model. American Orthopaedic Society for Sports Medicine, 31(5), Kozin, S. H., & Abzug, J. M. (2016). Wrist injuries in the immature athlete. Operative Techniques in Sports Medicine, 24(2), doi: /j.otsm Mariscalco, M, & Saluan, P. (2011). Upper extremity injuries in the adolescent athlete. Sports Medicine Arthroscopy Review, 19, Herman Wright, H, & Rettig, A.C. (2002). Chapter 128: Management of common sports injuries. In Mackin, Callahan, Skirven, Schneider, & Osterman (Eds.), Rehabilitation of the Hand and Upper Extremity (5th ed., Vol. 2, pp ). Philadelphia, PA: Mosby.

16 Thank you! Justine LaPierre MS, OTR/L