Mandelbaum B R, Bartolozzi A R, Davis C A, Teurlings L, Bragonier B
Division of Orthopaedic Surgery, UCLA School of Medicine.
Am J Sports Med. 1989 May-Jun;17(3):305-17. doi: 10.1177/036354658901700301.
Gymnast wrist pain syndrome presents a difficult diagnostic and therapeutic challenge. It is common and debilitating among gymnasts, resulting in a reduction in training and performance, and may be the result of a response to repetitive trauma during the period of growth and development. This study was undertaken to define and characterize factors contributing to the causes and development of gymnast wrist pain and to establish an effective means of systematic and comprehensive evaluation and treatment. Thirty-eight collegiate gymnasts (20 UCLA: 9 female, 11 male; 18 NCAA: all male) were evaluated by radiograph and questionnaire. Seventy-five percent (22) of the males and 33% (3) of the females had had wrist pain for at least 4 months. The UCLA males averaged 2.82 +/- 1.94 mm positive ulnar variance; this was significantly greater than that of the NCAA males, who averaged 1.28 +/- 1.02 mm (P less than 0.02). The UCLA females averaged 1.44 +/- 1.88 mm positive ulnar variance. All of the gymnasts had significantly greater variance than had the controls, who averaged -0.52 mm (P less than 0.0001). The pommel horse routine was consistently responsible for wrist pain among the males. Anatomical and histological correlation of cryosections with magnetic resonance imaging (MRI) was performed to establish the usefulness of MRI in the diagnosis of wrist pain. MRI was able to differentiate the complex transitions between cortical and trabecular bone, articular surfaces, the ligaments, and the triangular fibrocartilage (TFC) complex of the wrist joint. A therapeutic algorithm was established to facilitate the evaluation and management of gymnast wrist pain. Arthroscopic surgery was successful, and arthroscopic findings correlated well with those of MRI and arthrography. Prospective studies are now underway in the pediatric and adolescent population to define further the causes and development of wrist pain problems in gymnasts.
体操运动员腕痛综合征带来了诊断和治疗方面的难题。它在体操运动员中很常见且使人衰弱，导致训练和成绩下降，可能是生长发育期间反复创伤反应的结果。本研究旨在确定和描述导致体操运动员腕痛的病因及发展的因素，并建立系统全面评估和治疗的有效方法。通过X线片和问卷调查对38名大学体操运动员（20名加州大学洛杉矶分校：9名女性，11名男性；18名美国大学体育总会：均为男性）进行了评估。75%（22名）男性和33%（3名）女性有腕痛至少4个月。加州大学洛杉矶分校的男性平均尺骨正向变异为2.82±1.94毫米；这显著大于美国大学体育总会男性的平均值1.28±1.02毫米（P<0.02）。加州大学洛杉矶分校的女性平均尺骨正向变异为1.44±1.88毫米。所有体操运动员的变异均显著大于对照组，对照组平均为-0.52毫米（P<0.0001）。鞍马动作始终是男性腕痛的原因。对冷冻切片与磁共振成像（MRI）进行解剖学和组织学相关性分析，以确定MRI在腕痛诊断中的效用。MRI能够区分腕关节皮质骨和小梁骨、关节面、韧带以及三角纤维软骨（TFC）复合体之间的复杂转变。建立了一种治疗方案以促进体操运动员腕痛的评估和管理。关节镜手术成功，关节镜检查结果与MRI和关节造影结果相关性良好。目前正在儿科和青少年人群中进行前瞻性研究，以进一步确定体操运动员腕痛问题的病因及发展情况。
