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Physiotherapists And Doctors Services - Wrist Pain

 

Radial Epiphyseal Injury. Wrist Pain – compression injury to growth plate of radius bone at wrist

Presentation

- Pain in wrist/end of forearm. Worse with extension and support loading.

Contributing factors

- Young athlete – 8-14 years old - increased volume support loading wrist

Key management points

- Reduce overall loading aggravating activity
- Can resume loading with some pain, so long as no alteration of technique (e.g. limp/loss of power etc)
- Seek review of Sports Physician for confirmation of diagnosis – plain X-rays and possibly MRI
- Seek physio advice for confirmation of diagnosis, identification of possible contributing factors   

Management strategy

- Identify periods of increased growth (spurts) and reduce overall training loads until spurt over
- If findings of growth plate changes on investigations → must restrict loading completely for timeframes outlined by Sports Physician and Physiotherapist
- If no findings on investigations, unload until symptoms cease - reduce overall volume of aggravating apparatus/skill.
- Keep diary of activity levels → if symptoms increasing, reduce overall activity levels until pain begins to subside
- Address all areas of flexibility and conditioning to minimise loads on wrist (e.g. if ‘stiff’ or tight at shoulders, wrist may attempt to compensate to make up deficit causing overload at wrist)
- Assess technique and body posture during static and dynamic skills/drills to determine contributing factors (global flexibility, pelvic/trunk/scapula/forearm control)
- Use ‘Panda Paws’, wrist blocks, tape etc to control/limit wrist extension
- Ice baths post training if symptomatic
- Continue mid body and lower body programs    

Flexibility

- Thoracic flexibility
- Hip flexors
- Wrist flexors
- Triceps
- Lat dorsi
- Shoulder internal rotation

Strength/conditioning

- Trunk endurance exercise all planes of support
- Scapula conditioning all planes of support – hang/handstand/front/side/back
- Wrist conditioning

CV fitness

- Normal program

Physiotherapy

- Mobilisation of any joints above and below wrist possible contributing towards overload of wrist, and progression of conditioning exercises, review of suitable training progressions and timelines

Return to sport

- When given all-clear by doctor/physiotherapist - progression and increased loading depending on pain. If pain levels reduced to level allowing normal function, can resume activity. If pain increases then athlete to reduce overall volume of loading of aggravating activity.

Key management points

- Follow up with Sports Physician for investigation of possible growth plate involvement in wrist pain
- Seek physio advice for confirmation of diagnosis, identification of possible contributing factors, management outline   
- Unload wrist as per management advice doctor/physio
- Rehab to identify contributing factors to overload (see ‘Management Strategy’)
- Coaches to monitor ‘growth spurts’

 
 
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