Seven cases of osteochondrosis of the capitellum occurring in five high performance female gymnasts between the ages of 11 and 13 are presented. Two of the patients were treated by surgical excision of the loose osteochondral fragment in three elbows. Four of the five gymnasts, including the two who underwent surgical treatment, were able to return to full workouts without recurrence of symptoms within the 3 year followup. All conditions in gymnasts were detected after symptoms had presented. A survey of 37 actively competing gymnasts at a nationally known gymnastics academy was performed, including a detailed history and physical examination and radiographic examination. No other cases of osteochondrosis were detected. It was postulated that this condition represents a lateral compression injury because of repetitive valgus overload. Investigation of the capitellar blood supply indicates that the common factors in osteochondrosis of the capitellum are repetitive or prolonged trauma to a vulnerable epiphysis on a basis of vascular interruption. Gymnastics maneuvers require forceful weight-bearing through the upper extremities. Medical personnel and coaches associated with gymnastics need to be aware of the condition of osteochondrosis of the capitellum so that any gymnast who presents with a painful, tender, swollen or locked elbow is appropriately investigated and treated.
Between 1980 and 1983, 21 young, high-performance gymnasts with stress changes related to the distal radial epiphysis, were treated and followed for a mean of 24 months (range, 6 to 42 months). Eleven of the gymnasts presented with roentgenographic changes of the distal radial epiphysis, and in these recovery took at least 3 months. This group was compared to a group of ten gymnasts who had similar symptoms but no roentgenographic changes, and who recovered within an average of 4 weeks. The roentgenographic changes, which are described in detail, are considered to represent stress changes, possibly stress fractures, of the distal radial epiphysis. No residual growth-related problems have been observed. Possible etiologic factors are discussed, and the literature as it pertains to stress-related adaptation and injury in the growing athlete is reviewed.
Time loss from participation is often used to define injury, but one physician uses different criteria in evaluating wrestlers.
We conducted a radiographic survey to determine skeletal age and the nature and prevalence of stress-related changes affecting the distal radial growth plate in 60 young competitive gymnasts (39 females, 21 males). Comparison of results for chronological and skeletal age revealed a significant delay in maturation for girls (P less than 0.001). Radiographic evaluation revealed 5 gymnasts (4 girls and 1 boy) with stress-related changes of the left wrist, and four of these were considered to be minimal. These results, in conjunction with our previous findings and the review of related literature, reveal three important observations. First, the widening and irregularities of the distal radial physis that we described previously appear to be the first in a spectrum of abnormal changes secondary to overuse and probably represent a stress fracture of the distal radial growth plate. The radiographic changes associated with this injury are not the normal adaptive changes seen in young, competitive gymnasts. Secondly, more serious long-term abnormality may result even though the injury may initially resemble a Salter-Harris type I or II stress fracture. Long-term complications may include symmetrical or asymmetrical retardation or halted growth at the affected site, positive ulnar variance, and associated pathoanatomic sequelae. Thirdly, the incidence of distal radial growth plate stress injury remains unclear; we recommend a further, large-scale prospective epidemiologic study involving both male and female gymnasts. We urge that physicians and other health professionals associated with gymnastics clubs educate coaches about the possibility of significant injury to the distal radial physis, risk factors, and suggested preventive measures.
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