A wrist stress fracture is uncommon but can have a significant impact on athletes and active individuals. These injuries occur when repetitive stress exceeds the bone’s ability to repair itself, leading to small cracks or fractures. This article examines the various types of wrist stress fractures, their underlying causes, common symptoms, diagnostic approaches, and available treatment options.
Types of Wrist Stress Fractures
Scaphoid Stress Fracture
The scaphoid is a small carpal bone on the thumb side of the wrist. It is the most common site for wrist stress fractures. The scaphoid is particularly vulnerable to activities involving repetitive wrist extensions, such as gymnastics or weightlifting. Other sports at high risk include badminton, cricket, and tennis.
Distal Radial Epiphyseal Stress Reaction in Gymnasts
In young gymnasts, repetitive wrist loading during weight-bearing activities, such as vaulting or tumbling, can lead to a stress reaction in the growth plate of the distal radius. This condition, sometimes referred to as “gymnast’s wrist,” can cause pain, swelling, and tenderness over the distal radius, often affecting performance. Early diagnosis and management are crucial for preventing long-term complications, such as growth disturbances in the radius.
Hamate Stress Fracture
The hamate is another carpal bone that is often affected by repetitive stress, particularly in sports that require gripping motions, such as golf or baseball.
Symptoms of Wrist Stress Fractures
- Localised pain in the wrist, often exacerbated by activity. In scaphoid stress fractures, the tenderness is maximal at the anatomical snuffbox (at the base of the thumb).
- Decreased grip strength due to wrist pain
- Pain with specific wrist movements, such as extension or radial deviation.
How to Diagnose
Your doctor should thoroughly assess your pain, including any factors that aggravate or relieve it. It is critical to exclude a history of past or recent trauma. Your training history and bone health should also be assessed.
The examination involves carefully assessing the exact area of tenderness. Other conditions, including De Quervain’s tenosynovitis, wrist joint swelling, Kienbock’s disease, TFCC tear, ulnocarpal impingement, and acute traumatic fracture, need to be excluded.
We use imaging to confirm the diagnosis. X-rays may show a stress fracture, but a normal X-ray does not exclude it. MRI is the gold standard for detecting early bone stress and excluding other causes. Sometimes, a CT scan is used to assess the healing potential of a fracture.
Treatment Options for Stress Fracture Wrist
In most cases, we begin with conservative management, which typically involves wearing a wrist splint or cast for 4-6 weeks to allow the fracture to heal. We then cease sports activities and replace them with cross-training, such as swimming and cycling.
Once the splint is removed, athletes commence physical therapy to regain strength, range of motion and function.
Bone-healing treatments, such as LIPUS, are often used to promote bone healing. In addition, optimising calcium and vitamin D intake can help. Emerging evidence suggests that PRP injections may support bone healing in some cases.
Surgical Intervention
Surgery is considered for:
- Non-healing fractures.
- Displaced or unstable fractures.
- Persistent pain despite conservative treatment.
Procedures may include screw fixation or bone grafting to stabilise the fracture and promote healing.
Final word from Sportdoctorlondon about a Wrist Stress Fracture
While wrist stress fractures are less common, they can be debilitating if left untreated. Early diagnosis through clinical examination, imaging, and appropriate treatment is essential for full recovery. Conservative measures are effective in most cases. If you are an active individual experiencing wrist pain, it is recommended that you consult a sports doctor for an early diagnosis and treatment.
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