CHAPTER 85 • GYMNASTICS 503- Sever’s disease (calcaneal apophysitis):This was
the most common overuse injury in one survey
(Mackie and Taunton, 1994). It occurs in young ath-
letes, typically ages 7–14. The main finding on exam-
ination is tenderness at the insertion of the Achilles
tendon onto the calcaneus. Sever’s disease is a self-
limited condition, which resolves when the physis
closes. Treatment includes relative rest, ice, heel lifts
used on a short-term basis, stretching, and strengthen-
ing exercises. - Dorsal wrist pain: Chronic wrist pain affects
46–87% of young gymnasts (DiFiori, Puffer, and
Mandelbaum, 1996). Painful dorsiflexion while sup-
porting body weight and dorsal wrist pain, without
acute trauma or swelling, characterize gymnast’s wrist
(McAuley, Hudash, and Shields, 1987). Factors asso-
ciated with wrist pain include training hours, skill
level, and age at initiation of training. It appears to be
more common during the adolescent growth spurt.
Dorsal wrist pain is associated with radiographic find-
ings of distal radial physeal injury (DiFiori et al,
2002). Cases of premature closure of the distal radial
physis have been reported (Albanese et al, 1989).- The mainstay of treatment is reduction of loading
to the wrist. Strengthening of the wrist and upper
extremity may be helpful. Use of a brace with a
hyperextension block may decrease symptoms
(Ott, 2002). Premature closure of the distal radial
growth plate can result in symptomatic positive
ulnar variance (Caine, 2003a). In some skeletally
mature gymnasts, an ulnar shortening procedure is
required to treat this condition.
- The mainstay of treatment is reduction of loading
- Elbow dislocations:Elbow dislocations in gymnasts
are typically the result of a fall on out-stretched hand
(FOOSH) injury (Ott, 2002). As a result, gymnasts are
taught never to reach down with their hands when
they fall. Elbow joint dislocations require a thorough
neurovascular examination, X-rays, and in most cases
closed reduction (see Chap. 48).
INJURIES UNIQUE TO GYMNASTICS
- Clavicular stress fractures:Clavicular stress frac-
tures are rare but have been described in gymnasts,
presumably because of the repetitive forces to which
the upper extremity is exposed in activities such as
tumbling and vaulting. The injury can be diagnosed
with plain radiographs or computed tomography, but
an MRI should be done to rule out pathologic causes
of the fracture, such as a tumor or cyst. Treatment is
conservative. In one report, full training was resumed
after eight weeks of upper extremity rest (Fallon and
Fricker, 2001).- Osteochondritis dissecans of the capitellum:This is
believed to be underrecognized in gymnasts (Ott, 2002).
It occurs in young gymnasts with open growth plates,
typically ages 10–15, from repeated valgus stress to the
elbow. Symptoms include the gradual onset of lateral
elbow pain that worsens with activity, inability to fully
extend the elbow, and possibly locking or clicking.
Management depends on the severity of symptoms and
imaging results (see Chap. 49). - Forearm fracture:Griplockis an entity unique to
gymnastics. Gymnasts wear leather handgrips for bar
and ring work. With griplock, the grip accidentally
catches on the bar, and while the athlete’s momentum
carries him or her around the bar, the hand and fore-
arm are kept in a locked position. The result is a seri-
ous forearm fracture that may require surgery
(Samuelson, Reider, and Weiss, 1996). Griplock is
more common in male gymnasts, who use a bar with
a smaller circumference, and in gymnasts whose grips
are overused and stretched out. - Hand blisters/Rips:Gymnasts frequently train with
blisters or ripson their hands caused by the friction
created between skin and bars. These are difficult to
treat and prevent, since usual treatments such as tape
or moleskin will not adhere to the hands while prac-
ticing. The friction of the bars will usually cause the
blister to pop as soon as it arises. These areas should
be kept clean to avoid infection. Once an open lesion
has dried, the application of a topical antibiotic oint-
ment can be used at night in order to prevent both
infection and painful cracking of the lesion. - Abdominal wall contusion:Female gymnasts may
develop severe bruising around the lower abdomen
and anterior superior iliac spine by doing a beat
maneuver on the uneven bars. Gymnasts at the lower
competitive levels typically perform this skill, which
involves hanging from the high bar and dropping the
anterior pelvis and hips onto the low bar. Use of
padding may prevent repetitive injury (Weber, 1997).
Although painful, the prognosis of this injury is good.
Only ice and avoidance are generally required for
treatment. - Vulvar hematomas:Vulvar hematomas result from a
straddle injury on the balance beam. On most occa-
sions, these falls do not result in significant injury.
When a vulvar hematoma develops, incision and
drainage can be performed if the hematoma is very
large or is expanding (Propst and Thorp, 1998). In
minor cases, ice and relative rest are recommended. - Heel pad contusions:Heel pad contusions develop
after trauma to the fat pad, usually from a hard land-
ing onto the beam or unpadded floor. If symptoms
continue to worsen, radiographs and/or magnetic res-
onance imaging(MRI) should be performed to rule
- Osteochondritis dissecans of the capitellum:This is