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Causes of chronic wrist injury in children and adolescents

Causes of chronic wrist injury in children and adolescents
Condition Location Clinical features Radiographic findings Associated activities
Distal radius physis stress syndrome Radial Pain with dorsiflexion and axial loading Widening and irregularity of the physis; palmar spurring of metaphysis Gymnastics; rock climbing; weight lifting;
Median neuropathy (Carpal tunnel syndrome) Radial Dysesthesia or paresthesias; positive Tinels or Phelan sign Carpal tunnel view to exclude osseous compression Racquet, stick, and club sports; cycling; rowing; skiing; keyboard typing
Radial neuropathy (Wartenburg syndrome) Radial Pain and paresthesias over the dorsal thumb and dorsal radial hand Radiographs not necessary Activities that involve repeated supination and pronation
Scaphoid impaction Radial Pain over the scapholunate ligament when wrist is dorsiflexed and axially loaded Normal or may demonstrate ossicle formation Gymnastics; weight lifting
de Quervain tenosynovitis Radial Pain during pinch grasping or thumb and wrist movement Radiographs not necessary Racquet, stick, and club sports; fly fishing; repetitive thumb extension
Dorsal ganglion Radial, dorsal Cystic swelling Radiographs not necessary  
Kienbock disease(Osteonecrosis of the lunate) Radial, dorsal Mild swelling, persistent pain, crepitation, stiffness and decreased range of motion AP radiographs demonstrate progressive changes Martial arts; volleyball
Ulnar neuropathy (Guyon canal syndrome) Ulnar Weakness and paresthesias affecting the 4th and 5th digits Radiographs not necessary Racquet, stick, and club sports, cycling
Ulnar impaction syndrome Ulnar Tenderness of ulnar snuff box; tenderness with ulnar deviation Positive ulnar variance, cyst formation or sclerosis of ulnar head or lunotriquetral interface Gymnastics (vaulting)
Triangular fibrocartilage complex (TFCC) tears Ulnar, dorsal Point tenderness over the lateral wrist just distal to the ulnar styloid; pain with forced ulnar deviation or TFCC compression test Associated (but not diagnostic) findings: widening of DRUJ space, positive ulnar variance, fracture of ulnar styloid on AP; dislocation/subluxation on lateral Impact sports; racquet, stick, and club sports; gymnastics
Distal radioulnar joint (DRUJ) injury Ulnar, dorsal Pain with supination and pronation; positive DRUJ compression or piano key tests Dislocation can be seen on plain radiographs; MRI may be necessary for instability Impact sports; racquet, stick, and club sports; gymnastics
Extensor carpi ulnaris (ECU) tendonitis Ulnar, dorsal Tenderness over ECU tendon in ulnar groove exacerbated by wrist extension against resistance Radiographs not necessary Rowing; racquet, stick, and club sports
ECU subluxation Ulnar, dorsal Pain and snapping with rotation of forearm; can be observed with ulnar deviation in full supination Radiographs not necessary Racquet, stick, and club sports
Hamate hook fracture Ulnar, palmar Pain with sports but not daily activities; point tenderness over the hook of the hamate Fracture best seen on 45° supination oblique or carpal tunnel view or with computed tomography Racquet, stick, and club sports
Flexor tendonitis (flexor carpi radialis [FCR], fexor carpi ulnaris [FCU]) Palmar Tenderness over FCR or FCU Radiographs not necessary Racquet, stick, and club sports
Hypothenar hammer syndrome Palmar Pain in palm, coldness of digits, abnormal modified Allen test Radiographs not necessary Impact sports; martial arts; volleyball; racquet, stick, and club sports
Intersection syndrome Dorsal Tenderness 4 to 6 cm proximal to wrist joint; crepitus with active extension of the wrist Radiographs not necessary Rowing; weight training; racquet, stick, and club sports
Graphic 63434 Version 4.0

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