Wrist Epiphysitis

with Rehab

Wrist epiphysitis is a condition in which one of the growth plates of the wrist becomes inflamed. The growth plate that is usually inflamed is the one on the thumb side of the forearm (radius). The condition is usually the result of repetitive and/or strenuous bending of the wrist upward (hyperextension) and rotation of the wrist. This condition is characterized by wrist pain. Wrist epiphysitis usually only occurs in individuals who are skeletally immature; it is uncommon after the age of 16.

SYMPTOMS

  • Tenderness, inflammation, and/ or redness around the wrist.

  • Wrist pain and stiffness.

  • Pain that worsens with extension of the wrist.

  • Numbness or tingling of the hand (rare).

CAUSES

Wrist epiphysitis is caused by stress being placed on the growth plate, which results in an inflammatory response. This condition may cause the growth plate to close to early and result in a shortening of the bone.

RISK INCREASES WITH:

  • Activities in which hyperextension of the wrist is common (ie. gymnastics, especially vaulting).

  • Overtraining.

  • Rapid skeletal growth.

  • Poor strength and flexibility.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use proper technique. When possible, have a coach correct improper technique.

  • Avoid overtraining.

PROGNOSIS

The prognosis of wrist epiphysitis depends on the extent of injury. For mild cases, a slight reduction in activity will typically be enough to resolve the symptoms. Moderate to sever cases often require resting from activities that caused the problem for a prolonged period of time.

RELATED COMPLICATIONS

  • Bone infection.

  • Fracture of the growth plate.

  • Decreased wrist function.

  • Premature closure of the growth plate and shortened bone.

  • Prolonged disability.

  • Prolonged healing time, if improperly treated or re-injured.

TREATMENT

Treatment initially involves resting from any activities that aggravate the symptoms, and the use of ice and medications to help reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with referral to a therapist. If the condition is serious, then your caregiver may recommend immobilizing the wrist to allow for healing and prevent further injury. If a fracture of the growth plate occurs or if the bone has shortened, then surgery is usually necessary. Symptoms may reoccur and should be watched until the growth plates close naturally.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or soak your injury in warm water.

SEEK MEDICAL CARE IF:

  • Treatment seems to offer no benefit, or the condition worsens.

  • Any medications produce adverse side effects.

  • Any complications from surgery occur:

  • Pain, numbness, or coldness in the extremity operated upon.

  • Discoloration of the nail beds (they become blue or gray) of the extremity operated upon.

  • Signs of infections (fever, pain, inflammation, redness, or persistent bleeding).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Wrist Epiphysitis

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

STRENGTHENING EXERCISES - Wrist Epiphysitis

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress with the resistance and repetition exercises only as your caregiver advises.

STRENGTH – Wrist Flexors

  • Sit with your right / left forearm palm-up and fully supported. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.

  • Loosely holding a __________ weight or a piece of rubber exercise band/tubing, slowly curl your hand up toward your forearm.

  • Hold this position for __________ seconds. Slowly lower the wrist back to the starting position in a controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Wrist Extensors

  • Sit with your right / left forearm palm-down and fully supported. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.

  • Loosely holding a __________ weight or a piece of rubber exercise band/tubing, slowly curl your hand up toward your forearm.

  • Hold this position for __________ seconds. Slowly lower the wrist back to the starting position in a controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Ulnar Deviators

  • Stand with a ____________________ weight in your right / left hand or sit holding on to the rubber exercise band/tubing with your opposite arm supported.

  • Move your wrist so that your pinkie travels toward your forearm and your thumb moves away from your forearm.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day

STRENGTH - Radial Deviators

  • Stand with a ____________________ weight in your right / left hand or sit holding on to the rubber exercise band/tubing with your arm supported.

  • Raise your hand upward in front of you or pull up on the rubber tubing.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Forearm Supinators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm down.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Forearm Pronators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm up.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Grip

  • Grasp a tennis ball, a dense sponge, or a large, rolled sock in your hand.

  • Squeeze as hard as you can without increasing any pain.

  • Hold this position for __________ seconds. Release your grip slowly.

Repeat __________ times. Complete this exercise __________ times per day.