Imaging findings of overuse wrist injuries in young artistic gymnasts

Wrist pain is highly prevalent in young gymnasts. One of the causes is chronic overuse. Repetitive high-loading of the wrist during training on an immature skeleton affects the developing bony, cartilaginous, and tendinous structures. Overuse injuries include classic gymnast wrist, stress fractures of the radius or carpal bones, carpal boss, dorsal wrist impingement, triangular fibrocartilage complex tears, scapholunate diastasis or instability and various forms of tendinopathy and synovitis. These conditions tend to go underrecognized because symptoms are often nonspecific, and athletes tend to underreport their complaints. In addition, physical examination may also be inconclusive. Correct imaging and image interpretation is therefore of great relevance. Radiography remains the first-line modality, however it is often not sufficient to recognize the pathologies. Magnetic resonance imaging, preferably a high-field multiparametric protocol, should be the next step. The protocol should include high-resolution anatomical (proton density (PD)-weighted and T1-weighted sequences) and water-sensitive sequences (e.g. PD-weighted fat suppressed or Dixon water-only). In the presence of bone marrow edema but absence of other pathologies, one should always perform further diagnostics (computed tomography) since bone marrow edema is a sign rather than a diagnosis. This review provides an overview of imaging findings of the spectrum of chronic overuse-related wrist injuries in gymnasts and proposes a pragmatic modality-selection and approach for practicing radiologists and radiologists in training.