AAHS - Epidemiology and risk factors of wrist pain and injury in adolescent artistic gymnasts: A systematic review and meta-analysis

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Epidemiology and risk factors of wrist pain and injury in adolescent artistic gymnasts: A systematic review and meta-analysis
Stefania DiLeo, BKin^¹, Atefeh Noori, PhD^², Erin Day, BSc, MMASc^¹, Timothy Burkhart, BHK, MHK, PhD^¹, Ryan Paul, MD^{^1,2}; Andrea HW Chan, MD, MA, FRCSC^{^1,3}
(¹)University of Toronto, Toronto, ON, Canada, (²)Toronto Western Hospital, Toronto, ON, Canada, (³)Hospital for SickKids, Toronto, ON, Canada

Introduction

Gymnasts experience a high incidence of wrist injuries, with rates of up to 9.22 per 1000 athlete-exposures. The hyperextended wrist can experience loads up to twice the gymnast's bodyweight at rates over 16 times one's weight per second. During the adolescent growth spurt, the open distal radius and ulna physes are particularly susceptible to shear and tensile forces which can result in physeal injury, longitudinal growth disruption, and deformity. Despite its necessity for developing effective injury risk reduction strategies, comprehensive data on wrist pain, injury, and growth disturbance among adolescent artistic gymnasts remains limited. Therefore, this study aimed to conduct a systematic review and meta-analysis of the epidemiology and risk factors for wrist pain and other findings associated with wrist injury in this population.

Materials and Methods

A systematic review was conducted following PRISMA guidelines. We searched MEDLINE, EMBASE, CINAHL, COCHRANE, and SPORTDiscus from inception to January 2025. Observational studies reporting prevalence, incidence, and/or risk factors for wrist pain, acute or chronic injuries, or positive ulnar variance (PUV) in adolescent artistic gymnasts were included. The risk of bias was assessed in eligible studies. Meta-analyses were performed where applicable.

Results

Twenty-six studies were included. All evidence was deemed low to very low certainty. Nine studies suggested a pooled wrist pain prevalence of 53% (95%CI 39-66%). The proportion of new cases reported in one study was 2% over one year. The prevalence of acute wrist injuries reported in one study was 34%, and the pooled proportion of new cases was 4% (95%CI 2-7%: 2 studies) over a two-year period. The pooled prevalence of chronic wrist injuries was 36% (95%CI 12-70%: 6 studies), and the pooled proportion of new chronic injuries was 5% (95%CI 3-10%: 2 studies) over a two-year period. Two studies suggested a pooled PUV prevalence of 4% (95%CI 1-14%). The proportion of new cases reported in one study was 16% over 18 months. Age between 10-14 years, increased age of training onset, training intensity, BMI, years training, and weekly working hours were significantly associated with wrist pain.

Conclusion

Adolescent artistic gymnasts demonstrate a high prevalence of wrist pain and wrist injury, particularly during the period of peak skeletal growth. Understanding the epidemiology and risk factors for wrist pain and injury is crucial for establishing evidence-based guidelines that ensure the safety and long-term wrist health of young gymnasts and are imperative considering the increasing need to protect this vulnerable population.

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