Summary Gymnast's wrist is a distal radius physeal injury most commonly due to overuse of the wrist primarily affecting young gymnasts. Diagnosis is made clinically with tenderness at the distal radius with radiographs showing widened distal radial growth plate with ill-defined borders. Treatment involves rest, NSAIDs and immobilization for 3-6 weeks. Rarely, in the case of premature physeal closure, surgical treatment is indicated. Epidemiology Incidence up to 25% of non-elite gymnasts Etiology Pathophysiology wrist undergoes supraphysiological loads due to use as a weight bearing joint. repetitive stress causes inflammation at growth plate of distal radius. microtrauma can lead to premature closure of distal radial physis resulting in secondary overgrowth of ulna. Associated conditions orthopaedic distal ulnar overgrowth positive ulnar variance Presentation Symptoms wrist pain usually radial sided may be chronic in nature Physical exam inspection swelling may be present at wrist tenderness to palpation at distal radius motion decreased wrist flexion or extension may be present Imaging Radiographs recommended views AP and lateral of the wrist findings widened distal radial growth plate with ill-defined borders positive ulnar variance with chronic cases MRI indications chronic or cases non-responsive to treatment findings paraphyseal edema early physeal bridging bruising of radius Diagnosis Radiographic diagnosis confirmed by history, physical exam, and radiographs Treatment Nonoperative NSAIDS, rest, immobilization for 3-6 weeks indications first line of treatment Operative resection of physeal bridge indications small physeal closures ulnar epiphysiodesis and shortening with radial osteotomy as needed indications large physeal closures (roughly 50% of physis) Prognosis Good outcomes associated with early treatment. May lead to premature closure of distal radial physis.