Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Stress Fracture of the Radial Epiphysis

SYMPTOMS

There is exercise-induced pain and localised swelling over the distal radius. It is common in young gymnasts, soccer players and martial arts athletes.

AETIOLOGY

These symptoms are caused by a stress fracture of the radial epiphysis from excessive tension-compression activities.

CLINICAL FINDINGS

There is localised tenderness on palpation and pain on resisted dorsi-flexionpronation or supination of the wrist, in a ‘handshake test’.

INVESTIGATIONS

X-ray is usually normal. Repeat X-ray after two weeks; MRI or bone scintigram verifies the diagnosis.

TREATMENT

A stabilising bandage, brace or strapping on the wrist should be applied for two to four weeks. It is important to address what caused the injury to avoid further mistakes.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon for immobilisation or if the diagnosis is not clear.

EXERCISE PRESCRIPTION

Most sports can be maintained during healing but avoid direct impact on the wrist. After immobilisation the symptoms are usually relieved and most activities can be back to normal within six weeks. Running and cycling are good alternatives to keep up general
fitness. Gym training can be maintained.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs and good hand function. Compare with other hand.

DIFFERENTIAL DIAGNOSES

This is a clear clinical diagnosis but is still often missed because of the normal first X-ray.

PROGNOSIS

Excellent, if treated appropriately.

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