Epidemiology and Risk Factors of Wrist Pain and Injury in Adolescent Artistic Gymnasts: A Systematic Review and Meta-analysis.

Background: Adolescent gymnasts are at increased risk for wrist pathology due to repetitive high-impact wrist loading during the midgrowth spurt. Purpose: To conduct a comprehensive systematic review on the epidemiology and risk factors for wrist pain and injury in adolescent artistic gymnasts. Study Design: Systematic review; Level of evidence, 4. Methods: Under PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched MEDLINE, EMBASE, CINAHL, Cochrane, and SPORTDiscus from inception to January 2025. We included observational studies of adolescent artistic gymnasts that reported prevalence, incidence, and/or risk factors for wrist pain, acute injuries, chronic injuries (causing physeal stress or not attributable to a specific acute event), or positive ulnar variance (PUV). Where applicable, meta-analyses were conducted to estimate the pooled prevalence and proportion of new cases for each outcome using common- or random-effect models. Results from studies that were not possible to pool were also reported. Results: Of the 3650 records identified, 25 studies (185,107 gymnasts) were included for analysis. All evidence was deemed low to very low certainty. Nine studies suggested a pooled wrist pain prevalence of 53% (95% CI, 39%-66%), with 1 study reporting the proportion of new wrist pain cases to be 2% over 1 year. The prevalence of acute wrist injuries reported in 1 study was 34%, and the pooled proportion of new cases was 4% (n = 2 studies; 95% CI, 2%-7%) over a 2-year period. The pooled prevalence of chronic wrist injury was 36% (n = 6 studies; 95% CI, 12%-71%), and the pooled proportion of new chronic wrist injury cases was 5% (n = 2 studies; 95% CI, 3%-10%) over a 2-year period. Two studies suggested a pooled PUV prevalence of 4% (95% CI, 1%-14%), with 1 study reporting the proportion of new PUV cases to be 16% over an 18-month period in preteen gymnasts (mean ± SD age, 10 ± 2 years). Wrist pain was significantly associated with age between 10 and 14 years, increased age at training onset, training intensity, body mass index, years training, and weekly training hours. Conclusion: Our review demonstrated that adolescent artistic gymnasts demonstrate an alarmingly high prevalence of acute and chronic wrist pain and wrist injury. Further research on training intensity thresholds and risk reduction strategies is imperative for informing and implementing guidelines that protect the health of this vulnerable population.