Pommel horse, wrist MR go hand in hand

At the Olympic Superdome, where all of the gymnastics events are held, you can buy a T-shirt with an artist's rendering of what men's gymnastics is all about. In the background are black-and-white images representing the rings, horizontal bar, and floor exercise. But the most prominent feature -- in color -- is the pommel horse.

The pommel horse requires the athlete to maneuver around and along
the length of the apparatus while balanced only on his hands. Possibly
the most challenging of events in men's gymnastics, it has been the
nemesis of many an all-around hopeful, and it threw a couple of
wrinkles into the U.S. team's preliminary round on Saturday.

Stephen McCain came off the horse in the middle of his routine, costing him five tenths of a point in his score. And John Roethlisberger got on the apparatus' bad side during his warmup, dislocating his right index finger. With the hands as the only thing separating the body from the horse, 10 fingers in working order would appear to be a necessity. After the dislocated joint was realigned and taped in place, Roethlisberger seemed to approach the apparatus cautiously before his turn to compete, leaning into it with his hands on the pommels to make sure they would hold his weight.

Roethlisberger didn't let the pommel horse get the better of him,
however, scoring a 9.6 in the event and finishing with a triumphant
pump of his fist. But many athletes are not so lucky. In a 1989 study
published in the American Journal of Sports Medicine, UCLA
researchers found that the apparatus was consistently responsible for
wrist pain among male athletes.

Thirty-eight collegiate gymnasts, including 29 men, were evaluated
radiographically and completed a questionnaire regarding their pain
patterns: 75% (22) of the men and 33% (3) of the women reported that
they had had wrist pain for at least four months.

The researchers compared anatomic and histologic findings with MRI
and found that the modality was able to differentiate the subtle
transitions between cortical and trabecular bone, articular surfaces, the
ligaments, and the triangular fibrocartilage complex of the wrist joint.

And that was in 1989. Given the advances in wrist MR since then,
including the advent of MR arthrography, the modality likely has become much more effective in diagnosing the wrist injuries associated with men's gymnastics and the pommel horse in particular.

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