Hipermobilidade e dor no punho em ginastas jovens: perfil descritivo, análise de associação e relevância clínica

Abstract

Introduction: Flexibility is an important factor for gymnasts to perform their maneuvers and elements. A greater than normal range of motion in most of the joints is called general joint hypermobility. There is a higher prevalence of general joint hypermobility among gymnasts and some evidence indicates that it may be a risk factor for musculoskeletal symptoms. In addition, wrist pain is a common complaint among gymnasts and, despite the many possible causes, we must consider the great load to which this joint is exposed in gymnastics and try to identify other associated factors. Objectives: To investigate the relationship between joint hypermobility and the presence of wrist pain, handgrip strength and wrist function, in addition to presenting the clinical relevance of the variables comparing athletes with and without wrist pain and also athletes with and without joint hypermobility. Methods: This is a cross-sectional study that included elite gymnasts from the city of São Paulo, from ages 8 to 17 years old. All participants were assessed for the presence of general joint hypermobility (Beighton score), wrist range of motion (ROM), subjective pain assessment, handgrip strength, wrist function (Patient-Rated Wrist Evaluation – PRWE and Closed-Kinetic Chain Upper Extremity Stability Test - CKCUEST) and quality of life (Pediatric Quality of Life Inventory - PedsQL 4.0). A descriptive data analysis was performed. To assess the presence of association between variables, the Chi-square test was used, with a significance level of 5%. An assessment of the clinical relevance of the variables was also carried out, based on the effect size and the minimum important difference. Results: This study included 42 gymnasts (22 males and 20 females, with a mean age of 10.6 ± 2.5 years). Joint hypermobility was present in 66,7% of these athletes and 38.1% had wrist pain. No association was found between joint hypermobility and pain in the wrist, but an association was found between pain in the wrist and the number of hours of training per day (p = 0.024). Handgrip strength and CKCUEST scores showed moderate or large effect sizes when comparing subjects with and without wrist pain and with and without hypermobility. Conclusion: We found no association between the presence of joint hypermobility and wrist pain in young gymnasts. We identified an association between the presence of wrist pain and the number of hours of training per day, indicating that the longer training periods are associated with a higher prevalence of wrist pain in gymnasts. Athletes with joint hypermobility had better quality of life indexes, lower handgrip strength and greater wrist extension ROM, and athletes with wrist pain had lower handgrip strength, lower wrist extension ROM and better performance in the CKCUEST.