Wrist injuries in tennis players are, unfortunately, very common and can result from a single traumatic event or from chronic repetitive motions. Juan Martin Del Potro won the 2009 US Open only to miss most of the 2010 season due to a wrist injury.
Wrist injuries occur more frequently on the dominant side and can be associated with tendons, ligaments, bones and nerves. Tendon injuries are particularly common. Pain can be described by its location: radial (thumb side) or ulnar (pinkie side). Ulnar-sided wrist pain is the most common complaint of tennis players. The pain can be localized to the side of the wrist or in the palm, and it can present with a variety of symptoms ranging from clicking to pain.
Ulnar-sided tendon injuries most commonly involve the extensor carpi ulnaris (ECU), which is the tendon lying across the edge of the wrist. Injury to this tendon can involve inflammation (tendonitis) or subluxation (partial dislocation) of the tendon. Tendonitis is an inflammation of the tendon, and usually occurs in the non-dominant wrist in players with a two-handed backhand. Treatment for most tendonitis involves rest, ice, splinting, anti-inflammatory medications and/or cortisone injections. Subluxation or snapping of the tendon occurs when there is a rupture of the sheath or tunnel that the tendon passes through at the wrist. The tendon then slides in and out of its groove and causes snapping. The treatment of a snapping ECU tendon begins with immobilization in a cast or splint. In recalcitrant cases, surgical repair of the sheath may provide the best outcome.
DeQuervain’s stenosing tenosynovitis is the most common tendonitis affecting the tennis wrist. It is the result of trauma from repetitive gliding of the two tendons at the base of the thumb. The inflammation causes the tunnel around the tendons to swell, making thumb and wrist movements painful. DeQuervain’s leads to pain directly over the affected tendons and with tendon stretching. Treatment starts with activity modification, a splint that limits movement of the involved tendons, anti-inflammatory medications, and/or a steroid injection into the tendon compartment. If the symptoms persist despite these treatment modalities, surgery to open the compartment is recommended.
Wrist injuries in tennis players are most often the result of overuse and improper technique and equipment. Excessive wrist motion during the stroke will predisposed a player to injury. Prevention should begin with appropriate grip size and stroke modification. If a new wrist pain develops, see a musculoskeletal specialist to help aid in the appropriate diagnosis, treatment, and prevention. Always consult with a physician for the best course of treatment for your condition.
Dr. David Dines is an orthopedic surgeon at Hospital for Special Surgery. He serves as the medical director of the Association of Tennis Professionals (ATP Tour), the team physician for the US Davis Cup tennis team and an orthopedic consultant for the US Open Tennis Tournament.
Dr. Joshua Dines is an orthopedic surgeon and member of the Sports Medicine and Shoulder Service at Hospital for Special Surgery. He serves as a team physician for the US Davis Cup tennis team.