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Summer is upon us and the tennis season is in full swing; Mr Andy Hacker, Consultant Hand and Wrist Surgeon at BMI The Saxon Clinic discusses the most common tennis related injuries seen in his practice.
He offers advice about symptoms, treatments and prevention of common disorders.
How common are hand, wrist and elbow injuries in tennis players?
Unfortunately, hand and wrist injuries are very common amongst tennis players, both recreational and professional, and they can impact very heavily on both their ability to continue to play tennis and perform everyday tasks and activities of daily living.
What symptoms might suggest a tennis related hand, wrist or elbow injury?
Wrist and hand injuries occur more commonly in the dominant upper limb and may be associated with the bones, ligaments, tendons and nerves of the upper limb. Injury or inflammation to the tendons of the hand, wrist and elbow are the most common cause of discomfort. Patients may present with pain, swelling, stiffness, a feeling of an unstable wrist or clicking and clunking of the joints.
What are the most common tennis related problems that you see in your practice?
The three most common conditions are:
This injury involves the ECU (Extensor Carpi Radialis) tendon which crosses the wrist joint on the little finger side of the wrist in a bony groove of the ulna bone. Repetitive injury to this tendon may cause chronic inflammation and pain; in some cases it may cause the tendon to “snap” around the ulna bone in the wrist with certain movements, particularly rotation.
Treatment of this condition initially consists of simple anti-inflammatory medication, icing the area regularly, splinting, kinesiology taping and activity modification. Cases that don’t improve may benefit from a local steroid injection and patients with a “snapping tendon” may require surgery to stabilize the tendon.
De Quervain’s Tenosynovitis
This is probably the most common tendonitis that affects tennis player’s wrists. It is caused by inflammation of two of the tendons that cross the wrist at the base of the thumb. The tendons usually glide smoothly through a tight soft tissue tunnel and when they are inflamed this becomes more difficult and causes pain when moving the wrist and thumb.
Treatment is largely the same as it is for ECU tendonitis, and if this is not effective then sometimes a small operation is required to release the tendon from the soft tissue tunnel. It is important that any splint prescribed is the correct one and is best made by a specialist hand therapist.
Also known as lateral epicondylitis, this inflammatory disorder causes pain and aching on the bony part of the outside of the elbow. It is caused by repetitive micro-trauma to the insertion point of several of the muscles responsible for cocking your wrist back.
Patients often present with a severe, achy pain over the outside of the elbow, an inability to fully straighten their arm and worsening pain with various activities such as carrying heavy shopping.
The treatment of tennis elbow remains a point of contention amongst hand surgeons but the majority of us believe that specific, targeted and sustained physiotherapy and stretching, as well as activity modification, is the mainstay of treatment. Again, splinting and kinesiology taping can be very useful. Cases resistant to this treatment may benefit from other interventions such as injections and possibly surgery.
What advice can you offer to try and avoid these injuries?
There are several things that one can do to try and minimise the risk of developing a tennis related upper limb injury.
Ensure that your tennis racket “fits” you. Is the grip size correct for your hand? Is your tennis racket strung to the correct tension? Your local tennis shop should be able to advise you on these issues.
Pay attention to your technique. Are you holding your tennis racket correctly? Are you hitting the tennis ball at the right time during your swing? If in doubt, seek the advice of your local tennis coach.
Make sure you warm up and cool down each time you play, and adjust your activities if you develop discomfort or pain.
Approach your local tennis coach for a lesson to ensure your basic techniques are up to scratch.
Seek help from a specialist therapist. Should your symptoms not settle with measures such as rest, ice, splinting, analgesia and activity modification seek the advice of a suitably qualified upper limb surgeon.
At BMI Healthcare we offer sports injuries clinics and physiotherapy that provide tailored treatment. You can also prevent and manage your joint pain by downloading our free guide, which also includes running tips.
To find out more call us on 0808 101 0337 or
make an online enquiry.