11 Tennis Injuries to Your Wrists and Hands

In the US, there are about 18 million people who play tennis recreationally, and this number continues to grow.  Since the U.S. Open is underway, we thought it would be a great time to share with our readers, some of the more common injuries we encounter from tennis.

On average, players get about 0.05 to 2.9 injuries per year. This number increases for professional adult players, who get two to six injuries for every 1,000 hours of tennis they play.

Tennis injuries are almost inevitable, as they are often caused due to excessive play. However, they can also occur due to incorrect use of equipment or a poor grip.

If you’re an avid tennis player or even just starting, you can avoid these injuries by regularly exercising your wrists and perfecting your technique, and ensuring you’re holding your racket correctly.

There’s a list of some of the more common injuries below. If you ever experience any of these you must get a professional assessment to receive proper treatment for your injuries.

Reasons for Hand and Wrist Tennis Injuries

Upper extremity tennis injuries are usually chronic and are a result of non-contact mechanisms. Research shows that serving is often the root cause of tennis injuries to the hands and wrists.

A compromised stroke or serve due to fatigue or poor technique can worsen these injuries. This overloads joints, which leads to injury. Pressure, especially to the wrist, also depends on the player’s handgrip position when doing a forehand stroke.

The position of the ball on the racket during impact and the tightness of a player’s grip affect the force on the wrist. These can lead to wrist and elbow injuries.

It’s All in the Grip

A player’s tennis grip and technique help them to hit powerful shots and maintain consistency throughout their game. There are four traditional hand grip positions:

The Continental Grip

This grip allows versatility for many tennis strokes, particularly drop shots, volleying, overheads and slice serves. The position of the hand on a particular part of the racket handle allows the player to maneuver easily and gives him/her more precision when hitting the ball.

The Eastern Grip

This is also good for overhead shots, allowing a player to smash flat shots with more power and speed. It’s also a great grip to use for a backhand kick serve.

However, it’s not as effective when hitting high bouncing balls, especially at the baseline, and does not provide as much topspin as the Western or Semi-western grip.

The Semi-Western Grip

This grip is great for all types of courts – grass, clay, or hard. It’s easy to play with and facilitates grip changes, allowing a player to seamlessly go from a forehand grip at the baseline to a Continental grip to serve or volley.

Returns of low balls with this grip may not be successful as the correct contact point to return them can be obstructed due to the closed racket face.

The Western Grip

This grip generates maximum topspin and is a bit more extreme than the Semi-Western grip. It works well on clay courts as the spin helps keep it in, making it easier to handle high ball bounces.

It’s difficult to quickly change from this grip when volleying, and it may pose a problem when hitting low balls. It’s also harder for beginners to learn this grip.

You should be comfortable with the grip(s) you use. Compromising either your grip or technique can result in serious injury.

Tennis Injuries That Affect Your Wrists and Hands

The extent of tennis injuries that affect the wrists and hands will vary depending on the player’s style, including stroke mechanics. Injuries also tend to become worse further on into the season, as extensive play can exacerbate injuries.

1. Exterior Carpi Ulnaris (ECU) Tendon Injury

The ECU tendon is on the pinky or ulnar side of the hand. When inflamed, it results in ECU tendonitis.

This can occur during a forehand stroke as the ball repeatedly hits the racket. The force generated from the impact then travels to the wrist.

When a player grips the racket to execute a topspin stroke, this grip can also result in an ECU injury. It can also occur during a double-handed backhand stroke. Repeated injury of this tendon can result in tenosynovitis.

Symptoms include weakened grip and wrist pain. Movement of the palm up and down or any wrist motion toward the pinky side of the hand exacerbates these symptoms.

Treatment may include the application of a splint to immobilize the wrist, rest, application of ice, and anti-inflammatory medication such as naproxen and ibuprofen.

2. Dorsal Compartment (De Quervain’s) Tendonitis

De Quervain’s tendonitis is a radial side injury that often occurs in tennis players with an Eastern grip. It is the inflammation of the wrist tendons located at the base of the thumb and is also known as tenosynovitis.

It occurs as a result of the repeated gliding of the two tendons, which causes them to swell. It makes thumb and wrist movements painful.

This not only affects tennis players but can also affect piano players, office workers, carpenters, and people who engage in fly fishing, as they all use the same wrist motion.

Symptoms may be sudden or gradual. The pain starts at the first dorsal compartment of the wrist closer to the thumb. The pain may radiate either down the thumb or up the forearm.

Doctors may ask a patient to place their hand into a fist with their thumb inside. This is the Finkelstein test that is usually performed to confirm the diagnosis. This and other hand and thumb motions increase the pain, especially if they include forceful twisting or grabbing.

Treatment may include physical therapy, use of a splint or brace to immobilize the thumb and wrist, nonsteroidal anti-inflammatory drugs (NSAIDs), and the application of ice to the affected area.

3. Scaphoid Fracture and Stress Fracture

A scaphoid or navicular fracture occurs when one of the small bones in the wrist breaks. It often occurs when you try to break a fall with your outstretched hand. But it also occurs in athletes such as gymnasts and tennis players due to repetitive weight on the wrists when they’re in an extended position.

Repeated high volley backhands are most often the cause for tennis players, as these involve excessive dorsiflexion. A sign of this injury in tennis players is usually chronic wrist pain.

In addition to wrist pain when lifting or gripping objects, symptoms may include swelling or bruising of the wrist, especially after an impact or fall. Loss of motion in the wrist or thumb may also occur.

The displaced bones at the site of the fracture may be able to heal after the application of a cast. This may take six weeks or longer. If symptoms are persistent, it may be due to the bones shifting. Surgery will be required if this occurs.

4. Dorsal Carpal Ganglion Cyst

A ganglion cyst is usually a harmless, non-cancerous mass that can develop on various areas of the hand. It is most common on the upper or backside of the wrist. It occurs when fluid leaks from a tendon tunnel or joint and causes swelling beneath the skin.

The leak can be due to trauma, often as a result of chronic overuse, especially in tennis players.

There are usually no symptoms as the cysts are not painful. However, there might be slight pain or pressure when bending the joint. If the cyst is pressing on a nerve, there will also be general discomfort, including numbness and tingling.

When this occurs it causes weakening of the wrist and a decrease in the range of motion.

Treatment includes immobilizing the affected area using a splint, draining the fluid from the cyst, and making a surgical excision.

5. Wrist Sprains

Sprains occur when the wrist’s supporting ligaments stretch or tear. Forceful twisting or bending can cause this, as well as using an outstretched hand to break a fall.

Tennis players are susceptible to wrist sprains due to excessive use of the wrist during a stroke or the use of improper equipment or technique.

Symptoms include weakness, pain, limited mobility, swelling, bruising, tenderness or warmness near the injury, and a feeling of tearing or popping in the wrist.

Initial treatment should include resting the wrist for at least 48 hours after the injury, icing, bandaging the wrist and elevating it, or using a splint or cast to immobilize the wrist. The use of anti-inflammatory painkillers is optional.

6. Triangular Fibrocartilage Complex (TFCC) Tears

TFCC is the cartilage structure located in the wrist on the pinky side of the hand. It keeps the forearm bones stable as well as supports and cushions the small carpal bones in the wrist when the forearm rotates or the hand grabs an object.

Tearing of the TFCC will cause a weakened grip, pain on the pinky side of the hand or bending of the wrist from side to side, clicking in the wrist that’s also painful, and swelling.

TFCC injuries often occur in tennis players due to overuse. It’s also more common in players that use the Western grip with heavy topspin serves or forehands. Volleyball players can also suffer from TFCC injuries.

Immobilization of the wrist using a splint, brace, or cast is essential for TFCC injuries. Ibuprofen or steroid injections help to manage the pain and reduce swelling. Physical therapy also helps some people with this injury.

7. Ulnotriquetral (UT) Ligament Split Tears

The UT ligament originates from the ulnar styloid and TFCC. Applying excessive weight on an extended wrist with a rotated forearm can cause the ligament to tear. It is a common injury for athletes that take part in racket and batting sports.

The major symptom of a UT tear is incapacitating pain.

Treatment usually involves surgery that uses an arthroscope to stitch the ligament. This repairs the tear. After, the wrist is placed in a cast to help immobilize the joint.

8. Ulnar Impaction Syndrome

This is also known as ulnocarpal abutment syndrome. It is a degenerative condition that affects the TFCC and the carpals on the ulnar side of the hand.

This injury usually results in decreased forearm rotation and range of motion. Any attempt at movement will cause pain and aggravate the injury.

The wrist may lock when outstretched and there may be painful clicking. There may also be occasional swelling.

Treatment will include six to 12 weeks of immobilization and limiting any movements that aggravate the injury, NSAIDs, and corticosteroid injections. If pain persists, surgery is the next option.

9. Intersection Syndrome

This condition affects the dorsal wrist extensors. It usually occurs due to repeated friction where the tendons of the first and second dorsal compartments located in the wrist extensor cross over each other and create tenosynovitis.

This syndrome causes pain in the wrist and forearm. Flexing or extension of the wrist can exacerbate the pain.

Swelling may also occur. Movement of the wrist may sometimes cause arthritis-like pain or discomfort.

Treatment usually involves rest and modification of work or sporting activities that may aggravate the injury. This includes splinting and reducing any stress on the wrist. NSAIDs and ice are usually used to alleviate the pain.

10. Carpal Tunnel Syndrome (CTS)

CTS occurs when there is pressure on the median nerve in your wrist. Tennis players often experience CTS because of overuse of the wrist, falls, or grip issues.

Symptoms include numbness and pain in the fingers and hands, and tingling.

CTS is most commonly treated with corticosteroids, which relieve the pain. It is usually injected at the site of the injury and decreases swelling and inflammation. This, in turn, relieves pressure on the median nerve.

11. Lateral Epicondylitis (Tennis Elbow)

And last but not least, Tennis Elbow.  There are fewer occurrences of this ailment in tennis players due to:

  • The advancement of the tennis racquet from wood to composite materials,
  • Improvement in the weight of racquets
  • More precise stroke techniques by players

However, it is still a prevalent problem and can happen.

Overuse of your extensor tendons causes Tennis Elbow. It becomes painful at the insertion point of all the extensor muscles and facia.

Although located in your forearm, these muscles attach to the protruding bone of your elbow. It’s the reason you feel pain in your elbow which can extend to your forearm and wrist as well.

Tennis elbow is easily treatable with conservative measures, but sometimes an injection or surgery may be necessary.

Maintain Good Health and Lessen Injuries

Tennis provides an excellent form of exercise. It’s a full-body workout that improves metabolic function. It lowers blood pressure and your resting heart rate while increasing your aerobic capacity.

However, the more tennis you play, the more likely you are to suffer from one of the many tennis injuries. You can try to avoid this by ensuring you practice the right techniques and do strength-building exercises, especially for your hands and wrists.

If you do get an injury, it must be properly assessed so that you receive the right treatment. The Hand Surgery Specialists of Texas specialize in hand injuries including carpal tunnel syndrome. We will ensure you get the proper diagnosis and treatment for your injury.

Get back on the court. Schedule your appointment with us today!

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