Wrist Injuries in Tennis Players: A Narrative Review

Tennis Injuries Among German League Players: Investigating Patterns and Epidemiology of Acute and Chronic Injuries

Purpose

While injuries among elite tennis athletes are extensively documented, a notable research gap exists regarding tennis injuries among club-level players. This study examines tennis injuries in German league players, with a particular emphasis on the impact of racquet properties and court surfaces, distinguishing between chronic and acute injuries.

Patients and Methods

Retrospectively analyzing data from 600 tennis players over a 1.5-year period, a standardized questionnaire covered anthropometrics, injury characteristics, equipment usage, and court surface conditions.

Results

The study identified 1012 tennis-related injuries, averaging 1.7 per player. Acute injuries predominantly affected the lower extremity (56%), with ankle injuries being the most prevalent, and ligaments were the most commonly affected structures (36.4%). Chronic complaints (reported by 364 athletes) focused on the upper extremity (63.2%), primarily tendon injuries (56.8%). Racket properties exhibited no significant impact on chronic upper extremity injuries.

Conclusion

This study highlights a high incidence of acute lower extremity injuries, especially ankle ligament injuries, among German league tennis players. It offers crucial insights for devising targeted injury prevention strategies applicable to amateur, semi-professional, and professional tennis players, despite finding no significant link between racquet material and chronic upper extremity injuries.

Wrist Motion Assessment in Tennis Players using Three-Dimensional Motion Capture and Dynamic Electromyography

Background  Tennis players often present with ulnar-sided wrist pain, which may reflect repetitive stress and/or faulty mechanics. There is a role for investigating the biomechanics of tennis strokes and how they may relate to wrist pathology. The purpose of this study was to investigate whether three-dimensional motion capture technology and dynamic electromyography (EMG), when used to study groundstrokes in elite junior tennis players, reveals patterns of upper extremity motion that may correlate with the development of clinically relevant pathology. Case Description  Three-dimensional kinematic and EMG data were collected from two United States Tennis Association-ranked adolescent tennis players during groundstrokes. There were several observed differences in the two players' degree and timing of pronation/supination, ulnar/radial deviation, and flexion/extension during their strokes. Clinical Significance  Advanced motion capture technology facilitates a nuanced understanding of complex movements involved in groundstroke production. This methodology may be useful for identifying athletes who are at risk for injury and guiding rehabilitation for players experiencing pain. Level of Evidence  IV.

Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review

Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.

Identifying the Sweet Spot of Padel Rackets with a Robot

Although the vibration of rackets and the location of the sweet spot for players when hitting the ball is crucial, manufacturers do not specify this behavior precisely. This article analyses padel rackets, provides a solution to determine the sweet spot position (SSP), quantifies its behavior, and determines the level of vibration transmitted along the racket handle. The proposed methods serve to locate the SSP without quantifying it. This article demonstrates the development of equipment capable of analyzing the vibration behavior of padel rackets. To do so, it employs a robot that moves along the surface of the padel racket, striking it along its central line. Accelerometers are placed on a movable cradle where rackets are positioned and adjusted. A method for analyzing accelerometer signals to quantify vibration severity is proposed. The SSP and vibration behavior along the central line are determined and quantified. As a result of the study, 225 padel rackets are analyzed and compared. SSP is independent of the padel racket shape, balance, weight, moment of inertia, and padel racket shape (tear, diamond, or round) and is not located at the same position as the center of percussion.

The use of physically constraining tools for grip-specific skill development in racket, stick and club sports: A scoping review

Coaches use physically constraining tools to supplement their coaching when developing sport-specific skills, however, their effectiveness is unknown. This scoping review aimed to understand the efficacy of physically constraining tools used in racket, stick, and club sports for grip-specific skill development. This scoping review followed the Joanna Briggs Institute methodology and PRISMA guidelines. Peer-reviewed research, including quasi-experimental, true-experimental, case studies, and grey literature were considered. Peer-reviewed sources were searched on Web of Science, Medline, and SPORTDiscus until October 6th, 2022. Exclusion criteria were (1) not original peer-reviewed research; (2) disabled participants or used for rehabilitation; or (3) not available in English. Data extracted were the type of tool, research foci, measures, and outcomes of the tool's efficacy. Zero peer-reviewed sources were identified on the efficacy of using physically constraining tools for grip-specific skill development. Common trends identified from the excluded sources were explored to provide a basis for the importance of using physically constraining tools for grip-specific skill development. Many tools are used in coaching despite their unclear efficacy, however, the current results can guide future work to assess the acute and longitudinal effects of using these tools, specifically within the development and performance of sport-specific skills.

Comparison of Grip Strength, Forearm Muscle Activity, and Shock Transmission between the Forehand Stroke Technique of Experienced and Recreational Tennis Players Using a Novel Wearable Device

Upper limb tennis injuries are primarily chronic, resulting from repetitive overuse. We developed a wearable device which simultaneously measures risk factors (grip strength, forearm muscle activity, and vibrational data) associated with elbow tendinopathy development resulting from tennis players' technique. We tested the device on experienced (n = 18) and recreational (n = 22) tennis players hitting forehand cross-court at both flat and topspin spin levels under realistic playing conditions. Using statistical parametric mapping analysis, our results showed that all players showed a similar level of grip strength at impact, regardless of spin level, and the grip strength at impact did not influence the percentage of impact shock transfer to the wrist and elbow. Experienced players hitting with topspin exhibited the highest ball spin rotation, low-to-high swing path brushing action, and shock transfer to the wrist and elbow compared to the results obtained while hitting the ball flat, or when compared to the results obtained from recreational players. Recreational players exhibited significantly higher extensor activity during most of the follow through phase compared to the experienced players for both spin levels, potentially putting them at greater risk for developing lateral elbow tendinopathy. We successfully demonstrated that wearable technologies can be used to measure risk factors associated with elbow injury development in tennis players under realistic playing conditions.

Upper Extremity Kinematics and Electromyographic Activity in Uninjured Tennis Players

There has been an increase in ulnar-sided wrist pain among tennis players. The purpose of this study was to establish a normative dataset of kinematic and electromyography (EMG) data during the forehand and two-handed backhand groundstrokes. In total, 20 adolescent United States Tennis Association (USTA) ranked tennis players (11/20 Male, Age = 15.0 ± 1.8 years, Height = 1.7 ± 1.1 m, BMI = 21.3 ± 3.4 kg/m2, 18/20 right-arm dominant) participated in this study. Kinematics (range of motion and angular velocity) and EMG data were simultaneously acquired during the forehand and two-handed backhand groundstrokes. Minimal differences were found between groupings of age, sex, and USTA ranking. The two-handed backhand groundstroke is characterized by bilaterally flexed elbows and ulnarly deviated wrists, with a flexed wrist and pronated forearm on the non-dominant side and an extended wrist and supinated forearm on the dominant side. EMG activation occurs bilaterally by peak backswing. The forehand groundstroke is characterized by a flexed elbow, pronated forearm, and ulnarly deviated and extended wrist. The wrist is at maximum ulnar deviation at ball impact. This study established an initial foundation for normative data for the forehand and two-handed backhand groundstrokes, which can be used for injury detection, rehabilitation, prevention, and ultimately performance improvement of tennis athletes.

Validity and reliability of a novel monitoring sensor for the quantification of the hitting load in tennis

Wearable sensor systems are a emerging tools for the evaluation of the sport’s activity and can be used to quantify the external workload of the athlete. The main goal of this paper was to evaluate the validity and reliability of the “Armbeep inertial measurement unit” (IMU) sensor both in a closed tennis exercise and in open matchplay. Twentyfour junior tennis players performed a baseline drill and played matches, during which they wore a combined accelerometer and gyroscope sensor. Video footage was concomitantly recorded using a digital video camera. The agreement between the measurements was assessed with the intraclass correlation coefficient (ICC) and the standard error of measurement (SEM). A simple linear regression was used to predict the number of shots registered from the video and from the Armbeep IMU sensor’s data. The number of total forehand and backhand shots during the drill repetitions showed an excellent test and re-test reproducibility (ICC≥0.90). There was a significant relationship between the Armbeep IMU sensor’s number of contacts and the total number of shots (R² = 0.938) which indicated the excellent reliability of the tested Armbeep IMU sensor for those parameters. Considering the accuracy of the total tennis shots and the small magnitude of error for wrist speed and acceleration, the Armbeep IMU sensor appears to be an appropriate on-court tool that can be used to monitor the hitting load during tennis practice and matches.

Common and Less Well-known Upper-limb Injuries in Elite Tennis Players

A recent increase in epidemiology studies on injuries in elite tennis players has helped to shed light on the types of injuries these athletes sustain. This article reviews the common upper-limb injuries in elite players and includes less well known, but important, injuries. A search was conducted to identify current relevant studies involving elite tennis players. Injury frequency rates, injuries by regions, and types of injuries together with a list of commonly reported injuries in the upper limb were established. This list was then reviewed and refined by a sports medicine physician who cares for elite tennis players to include both those injuries of the upper limb that are common and those that are less well known but still important and frequently encountered. Common injuries include internal shoulder impingement, rotator cuff pathology, labral tears, elbow tendinopathies, as well as extensor carpi ulnaris tendinopathies and subluxation. Posterior shoulder instability, distal humeral bone stress, elbow medial collateral ligament, and nondominant wrist ulnar collateral ligament injuries are not commonly reported injuries, but they are of significant clinical importance.

A kinematic analysis of the upper limb during the topspin double-handed backhand stroke in tennis

The purpose of this study was to compare double-handed backhand kinematics of the non-dominant wrist of tennis players using either an eastern or continental grip position with the non-dominant hand. Trajectory data were captured using sixty reflective markers on sixteen sub-elite right-handed tennis players using a 12-camera VICON motion capture system (250 Hz). Participants executed double-handed backhands using two non-dominant grip positions (Eastern [E] and Continental [C]), aiming for two crosscourt zones (Deep [D] and Short [S]), totalling to four conditions (ED, CD, ES and CS). Three successful attempts from each condition were selected for analysis. The eastern grip demonstrated faster horizontal racket head velocity compared to the continental grip. However, no differences were observed in accuracy or spin rate between grips (p > 0.05). In the non-dominant upper limb, elbow flexion was smaller in the continental condition throughout the swing, whilst wrist extension and ulnar deviation was larger. Collectively, these data suggest that the continental grip may place the wrist in a position vulnerable to overuse injury. Future research into the kinetics of the double-handed backhand would help better understand the onset of ulnar-side wrist pain in tennis.

Do magnetic resonance imaging abnormalities of the non-dominant wrist correlate with ulnar-sided wrist pain in elite tennis players?

OBJECTIVE

Ulnar-sided injuries of the non-dominant wrist are common in elite tennis players that use the double-handed backhand technique. This study aimed to define the relationship between ulnar-sided wrist pain in symptomatic and asymptomatic elite tennis players, and the presence of abnormalities on magnetic resonance imaging (MRI).

MATERIALS AND METHODS

Fourteen symptomatic tennis players, 14 asymptomatic tennis players, and 12 healthy controls who did not play tennis, were analyzed prospectively, after undergoing MRI of their non-dominant wrist. Five anatomical regions were analyzed, thought to relate to ulnar-sided wrist pain. These consisted of the triangular fibrocartilage complex (TFCC), ulnar collateral ligament (UCL), extensor carpi ulnaris tendon (ECU), osseous-articular structures, and ganglia. Images were independently reviewed by two blinded musculoskeletal radiologists.

RESULTS

Non-dominant, ulnar-sided, wrist pain in elite tennis players was not statistically significantly associated with an increased number of MRI abnormalities when compared with asymptomatic tennis players (p > 0.05). However, some evidence of statistical association was seen with an increased prevalence of ECU tendon abnormalities (OR = 8.0, 95% CI = (0.74, 20.00), p = 0.07). A statistically significant increase in MRI abnormalities of osseous structures (OR = 15.1, 95% CI = (1.56, 656.05), p = 0.02) and the dorsal radioulnar ligament (DRUL) (OR = 12.5, 95% CI = (2.15, 111.11), p = 0.03), was observed in symptomatic players compared with controls.

CONCLUSIONS

Non-dominant, ulnar-sided, wrist pain in a subgroup of elite tennis players using a double-handed backhand technique is not associated with a statistically significant increased prevalence of MRI abnormalities when compared with asymptomatic tennis players, other than some evidence of statistical association with ECU tendon abnormalities. Therefore, significance of MRI abnormalities should be interpreted in the context of clinical findings.

A hidden mismatch between experiences of young athletes with overuse injuries of the wrist and sports physicians' perceptions: a focus group study

BACKGROUND

Although overuse wrist injuries can have serious consequences, young athletes often do not immediately report their injury to a physician. This qualitative study aimed to identify symptoms and limitations related to overuse wrist injuries that young athletes consider important and to compare those with sports physicians' opinions, in order to improve the diagnostic process for early identification of overuse wrist injuries.

METHODS

Twenty-one athletes aged 13-25 years in wrist-loading sports (gymnastics, tennis, judo, field hockey, volleyball and rowing) with a (previous) overuse wrist injury were included. In five focus groups, participants discussed important signals and limitations of their injury, as well as a list of relevant items previously composed by sports physicians. Data were grouped into themes and (sub)categories and subsequently coded.

RESULTS

Of the resulting 224 signals and 80 limitations, respectively 81 and 20 were labelled important. Athletes considered both pain and limitations during daily life activities important indicators of overuse wrist injury, as well as long pain duration, acute onset of pain, and accompanying symptoms like swelling, cracking and discoloration. All of the sports physicians' items were also considered important by the athletes, but sport-related pain and limitations were regarded by many athletes as a natural part of their sport.

CONCLUSIONS

Discrepancies exist between the opinions of young athletes and sports physicians on sport-related pain reporting and competing regardless of pain or limitations. Although clinicians may be inclined to focus on these aspects, they are advised to also inquire specifically about limitations and pain during daily life activities in young athletes with overuse wrist injuries.

Specialization patterns across various youth sports and relationship to injury risk

OBJECTIVES

Current trends among young athletes towards earlier specialization age and year-round training on multiple teams has raised concern for increased injury risk. Our previous analyses showed higher risk for injury in highly specialized young athletes. The goal of this research was to determine whether sports specialization and injury patterns vary by sports type.

METHODS

In this clinical case-control study, injured athletes (aged 7-18 years) were recruited from sports medicine clinics and compared to similarly aged uninjured athletes recruited from primary care clinics. Participants completed a survey reporting age, gender, sport type, specialization patterns, and details regarding sports-related injuries in the previous 6 months. Clinical diagnoses were collected from patients' medical records. Injuries were classified as acute, overuse, or serious overuse.

RESULTS

Of 1,190 athletes enrolled, 26% (313) were single-sport specialized (reported participation in one sport and trained >8 months/year). Sports with the highest proportion of single-sport specialized athletes were tennis (46.7%), gymnastics (30.1%), and dance (26.3%). Single-sport specialized athletes in individual sports started specializing at a younger age (11.2 ± 2.4 vs. 12.0 ± 2.7, p = 0.05) and reported higher training volumes (11.8 vs. 10.3 h/week, p = 0.04) than those in team sports. Sports with the youngest specialization age were gymnastics (8.9 ± 1.7), dance (10.8 ± 3.0), and soccer (10.9 ± 2.4). Single-sport specialized athletes in individual sports accounted for a higher proportion of overuse injuries (44.3% vs 32.2%, OR = 1.67, p = 0.037) and serious overuse injuries (23.4% vs 11.6%, OR = 2.38, p = 0.011), but a lower proportion of acute injuries (28.8% vs 13.8%, OR = 0.37, p = 0.001) compared to single-sport specialized athletes involved in team sports.

CONCLUSIONS

Athletes in individual sports may be more likely to specialize in a single sport than team sport athletes. Single-sport specialized athletes in individual sports also reported higher training volumes and greater rates of overuse injuries than single-sport specialized athletes in team sports.