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Arrigoni P, Cucchi D, Beltrame G, Ribolzi R, Ceccarelli C, Zaolino C, Ellenbecker T, Randelli PS. A low carrying angle is measured in elite tennis players just before ball impact during the forehand, suggesting a dynamic varus instant accommodation moving towards full extension. Knee Surg Sports Traumatol Arthrosc 2024; 32:29-36. [PMID: 38226669 DOI: 10.1002/ksa.12016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/21/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE The goal of this study was to use image analysis recordings to measure the carrying angle of elite male tennis players during the forehand stroke, with the hypothesis that elite tennis players overstress their elbow in valgus over the physiological degree in the frontal plane just before ball contact on forehand groundstrokes. METHODS The carrying angle of male tennis players ranked in the top 25 positions in the ATP ranking was measured on selected video frames with the elbow as close as possible to full extension just before the ball-racket contact in forehands. These frames were extracted from 306 videos professionally recorded for training purposes by a high-profile video analyst. All measures were conducted by three independent observers. RESULTS Sixteen frames were finally included. The mean carrying angle was 11.5° ± 4.7°. The intraclass correlation coefficient value was 0.703, showing good reliability of the measurement technique. The measured carrying angle was lower than what has been observed in historical cohorts using comparable measurement methodology, suggesting a possible instant varus accommodation mechanism before hitting the ball. CONCLUSIONS The observed decrease in the carrying angle is a consequence of an increase in elbow flexion position dictated by the transition from a closed to open, semi-open stances. As the elbow flexes during the preparation phase, it is less constrained by the olecranon and its fossa, increasing the strain on the medial collateral ligament and capsule structures. Moving towards full extension before the ball-racket contact, the elbow is dynamically stabilised by a contraction of the flexor muscles. These observations could provide a new explanation for medial elbow injuries among elite tennis players and drive specific rehabilitation protocols. STUDY DESIGN Descriptive epidemiology study. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Paolo Arrigoni
- Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Giulia Beltrame
- Scuola Di Specializzazione in Ortopedia e Traumatologia Università Degli Studi Di Milano, Milan, Italy
| | - Romeo Ribolzi
- Scuola Di Specializzazione in Ortopedia e Traumatologia Università Degli Studi Di Milano, Milan, Italy
| | | | - Carlo Zaolino
- Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Todd Ellenbecker
- Medical Services, ATP Tour, Ponte Vedra Beach, Jacksonville, Florida, USA
- Rehab Plus Sports Therapy Scottsdale, Scottsdale, Arizona, USA
| | - Pietro S Randelli
- Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics, Università Degli Studi Di Milano, Milan, Italy
- Department of Biomedical Sciences for Health, Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Università Degli Studi Di Milano, Milan, Italy
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Watson L, Hoy G, Wood T, Pizzari T, Balster S, Barwood S, Warby SA. Posterior Shoulder Instability in Tennis Players: Aetiology, Classification, Assessment and Management. Int J Sports Phys Ther 2023; V18:769-788. [PMID: 37425109 PMCID: PMC10324327 DOI: 10.26603/001c.75371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/14/2023] [Indexed: 07/11/2023] Open
Abstract
Background Micro-traumatic posterior shoulder instability (PSI) is an often missed and misdiagnosed pathology presenting in tennis players. The aetiology of micro-traumatic PSI in tennis players is multifactorial, including congenital factors, loss of strength and motor control, and sport-specific repetitive microtrauma. Repetitive forces placed on the dominant shoulder, particularly combinations of flexion, horizontal adduction, and internal rotation contribute to the microtrauma. These positions are characteristic for kick serves, backhand volleys, and the follow-through phase of forehands and serves. The aim of this clinical commentary is to present an overview of the aetiology, classification, clinical presentation, and treatment of micro-traumatic PSI, with a particular focus on tennis players. Level of Evidence 5.
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Affiliation(s)
- Lyn Watson
- Melbourne Shoulder Group, 305 High Street, Prahran, Victoria, Australia, 3181
| | - Gregory Hoy
- Melbourne Orthopaedic Group, 33 The Avenue Windsor, Victoria, Australia, 3181
- Monash University, Department of Surgery, Monash Medical Centre Level 5, Block E 246 Clayton Road Clayton, Victoria, Australia, 3168
- Glenferrie Private Hospital, 25 Linda Crescent, Hawthorn, Victoria, Australia, 3122
| | - Timothy Wood
- Glenferrie Private Hospital, 25 Linda Crescent, Hawthorn, Victoria, Australia, 3122
| | - Tania Pizzari
- Melbourne Shoulder Group, 305 High Street, Prahran, Victoria, Australia, 3181
- Mill Park Physiotherapy, 22/1 Danaher Dr, South Morang, Victoria, Australia, 37522
- La Trobe University, Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, Corner of Kingsbury Drive and Plenty Road Bundoora, Victoria, Australia, 3080
| | - Simon Balster
- Melbourne Shoulder Group, 305 High Street, Prahran, Victoria, Australia, 3181
| | - Shane Barwood
- Melbourne Orthopaedic Group, 33 The Avenue Windsor, Victoria, Australia, 3181
| | - Sarah Ann Warby
- Melbourne Shoulder Group, 305 High Street, Prahran, Victoria, Australia, 3181
- La Trobe University, Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, Corner of Kingsbury Drive and Plenty Road Bundoora, Victoria, Australia, 3080
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Kasper AA, Gibbons JL, Abboudi J, Aita D, Takei TR, Fletcher D, Gallant GG, Kwok M, Beredjiklian P. Pickleball- and Paddleball-Related Injuries to the Upper Extremity. Cureus 2023; 15:e39831. [PMID: 37397683 PMCID: PMC10314735 DOI: 10.7759/cureus.39831] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction While pickleball and paddleball are rapidly growing as popular sports in the United States, research on the incidence of hand and upper extremity injuries and treatments in outpatient clinics are lacking. This study evaluates the incidence rates and treatment options, both surgically and nonsurgically, for patients presenting with pickleball/paddleball-related injuries. Methods A retrospective database search of our multispecialty, multilocation electronic medical record (EMR) system from 2015 to 2022 identified 204 patients with outpatient pickleball- and paddleball-related injuries. The data from these patients' charts were reviewed for injury incidences, treatment trends, and demographics. Results The majority of patients suffered wrist fractures due to a fall/dive and were treated nonsurgically. The most common surgical treatment, when required, was open reduction and internal fixation of the distal radius. We found that pickleball and paddleball players who sustained wrist fractures required surgery at a higher rate than the general population if above the age of 65. Conclusion As pickleball and paddleball continue to gain popularity, hand surgeons should be aware of the types of injuries that can occur and, when possible, counsel patients accordingly to try to prevent them. Additionally, hand surgeons should recognize the common treatments and outcomes that arise from pickleball/paddleball-related injuries.
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Affiliation(s)
- Alexis A Kasper
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - John L Gibbons
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, USA
| | - Jack Abboudi
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Daren Aita
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - T Robert Takei
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Daniel Fletcher
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Greg G Gallant
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Moody Kwok
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Pedro Beredjiklian
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
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Rigozzi CJ, Vio GA, Poronnik P. 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. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23115146. [PMID: 37299874 DOI: 10.3390/s23115146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Chantelle Jean Rigozzi
- FMH Media Lab, School of Medical Sciences, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney 2006, Australia
| | - Gareth A Vio
- School of Aerospace, Mechanical and Mechatronic Engineering, The University of Sydney, Sydney 2006, Australia
| | - Philip Poronnik
- FMH Media Lab, School of Medical Sciences, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney 2006, Australia
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Hackenbroch C, Kreitner KF. [Stress reactions and stress fractures]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:259-267. [PMID: 36882548 DOI: 10.1007/s00117-023-01129-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
Bone stress injuries is an umbrella term that encompasses repetitive microtraumatic events that accumulate to surpass the threshold of bone failure, which can range from bone marrow edema to frank stress fracture as the end point. Due to nonspecific clinical complaints and physical findings, imaging plays a central role in the diagnostic workup of these entities. Magnetic resonance imaging (MRI) is the most important imaging modality with a high sensitivity and specificity and allows for differential diagnosis of other diseases. Edema-sensitive with fat suppression and T1-weighted sequences are the core sequence types, and contrast-enhanced imaging-albeit displaying subtle fractures much more easily-is rarely necessary. Furthermore, MRI enables differentiation of injury severity, which has an impact on length of rehabilitation, therapeutic regimen, and the time to return to sports in athletes.
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Affiliation(s)
- Carsten Hackenbroch
- Klinik für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Karl-Friedrich Kreitner
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie der Universitätsmedizin Mainz, Johannes Gutenberg-Universität, Langenbeckstraße 1, 55131, Mainz, Deutschland.
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Wahle CF, Hart CM, Beck JJ. First Rib Stress Fracture in an Adolescent Elite Tennis Player: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00013. [PMID: 36821418 DOI: 10.2106/jbjs.cc.22.00519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
CASE A 16-year-old, right-hand-dominant, Asian male, elite tennis player presented to the clinic with a 1-month history of left shoulder pain. Originally, the pathology was believed to be shoulder-based, but lack of improvement after several weeks of therapy warranted further imaging, which ultimately revealed a nondisplaced fracture of the posterior left first rib. CONCLUSION Stress injuries are not uncommon in the sport of tennis, but atraumatic rib fractures are rare. Given the increase in youth sports specialization and overtraining and other risk factors such as adolescent age and race, it is important to keep rib stress fracture on the differential.
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Affiliation(s)
| | - Christopher M Hart
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jennifer J Beck
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.,Orthopaedic Institute for Children, Los Angeles, California
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Wang J, Li Y. STRENGTH TRAINING METHOD FOR TENNIS PLAYERS. REV BRAS MED ESPORTE 2023. [DOI: 10.1590/1517-8692202329012022_0632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
ABSTRACT Introduction: Tennis is highly technical, and any error in its players’ strength training can exponentially impact the competition. A timely review and analysis of tennis players’ biomechanics will help to better understand the training system and reveal the basis for future scientific sports training strategies. Objective: Analyzes the effect of different strength training methods to design the best protocol considering tennis players’ speed and success rate. Methods: The effect of training on 40 tennis players is discussed. The volunteers were divided into the experimental and control group. The experimental group performed strength training for 40 minutes daily, thrice a week. The control group continued with conventional training. The trial lasted eight weeks. The speed and success rate of the training were tested before and after the experiment. Results: The experimental group players significantly improved serve speed (P<0.05). The success rate of the experimental group was also significantly improved (P<0.05). Conclusion: The proposed strength training significantly improved the success rates of speed in tennis players. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.
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Liu L. CORRELATION BETWEEN LOCATION AND CAUSE OF INJURIES IN TENNIS PLAYERS. REV BRAS MED ESPORTE 2023. [DOI: 10.1590/1517-8692202329012022_0299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT Introduction Tennis is a network sport that requires strength, endurance, agility, speed, skill, and other physical demands from participants. Tennis athletes are subject to injuries in their daily training, affecting their competitive performance. Objective Explore the correlation between the location of injuries and the cause of injuries in tennis players. Methods Tennis players were selected as the research subjects. In this study, a questionnaire was used to record tennis injuries. The rehabilitation treatment of tennis players after injuries was summarized and analyzed through statistical methods. Results The main forms of serious sports injuries caused by tennis players were acute and moderate injuries. The most common fractures are mainly ligament and tendon: joint ligament injury or tear, muscle ligament injury, bursitis, and soft tissue ligament contusion. The joints most commonly involved are knees, ankles, elbows, wrists, and shoulders. Conclusion The common causes of sports injuries in tennis players are the inaccuracy of technical movements, insufficient muscular strength, and insufficient strength for preparatory technical activities. In practice, it is recommended that athletes correct and standardize their movements. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.
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Ke W. RESPONSES OF TAI CHI IN UPPER LIMB SPORTS INJURIES REHABILITATION ON YOUNG PEOPLE. REV BRAS MED ESPORTE 2022. [DOI: 10.1590/1517-8692202228062022_0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction Practicing sports can strengthen the body both physically and mentally. Although Tai Chi can help injured athletes to recover quickly and shorten the return to sports training and competition, there are still no detailed studies about its effectiveness in lower limb injuries in young people. Objective Analyze the effects of Tai Chi in upper limb sports injuries rehabilitation on young people. Methods 91 patients with sports injuries are selected and randomly divided into a control group (n=44) and an experimental group (n=47). The control group received regular exercises for rehabilitation, while the experimental group used Tai Chi exercises. Mathematical statistics are used to analyze the effects before and after the activities. Results There are considerable statistical differences in the effects of exercise on the two groups of patients. Conclusion Tai Chi exercise can help young people recover from upper limb sports injuries. Evidence level II; Therapeutic Studies - Investigating the results.
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Affiliation(s)
- Wanli Ke
- Henan Institute of Economics and Trade, China
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10
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Evaluation and treatment of shoulder injuries in tennis players: a review. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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