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

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

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.

Posterior Shoulder Instability in Tennis Players: Aetiology, Classification, Assessment and Management

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.

Pickleball- and Paddleball-Related Injuries to the Upper Extremity

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.

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.

[Stress reactions and stress fractures]

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.

First Rib Stress Fracture in an Adolescent Elite Tennis Player: A Case Report

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.

STRENGTH TRAINING METHOD FOR TENNIS PLAYERS

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.

CORRELATION BETWEEN LOCATION AND CAUSE OF INJURIES IN TENNIS PLAYERS

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.

RESPONSES OF TAI CHI IN UPPER LIMB SPORTS INJURIES REHABILITATION ON YOUNG PEOPLE

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.