A Pictorial Review of Wrist Injuries in the Elite Golfer (P1)
Golf is a sport played and watched by millions of amateurs. It’s popularity is increasing globally, with some 20 million players projected to play in China alone by 2020. At the pinnacle of the sport are small group of elite professional golfers who make a living from tournament prize money and sponsorship deals. The elite male golfer is young with an average age of 24, this along with different swing mechanics and increased repetitive strain is thought to result in injury patterns which differ from the amateur. The frequency and nature of wrist injuries in the elite golfer has not been reliably documented until recently; a study carried out by Hawkes on the top professional golfers on the European tour in 2009 reported that the majority of injuries were sustained in the leading wrist, with ulnar sided injuries being most commonly reported. Complex swing mechanics are thought to subject the leading wrist to considerable stress as it moves from ulnar to radial deviation and then back to ulnar deviation during the swing. There is also movement from pronation to supination and from flexion to extension through impact. This impact is substantial as professionals aim to ‘hit through the ball’ with the club face, often hitting the ground and taking a divot of turf in order to make more controlled shots through imparted spin. This article will review the common wrist injuries encountered by the examining sports physician in the elite golfer. Injuries to the wrist can be classified by the anatomical localisation of pain and other symptoms; common ulnar sided, radial sided and dorsal injuries will be evaluated.
The Golf Swing
The wrists link the body to the golf club and form the final component of a kinematic chain composed of the hips, spine and shoulders. An overview of wrist movement through the swing does however aid our appreciation of the stresses incurred at the wrist and provides a useful framework on which to correlate pathology.
The non-dominant wrist (the left wrist for right handed golfers) begins the golf swing in a position of ulnar deviation when addressing the ball. As the club is lifted away into the backswing, this wrist moves into radial deviation until it sits maximally radially deviated at the top of the backswing. At this point, the club changes direction to begin the downswing and the non dominant wrist returns to ulnar deviation until the ball is hit. The dominant wrist moves in a different path altogether, being in neutral at address before moving quickly into maximal extension during the backswing and only coming back into neutral (and ultimately flexion) just before ball strike. In this way, the wrists control the golf club and impart significant power to the ball strike. The limited joint movement insures consistency and increased reproducibility in the swing.
These opposite motion paths (ulnar/radial deviation for the non-dominant wrist, flexion/ extension for the dominant wrist) allow an understanding of the incidence of certain injury patterns in golf. The ulnar and radial deviation movements of the leading wrist are likely to predispose to problems with the tendons on the radial and ulnar borders of the wrist as they move through a near-maximal excursion with these wrist movements. This explains the high incidence of de Quervain’s tendonitis and extensor carpi ulnaris (ECU) sheath and tendon problems in the non-dominant hand.