Course Instructor (P12)
Wrist and Elbow Injuries
- Wrist and elbow injuries are fairly common among amateur golfers due primarily to poor golf swing mechanics and faults. These injuries are typically caused by repetitive mechanical straining of wrist and elbow tendons and muscles and ligamentous sprains.
- A common cause of wrist and elbow injuries is an improper grip on the club such as baseball grips and super strong grips where the four knuckles of the left hand can be seen. An improper grip causes the club head and shaft to travel in an improper swing path which in turn places mechanical strain on the elbow and wrist during the downswing. Also, an improper grip will limit or restrict the normal unlocking of the wrists prior to impact.
- A simple way to rectify an improper grip is to utilize a grip trainer which promotes a proper grip on the club.
Wrist And Hand Injury
The wrist and hand comprise the most dynamic areas of movement in the body. The wrist and the hand are the sights of numerous minor, yet very irritating conditions experienced by golfers. For example, heat and friction will lead to blisters, calluses, while repetition can lead to chronic sprains and strains.
The wrist and the hand contain 27 bones, 8 carpal bones, 5 metacarpal bones and 14 phalanges, comprising 38 joints. The carpal bones are the navicular (scaphoid), lunate, triquetrum, pisiform, trapezium, trapezoid, capitate and hamate. According to Basic Athletic Training, the authors Kenneth E. Wright and William R. Whitehill suggest remembering these bones by using the first letter of this statement “never leave the player, the trainer can help.”
The lunate bone is the most often dislocated of the wrist bones, while the navicular is the most commonly fractured. The joints and the wrist comprise the radiocarpal, midcarpal, carpometacarpal, intercarpal and metacarpophalangeal and interphalangeal, which include the distal interphalangeal and the proximal interphalangeal joints in the fingers. The muscles surrounding the wrist and hand include the abductor pollicis brevis, flexor pollicis brevis, opponens pollicis and adductor pollicis, palmaris brevis, abductor digiti minimi, flexor digiti minimi brevis, opponens digiti minimi, lumbricals, the palmar interossei, and the dorsal interossei.
Generally, fractures are uncommon as a result of golf play. Falls or similar concussive injuries may lead to fractures in the golfer. The nagging repetitive-type injuries are those which most significantly impact the golfer and require the attention of the health care provider.
- Blisters – this is a thin, rounded swelling of the skin that contains fluid. It is caused by irritation, excessive heat or burns and is also known as a vesicle or bulla. Blisters can be limited by the use of gloves, repeat drying of the hands or use of powder. Once the blister has occurred, it is best to leave the skin unbroken to decrease the chance of infection. If repeated irritation occurs after the formation of the blister, it would be necessary to break the overlying skin. The use of a sanitized needle or pin would help drain the blister, but removal of the skin and wrapping of the tissue must follow. The use of a moleskin pad or a gauze bandage is beneficial. It is wise to wash with soap and water prior to application of the cover. Topical application of triple antibiotics, such as Neosporin, is helpful. Though iodine and camphor-phenol will clearly kill germs, there high concentration may also kill cells and decrease healing. The dressing should be changed regularly and the area should remain covered from additional irritation.
- Fractures – navicular (scaphoid) fractures comprise 75% of carpal injuries, in the most at risk groups, which are men ages 15 to 30 years. The most common mechanism for a fracture is falling on an outstretched or extended wrist, usually leading to the scaphoid or even a Colles’ fracture. The Colles’ fracture is a break which occurs approximately 1 inch above the wrist on the radius and is easy to recognize by the hand position that it causes. It would be impossible to supinate the hand in the presence of a Colles’ fracture; in essence, there will be a dorsal angulation rather than a volar angulation seen with a Smith’s fracture of the same structure.
- Dislocation – the scapholunate dislocation results from a tearing of the scapholunate ligament just below the radial head. Swelling, ecchymosis and deviation will be present. This will lead to a long period of immobilityand dissuasion away from playing golf for several weeks. The usual acute protocols would be applied. A wrist spica would be applied and a slow and steady rehabilitative phase would occur. Poor motion over a sustained period of time may necessitate a surgical consultation.