Wrist Problems in Golfers
Golf has historically been viewed as a refined sport with a low injury rate. Most injuries reported were anecdotal and due to odd ccurrences, such as a thrown club or a fall from a golf cart. In a 1989 study of high school athletes, there were no injuries attributable to golf. Despite the perceived safety of golf, golfers do injure their wrists. A study of 225 professional golfers showed a 34% incidence of wrist and hand injuries. These injuries involved the soft tissue, cartilage, bone, nerve, and vascular structures.
How is the wrist injured?
Tendinitis (inflammation of the tendon) can occur in golfers (Fig. 1). If a golfer increases practice time, an overuse injury can occur, particularly if the mechanics of the swing are poor. Advancing age, a previous injury, and anatomic abnormalities can further increase the risk of tendinitis. Patients are treated with rest, nonsteroidal anti-inflammatory drugs, and avoidance of activities that cause pain. If this treatment is unsuccessful, one to two corticosteroid injections into the area can decrease the inflammation.
If injections are unsuccessful, surgery may be necessary to release a band of tissue (retinaculum) to create more space for the tendon (Fig. 2). After surgery, most patients refrain from golf for four weeks. After the initial four weeks, they begin practice swings. As motion and strength improve, usually between 8 and 12 weeks, they return to the game without restrictions.
Triangular fibrocartilage complex injuries are also seen in golfers. The triangular fibrocartilage complex is a structure on the ulnar side (outside) of the wrist, which is important to wrist stability (Fig. 3). With the increased motion of the wrist that occurs in golfers, this structure is prone to tearing. Very often, nonoperative treatment, such as rest, reduction of play, and nonsteroidal anti-inflammatory drugs, is successful in relieving pain. If it is not, the inflamed tissue can be removed by arthroscopic surgery (surgery using small incisions). If the cartilage tear is large, repair of the cartilage through an open incision is sometimes necessary.
Golfers can break their hamate, or wrist bone, with a “fat” shot or in cold weather when the hand strikes the hard ground with the club, the force is transmitted to the bone (Fig. 4). The butt of the golf club rests against the hook of the hamate, a bone in the wrist. Diagnosis is usually made by physical examination and confirmed with x-rays. If found and treated early, this fracture will heal in a cast.
However, many hamate injuries are diagnosed late. In these patients, removing the bone to relieve the pain is sometimes necessary. Patients should understand that this bone is closely related to important structures of the hand, including the ulnar artery and ulnar nerve, and both structures can be involved in the injury or affected by surgical intervention. Although golf injury is rare, the wrist is one of the most commonly injured anatomic locations in the sport. Wrist injuries can occur not only in the average golfer but also in the high-level professional. They are usually the result of overuse due to excessive practice, or excessive play or poor mechanics that place the wrist at risk. Nonsurgical treatment is usually effective; however, in some patients, surgical treatment is necessary to return the patient to play.