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Ask the High Perfomance Lab

May 25, 2008 12:25 PM

PLEASE NOTE: The medical opinions in USTA.com's Ask the High Performance Lab are responses intended for the average player. Please consult with your primary physician before beginning any new exercise program.

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This column features a question and a follow-up question regarding wrist injuries in tennis players. All answers were provided by Dr. W. Ben Kibler. Dr. Kibler is a world-renowned orthopedist and a member of the USTA Sport Science Committee.

He is a leading expert in shoulder surgery as well as the biomechanics of shoulder and upper body injuries. Dr. Kibler is also an avid tennis player and has focused much of his research on topics aimed at better understanding injuries in tennis.

Question: Thanks for the article on Prevention of Wrist Injuries in Tennis Players. My daughter is a 17 year old competitive tennis player. She has a wrist injury that has been brothering her for over eight months. We believe that the injury originally occurred during a mixed doubles tournament in which the boys were very hard hitters. She went to an orthopedic doctor who diagnosed it as a TFCC injury.

She went through physical therapy to rehab the wrist and everything appeared to be going fine. She took three months off and started to play again in and all was well for about two months. She now experiences swelling in the wrist after playing for a short period of time (1/2 hour), but has no pain. When her wrist swells, her hand feels weak and she has muscle spasms if she plays for an extended period of time.

She has seen three doctors including a hand specialist and has had x-rays, an MRI and a bone scan. Everything turned up negative for tears, fractures, etc. Her form has been looked at and she has changed rackets and grip size. Nothing seems to help. Have you heard of any similar cases? Any help is appreciated.

Dr. Kibler: The problem sounds pretty familiar and the injury may involve the Triangular Fibro-Cartilage Complex (TFCC) in the wrist – which functions much like the meniscus in the knee. However, this injury is impossible to diagnose over the Internet and the player would need to have the x-rays examined by a doctor who has experience with TFCC injuries, and has experience with tennis players, to get an accurate diagnosis. Unfortunately, I have found that not a lot of doctors really know what TFCC injuries in tennis players look like.

The classical treatments for a TFCC injury include change in grip - not necessarily a racquet change (e.g. use less of a Western grip on the forehand, less cocking on the two-handed backhand), taping the wrist, strengthening not only the wrist but the forearm and shoulder muscles, and making sure the player uses the entire kinetic chain, not just the arm when hitting.

Surgical treatment may be necessary if symptoms persist. The problem is often not in the actual TFCC, but in the attachments around the edges of the TFCC. When these attachments are damaged, the TFCC slides into the joint between the bones, and can give pain, swelling, and clicking.

Follow-up question: The confusing thing about this is that the x-ray, MRI and bone scan don't show any tears or damage and that she doesn't have any real pain. She does have the "clicking" sound associated with the TFCC injury, but wouldn't something show-up?

What would be causing the swelling and the muscle fatigue that's been bothering her? She's takes an anti-inflammatory and has had a cortisone shot, but they don't appear to help. Her doctors want to do surgery as a last resort, but it would be exploratory since they can't see anything wrong.

This injury has been real frustrating for my daughter and everyone else involved. Please let us know what you find. Any information and help is appreciated. Thank you.

Dr. Kibler: Thank you for your e-mail. I am sorry that the usual treatments have been of little effect. In response to your questions, here is some more information about TFCC injuries in tennis players:

  • TFCC injuries can show up, especially on MRIs, but most of the time they require injection of a dye into the joint to outline the tear. Sometimes, the injury can be hard to see if there has been a scar healing response, which even though it is not good tissue, can mask the injured area.
  • This injury does not seem to get much worse with play, but as you know it does not get much better with rest either.
  • The longer an injury of this nature lasts, the less likely it is to resolve on its own, due to the fact that this becomes a "failed healing response"- the body seems to give up trying to heal the injury and either puts down some scar or leaves the tear.
  • There are several theories about the weakness, but no hard facts. It is probably due to changes in the way the hand grips the racquet, or weakness due to swelling produced weakness.

Additional Resources

There are several additional resources that you can download from the USTA Player Development website:









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