Mount Sinai Health Tip:
It's in the Wrist
Mount Sinai | July 20, 2018
The modern power game of tennis has caused more of the top players to be sidelined with wrist injuries in recent years, with Juan Martin del Potro (pictured above) and Kei Nishikori just the latest.
Both players are back to top form, but it did take some time, which underscores how difficult it can be to recover from a serious wrist injury.
Fortunately, most amateur players can recovery more quickly from everyday wrist problems, according to Michael Hausman, MD, Chief of Hand and Upper Extremity Surgery for the Mount Sinai Health System, who has literally written the book on wrist injuries for young tennis players. Mount Sinai Health System is the official medical services provider of the United States Tennis Association (USTA) Eastern Section and the US Open.
In this Q&A, Dr. Hausman explains why wrist injuries are more common and what you can do if your wrist is giving you trouble. ADVERTISEMENT In most cases, rest and anti-inflammatory medicines should be enough. Some players may want to consider minor adjustments to their technique and their equipment.
Why are we seeing more wrist injuries these days?
Dr. Hausman: The biggest reason why this is very common now is that players are hitting the ball with lots of topspin. That involves rotating your forearm violently as you come over the ball. You are not only rotating your forearm, but you are also turning your wrist so that your thumb begins by pointing to the right (for a right-hander) and ends up pointing to the left. Your wrist can get quite a workout, which puts pressure on the tendon. It’s the same for both forehand and backhand. But wrist troubles are not a necessary part of the game. For amateur players, wrist injuries are most often the result of overuse or poor technique. In some cases, I see wrist injuries from a fall.
What should I do if I am feeling pain in my wrist?
Dr. Hausman: The first thing you should do is take a break from playing. I also suggest taking anti-inflammatory medications, such as ibuprofen (Advil or Motrin), which are a class of medicines called NSAIDs (nonsteroidal anti-inflammatory drugs). In many cases, the pain will go away in about a week. For more than three-quarters of my patients, this is enough. However, if the pain persists, you can talk with your doctor. The doctor may order an MRI to assess the extent of the problem and determine whether the tendon is inflamed or whether there has been some damage. You should also make sure you’re not hurting your wrist by hitting the ball improperly. You may want to try hitting with less topspin or talk to a tennis pro for other suggestions about your technique. Some players like using wrist braces, though I have not seen much benefit.
Is surgery an option?
Dr. Hausman: In my experience, surgery is rarely required. If your tendon is inflamed, a cortisone shot is generally enough. Surgery might be required if there is significant damage to the tendon and the pain is bothering you. The operation has a very high rate of success. But it can take up to four months before you can return to playing, and even longer until you are back to normal.
What about changing my racquet or strings?
Dr. Hausman: In recent years, there have been significant changes in racquet design and strings. If you are having trouble with your wrist, you may want to try different racquets and experiment with your strings to see if that makes a difference. For example, some players are choosing “closed” string patterns (ones with more strings that form a tighter pattern with smaller openings). They tend to offer more control than more “open” string patterns (ones with fewer strings and larger openings between strings). However, a closed string pattern can be stiffer and can transmit more force to your arm and wrist. Some manufacturers are advertising strings that are easier on your arm, and the tension you use to string your racquets can also make a difference.
Michael Hausman, MD, is the Robert K. Lippmann Professor of Orthopedic Surgery at the Icahn School of Medicine at Mount Sinai, Vice-Chair of the Department of Orthopedics at Mount Sinai, and Chief of Hand and Upper Extremity Surgery for the Mount Sinai Health System. He is an internationally recognized surgeon who treats disorders of the hand, elbow, shoulder and peripheral nerves (the nerves that connect the brain to the rest of your body). He has devised new treatments for conditions of the wrist and reconstruction of injured peripheral nerves as well as common conditions, such as tennis elbow. He has published more than 100 articles about these treatments and his research.