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Professional tennis players suffer high prevalence of shoulder alterations during the season: a possible tennis shoulder syndrome

  • SPORTS MEDICINE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To analyze the shoulder alterations of professional tennis players during the competition season and to compare the differences between their dominant vs. non-dominant shoulders, as well as gender and age differences.

Methods

Two-hundred and seventy shoulders of (78 men and 57 women) professional active tennis players were assessed during 3 ATP and WTA tournaments. Main variables studied: long head of biceps (LHB) tenderness and synovitis; glenohumeral internal rotation deficit (GIRD), total range of motion (TRM), external rotation (ER) and scapular dyskinesis (DK). Secondary variables: shoulder dominance, gender, age, training hours, ranking, type of backhand. LHB tenderness and synovitis were assessed by clinical and ultrasound examination, TRM with goniometer and DK by dynamic observation.

Results

LHB tenderness of the dominant shoulder was present in 35% of all players, being more prevalent in women (47.4%) than men (26.9%) p = 0.023. LHB synovitis of the dominant shoulder was present in 20.2% of all players without difference between genders (n.s). High prevalence of GIRD was found in both dominant (87.4%) and non-dominant (56.3%) shoulders, being more prevalent in the dominant shoulder p = 0.00005. TRM was decreased in both dominant (144.5° ± 20.2°) and non-dominant shoulders (161.2° ± 18.9°) p = 0.00005. ER was normal in dominant (93.8° + /9.3°) and non-dominant shoulders (93.4° + /8.4°) (n.s). DK was present in 57.7% of dominant and 45.9% of non-dominant shoulders (n.s). The combination of LHB alterations, GIRD and DK in the dominant shoulder was present in 13.3% of the participants. There were no significant differences between younger (< 22 years) vs older players (≥ 22 years).

Conclusion

Professional tennis players actively playing suffer a high prevalence of LHB inflammation, GIRD, scapular dyskinesis and decreased TRM in their dominant and non-dominant shoulders. The LHB is a significant cause for anterior shoulder pain in this population. Women suffer more LHB tenderness than men. Young players are as affected as older players.

Level of evidence

Level IV.

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Data Availability

We stated the data related to the study will be available upon request without restrictions.

Abbreviations

ATP:

Association of tennis players

BMI:

Body mass index

Dysk:

Dyskinesis

DS:

Dominant shoulder

ER:

External rotation

GIRD:

Glenohumeral internal rotation deficit

h:

Hours

IC:

Confidence interval

IR:

Internal rotation

LHB:

Long head of the biceps

Mhz:

Megahertzs

Min:

Minimum

Max:

Maximum

n:

Sample size

NDS:

Non-dominant shoulder

TROM:

Total range of motion

SD:

Standard deviation

SLAP:

Superior labral tear from anterior to posterior

SPSS:

Statistical package for the social sciences

US:

Ultrasound

VAS:

Visual analogic scale

yo:

Years old

WTA:

Women tennis association

References

  1. Patel H, Lala S, Helfner B, Wong TT (2021) Tennis overuse injuries in the upper extremity. Skeletal Radiol 50:629–644

    Article  PubMed  Google Scholar 

  2. Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology. Part II: evaluation and treatment of SLAP lesions in throwers. Arthroscopy 19:531–539

    Article  PubMed  Google Scholar 

  3. Ellenbecker TS, Roetert EP, Bailie DS, Davies GJ, Brown SW (2002) Glenohumeral joint total rotation range of motion in elite tennis players and baseball pitchers. Med Sci Sports Exerc 34:2052–2056

    Article  PubMed  Google Scholar 

  4. Keller RA, De Giacomo AF, Neumann JA, Limpisvasti O, Tibone JE (2018) Glenohumeral internal rotation deficit and risk of upper extremity injury in overhead athletes: a meta-analysis and systematic review. Sports Health 10:125–132

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kibler W, Kuhn J, Wilk K, Sciascia A, Moore S, Laudner K, Ellenbecker T, Thigpen C, Uhl T (2013) The disabled throwing shoulder: spectrum of pathology-10-year update. Arthroscopy 29:141–161

    Article  PubMed  Google Scholar 

  6. Kibler WB, Wilkes T, Sciascia A (2013) Mechanics and pathomechanics in the overhead athlete. Clin Sports Med 32:637–651

    Article  PubMed  Google Scholar 

  7. Robison HJ, Boltz AJ, Morris SN, Collins CL, Chandran A (2021) Epidemiology of injuries in national collegiate athletic association men’s tennis: 2014–2015 through 2018–2019. J Athl Train 56:773–779

    Article  PubMed  PubMed Central  Google Scholar 

  8. Shanley E, Rauh MJ, Michener LA, Ellenbecker TS, Garrison JC, Thigpen CA (2011) Shoulder range of motion measures as risk factors for shoulder and elbow injuries in high school softball and baseball players. Am J Sports Med 39:1997–2006

    Article  PubMed  Google Scholar 

  9. Wilk KE, Macrina LC, Fleisig GS, Porterfield R, Simpson CD, Harker P, Paparesta N, Andrews JR (2011) Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med 39:329–335

    Article  PubMed  Google Scholar 

  10. Alrabaa RG, Lobao MH, Levine WN (2020) Rotator cuff injuries in tennis players. Curr Rev Musculoskelet Med 13:734–747

    Article  PubMed  PubMed Central  Google Scholar 

  11. Borsa PA, Wilk KE, Jacobson JA, Scibek JS, Dover GC, Reinold MM, Andrews JR (2005) Correlation of range of motion and glenohumeral translation in professional baseball pitchers. Am J Sports Med 33:1392–1399

    Article  PubMed  Google Scholar 

  12. Kekelekis A, Nikolaidis PT, Moore IS, Rosemann T, Knechtle B (2020) Risk factors for upper limb injury in tennis players: a systematic review. Int J Environ Res Public Health 17:2744

    Article  PubMed  PubMed Central  Google Scholar 

  13. Busra Cigercioglu N-B, Guney-Deniz H, Unuvar E, Colakoglu F, Baltaci G (2021) Shoulder range of motion, rotator strength, and upper-extremity functional performance in junior tennis players. J Sport Rehabil 30:1129–1137

    Article  PubMed  Google Scholar 

  14. Gillet B, Begon M, Sevrez V, Berger-Vachon C, Rogowski I (2017) Adaptive alterations in shoulder range of motion and strength in young tennis players. J Athl Train 52:137–144

    Article  PubMed  PubMed Central  Google Scholar 

  15. Johansson F, Asker M, Malmberg A, Fernandez-Fernandez J, Warnqvist A, Cools A (2022) Eccentric and isometric shoulder rotation strength and range of motion: normative values for adolescent competitive tennis players. Front Sports Act Living 4:798255

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kalo K, Vogt L, Sieland J, Banzer W, Niederer D (2020) Injury and training history are associated with glenohumeral internal rotation deficit in youth tennis athletes. BMC Musculoskelet Disord 21:553

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kibler WB, Chandler TJ, Livingston BP, Roetert EP (1996) Shoulder range of motion in elite tennis players. Effect of age and years of tournament play. Am J Sports Med 24:279–285

    Article  CAS  PubMed  Google Scholar 

  18. Tooth C, Croisier J-L, Schwartz C, Tubez F, Gofflot A, Bornheim S, Forthomme B (2022) The influence of growth and development on shoulder rotators strength in young male and female elite tennis players. J Sports Med Phys Fitness 62:1638–1645

    Article  PubMed  Google Scholar 

  19. Brasseur J-L, Lucidarme O, Tardieu M, Tordeur M, Montalvan B, Parier J, Le Goux P, Gires A, Grenier P (2004) Ultrasonographic rotator-cuff changes in veteran tennis players: the effect of hand dominance and comparison with clinical findings. Eur Radiol 14:857–864

    Article  PubMed  Google Scholar 

  20. Harada Y, Yokoya S, Sumimoto Y, Iwahori Y, Kajita Y, Deie M, Adachi N (2022) Prevalence of rotator cuff tears among older tennis players and its impact on clinical findings and shoulder function. J Sport Rehabil 31:849–855. https://doi.org/10.3389/fspor.2022.798255

    Article  PubMed  Google Scholar 

  21. Torres RR, Gomes JL (2009) Measurement of glenohumeral internal rotation in asymptomatic tennis players and swimmers. Am J Sports Med 37:1017–1023

    Article  PubMed  Google Scholar 

  22. Mehta P, Rand EB, Visco CJ, Wyss J (2018) Resident accuracy of musculoskeletal palpation with ultrasound verification. J Ultrasound Med 37:1719–1724

    Article  PubMed  Google Scholar 

  23. Naredo E, Aguado P, De Miguel E, Uson J, Mayordomo L, Gijon-Banos J, Martin-Mola E (2002) Painful shoulder: comparison of physical examination and ultrasonographic findings. Ann Rheum Dis 61:132–136

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Ostrowski JL, Beaumont A, Dochterman E (2021) Diagnostic accuracy of musculoskeletal ultrasound on long head biceps tendon pathologies. J Sport Rehabil 30:1098–1101

    Article  PubMed  Google Scholar 

  25. Drolet P, Martineau A, Lacroix R, Roy J-S (2016) Reliability of ultrasound evaluation of the long head of the biceps tendon. J Rehabil Med 48:554–558

    Article  PubMed  Google Scholar 

  26. Bélanger V, Dupuis F, Leblond J, Roy J-S (2019) Accuracy of examination of the long head of the biceps tendon in the clinical setting: a systematic review. J Rehabil Med 51:479–491

    Article  PubMed  Google Scholar 

  27. Wilk KE, Reinold MM, Macrina LC, Porterfield R, Devine KM, Suarez K, Andrews JR (2009) Glenohumeral internal rotation measurements differ depending on stabilization techniques. Sports Health 1:131–136

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kibler WB, Sciascia A, Moore S (2012) An acute throwing episode decreases shoulder internal rotation. Clin Orthop Relat Res 470:1545–1551

    Article  PubMed  Google Scholar 

  29. Kibler WB, Ludewig PM, McClure P, Uhl TL, Sciascia A (2009) Scapular summit 2009: introduction. July 16, 2009, Lexington Kentucky. J Orthop Sports Phys Ther 39:A1–A13

    Article  PubMed  Google Scholar 

  30. Jildeh TR, Ference DA, Abbas MJ, Jiang EX, Okoroha KR (2021) Scapulothoracic dyskinesis: a concept review. Curr Rev Musculoskelet Med 14:246–254

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kibler WB, Sciascia A (2019) Evaluation and management of scapular dyskinesis in overhead athletes. Curr Rev Musculoskelet Med 12:515–526

    Article  PubMed  PubMed Central  Google Scholar 

  32. Saini SS, Shah SS, Curtis AS (2020) Scapular dyskinesis and the kinetic chain: recognizing dysfunction and treating injury in the tennis athlete. Curr Rev Musculoskelet Med 13:748–756

    Article  PubMed  PubMed Central  Google Scholar 

  33. Tsur A, Gillson S (2000) Brachial biceps tendon injuries in young female high-level tennis players. Croat Med J 41:184–185

    CAS  PubMed  Google Scholar 

  34. Guzowski K, Stolarczyk A, Czyrny Z, Dębek A, Kranc B (2019) Assessment of ultrasonography as a diagnostic tool in shoulder pain and alterations in glenohumeral range of motion in tennis players. Wideochir Inne Tech Maloinwazyjne 14:114–125

    PubMed  PubMed Central  Google Scholar 

  35. Camp CL, Zajac JM, Pearson DB, Sinatro AM, Spiker AM, Werner BC, Altchek DW, Coleman SH, Dines JS (2017) Decreased shoulder external rotation and flexion are greater predictors of injury than internal rotation deficits: analysis of 132 pitcher-seasons in professional baseball. Arthroscopy 33:1629–1636

    Article  PubMed  Google Scholar 

  36. Zajac JM, Tokish JM (2020) Glenohumeral internal rotation deficit: prime suspect or innocent bystander? Curr Rev Musculoskelet Med 13:86–95

    Article  PubMed  PubMed Central  Google Scholar 

  37. Escamilla RF, Andrews JR (2009) Shoulder muscle recruitment patterns and related biomechanics during upper extremity sports. Sports Med 39:569–590

    Article  PubMed  Google Scholar 

  38. López-Vidriero R, López-Vidriero E, Maldonado A (2016) Suprascapular nerve entrapment in elite tennis players. Presented at the 17Th ESSKA Congress. Barcelona, Spain.

  39. Okholm Kryger K, Dor F, Guillaume M, Haida A, Noirez P, Montalvan B, Toussaint J-F (2015) Medical reasons behind player departures from male and female professional tennis competitions. Am J Sports Med 43:34–40

    Article  PubMed  Google Scholar 

  40. Oliver GD, Downs JL, Barbosa GM, Camargo PR (2020) Descriptive profile of shoulder range of motion and strength in youth athletes participating in overhead sports. Int J Sports Phys Ther 15:1090–1098

    Article  PubMed  PubMed Central  Google Scholar 

  41. Crockett HC, Gross LB, Wilk KE, Schwartz ML, Reed J, O’Mara J, Reilly MT, Dugas JR, Meister K, Lyman S, Andrews JR (2002) Osseous adaptation and range of motion at the glenohumeral joint in professional baseball pitchers. Am J Sports Med 30:20–26

    Article  PubMed  Google Scholar 

  42. Meister K, Day T, Horodyski M, Kaminski TW, Wasik MP, Tillman S (2005) Rotational motion changes in the glenohumeral joint of the adolescent/little league baseball player. Am J Sports Med 33:693–698

    Article  PubMed  Google Scholar 

  43. Reagan KM, Meister K, Horodyski MB, Werner DW, Carruthers C, Wilk K (2002) Humeral retroversion and its relationship to glenohumeral rotation in the shoulder of college baseball players. Am J Sports Med 30:354–360

    Article  CAS  PubMed  Google Scholar 

  44. Fleisig G, Nicholls R, Elliott B, Escamilla R (2003) Kinematics used by world class tennis players to produce high-velocity serves. Sports Biomech 2:51–64

    Article  PubMed  Google Scholar 

  45. Silva RT, Takahashi R, Berra B, Cohen M, Matsumoto MH (2003) Medical assistance at the Brazilian juniors tennis circuit–a one-year prospective study. J Sci Med Sport 6:14–18

    Article  CAS  PubMed  Google Scholar 

  46. Gillet B, Begon M, Diger M, Berger-Vachon C, Rogowski I (2021) Alterations in scapulothoracic and humerothoracic kinematics during the tennis serve in adolescent players with a history of shoulder problems. Sports Biomech 20:165–177

    Article  PubMed  Google Scholar 

  47. Lopez-Vidriero E, Lopez-Vidriero R (2014) Biceps tenosynovitis and scapular dyskinesia. Knee Surg Sports Traumatol Arthrosc 22:S396

    Google Scholar 

  48. Ellenbecker TS, Dines DM, Renstrom PA, Windler GS (2020) Visual observation of apparent infraspinatus muscle atrophy in male professional tennis players. Orthop J Sports Med 8:2325967120958834

    Article  PubMed  PubMed Central  Google Scholar 

  49. Walker CR, Belisario JCY, Vasudevan JM (2021) Suprascapular neuropathy in collegiate tennis player: a case report. Cureus 13:e20824

    PubMed  PubMed Central  Google Scholar 

  50. Arriaza R, Ballesteros J, López-vidriero E (2013) Suprascapular neuropathy as a cause of swimmer’s shoulder: results after arthroscopic treatment in 4 patients. Am J Sports Med 41:887–893

    Article  PubMed  Google Scholar 

  51. Elliott B (2006) Biomechanics and tennis. Br J Sports Med 40:392–396

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Elliott B, Fleisig G, Nicholls R, Escamilia R (2003) Technique effects on upper limb loading in the tennis serve. J Sci Med Sport 6:76–87

    Article  CAS  PubMed  Google Scholar 

  53. Gescheit DT, Cormack SJ, Duffield R, Kovalchik S, Wood TO, Omizzolo M, Reid M (2017) Injury epidemiology of tennis players at the 2011–2016 Australian open grand slam. Br J Sports Med 51:1289–1294

    Article  PubMed  Google Scholar 

  54. van der Hoeven H, Kibler WB (2006) Shoulder injuries in tennis players. Br J Sports Med 40:435–440

    Article  PubMed  PubMed Central  Google Scholar 

  55. Reinold MM, Wilk KE, Macrina LC, Sheheane C, Dun S, Fleisig GS, Crenshaw K, Andrews JR (2008) Changes in shoulder and elbow passive range of motion after pitching in professional baseball players. Am J Sports Med 36:523–527

    Article  PubMed  Google Scholar 

  56. Moreno-Pérez V, López-Samanes Á, Domínguez R, Fernández-Elías VE, González-Frutos P, Fernández-Ruiz V, Pérez-López A, Fernández-Fernández J (2019) Acute effects of a single tennis match on passive shoulder rotation range of motion, isometric strength and serve speed in professional tennis players. PLoS ONE 14:e0215015

    Article  PubMed  PubMed Central  Google Scholar 

  57. Martin C, Kulpa R, Ezanno F, Delamarche P, Bideau B (2016) Influence of playing a prolonged tennis match on shoulder internal range of motion. Am J Sports Med 44:2147–2151

    Article  PubMed  Google Scholar 

  58. Proske U, Morgan DL (2001) Muscle damage from eccentric exercise: mechanism, mechanical signs, adaptation and clinical applications. J Physiol 537:333–345

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Proske U, Morgan DL (1999) Do cross-bridges contribute to the tension during stretch of passive muscle? J Muscle Res Cell Motil 20:433–442

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors thank Ángel Vilches Arenas from the department of Public Health and Preventive Medicine of the University of Seville for his invaluable help with the statistical analysis. We are also grateful to Sebastian Tobaruela, technical director of the Andalusian Tennis Federation (FATENIS) and to the Educational Board of the Royal Spanish Tennis Federation (RFET). Our special gratitude to Dr Julian P Ballesteros (from Kaiser Permanente, Downey, California) for his feedback and language supervision. Finally, we acknowledge the contribution of Club Tenis Betis, Club Rio Grande and Club Pineda for their support and enabling us to perform the recruitment and physical examination of the tennis players in their facilities.

Funding

This study did not receive any funding.

Author information

Authors and Affiliations

  1. ISMEC (International Sports Medicine Clinic), Seville, Spain

    Rosa López-Vidriero Tejedor & Emilio López-Vidriero Tejedor

  2. Hospital Universitario Infanta Elena, Madrid, Spain

    Rosa López-Vidriero Tejedor & Emilio López-Vidriero Tejedor

  3. Department of Orthopaedics and Sports Medicine Unit, Hillel Yaffe Medical Center (HYMC), Hadera, Israel

    Lior Laver

  4. Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel

    Lior Laver

  5. AtrhroSport Clinic, Tel-Aviv, Israel

    Lior Laver

  6. Mutua Madrid Open 1000 ATP/WTA Tennis Masters, Madrid, Spain

    Rosa López-Vidriero Tejedor & Emilio López-Vidriero Tejedor

  7. Andalusian Tennis Federation, Seville, Spain

    Emilio López-Vidriero Tejedor

  8. Orthopedic Department, Hospital Universitario Virgen Macarena, Seville, Spain

    Emilio López-Vidriero Tejedor

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  1. Rosa López-Vidriero Tejedor
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  3. Emilio López-Vidriero Tejedor
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Contributions

RL-V: design of the study, research, physical examination, recruiting, statistical analysis and write the manuscript. LL: write the manuscript, supervision of English. EL-V: design of the study, research, physical examination, recruiting and write the manuscript.

Corresponding author

Correspondence to Rosa López-Vidriero Tejedor.

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Each author declares that no possible conflict of interest (financial or nonfinancial) exist in connection with this study.

Ethical approval

This study was approved from the Ethics Committee of Seville Management Unit and the Andalusian Tennis Federation., Diarie number: 0112-N-18.

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López-Vidriero Tejedor, R., Laver, L. & López-Vidriero Tejedor, E. Professional tennis players suffer high prevalence of shoulder alterations during the season: a possible tennis shoulder syndrome. Knee Surg Sports Traumatol Arthrosc 31, 2152–2159 (2023). https://doi.org/10.1007/s00167-023-07310-5

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