Abstract
The wrist/hand complex forms the crucial final link in the kinetic chain between the body and the racquet and therefore has a number of important roles in the production of all tennis strokes. However, the internal and external loads that are created at the wrist during these strokes have the potential to contribute to pain and injury. Therefore, the purposes of this narrative review are to (1) determine the extent of the problem of wrist pain/injury in tennis players, (2) identify bony and soft tissue structures of the wrist that are susceptible to damage as a result of tennis play and (3) explore factors that may influence the development of wrist pain/injury in tennis players. The epidemiological data revealed two important points. First, some evidence suggests wrist pain/injury accounts for a higher percentage of total injuries in more recent studies (2014–2015) than in early studies (1986–1995). Second, the relative frequency of wrist pain/injury compared with other well-recognized problem areas for tennis players such as the shoulder complex, elbow and lumbar spine is noticeably higher in more recent studies (2014–2015) than in early studies (1986–1995), particularly among females. Collectively, this would seem to indicate that the problem of wrist pain/injury has increased in the modern game. In fact, some wrist injuries appear to be related to the use of certain forehand grip types and the predominant use of the two-handed backhand. While the loads experienced at the wrist during tennis stroke production seem to be below threshold levels for a single event, the cumulative effects of these loads through repetition would appear to be an important consideration, especially when inadequate time is allowed to complete normal processes of repair and adaptation. This is supported by the evidence that most wrist injuries in tennis are associated with overuse and a chronic time course. The complex interaction between load, repetition, and training practices in tennis, particularly among young developing players who choose a path of early specialization, needs to be further explored.
Similar content being viewed by others
References
Elliott B. Biomechanics and tennis. Br J Sports Med. 2006;40(5):392–6.
Tanabe S, Ito A. A three-dimensional analysis of the contributions of upper limb joint movements to horizontal racket head velocity at ball impact during tennis serving. Sports Biomech. 2007;6(3):418–33.
Stepien A, Bober T, Zawadzki J. The kinematics of trunk and upper extremities in one-handed and two-handed backhand stroke. J Hum Kinet. 2011;30:37–47.
Seeley MK, Funk MD, Denning WM, et al. Tennis forehand kinematics change as post-impact ball speed is altered. Sports Biomech. 2011;10(4):415–26.
Chow JW, Knudson DV, Tillman MD, et al. Pre- and post-impact muscle activation in the tennis volley: effects of ball speed, ball size and side of the body. Br J Sports Med. 2007;41(11):754–9.
Bahamonde R, Knudson D. Kinetics of the upper extremity in the open and square stance tennis forehand. J Sci Med Sport. 2003;6(1):88–101.
Whiteside D, Elliott B, Lay B, et al. The effect of age on discrete kinematics of the elite female tennis serve. J Appl Biomech. 2013;29(5):573–82.
Reid M, Elliott B, Crespo M. Mechanics and learning practices associated with the tennis forehand: a review. J Sports Sci Med. 2013;12(2):225–31.
King MA, Kentel BB, Mitchell SR. The effects of ball impact location and grip tightness on the arm, racquet and ball for one-handed tennis backhand groundstrokes. J Biomech. 2012;45(6):1048–52.
Wei SH, Chiang JY, Shiang TY, et al. Comparison of shock transmission and forearm electromyography between experienced and recreational tennis players during backhand strokes. Clin J Sport Med. 2006;16(2):129–35.
Elliott BC. Tennis: the influence of grip tightness on reaction impulse and rebound velocity. Med Sci Sports Exerc. 1982;14(5):348–52.
Tagliafico AS, Ameri P, Michaud J, et al. Wrist injuries in nonprofessional tennis players: relationships with different grips. Am J Sports Med. 2009;37(4):760–7.
Abrams GD, Sheets AL, Andriacchi TP, et al. Review of tennis serve motion analysis and the biomechanics of three serve types with implications for injury. Sports Biomech. 2011;10(4):378–90.
Hatch GF 3rd, Pink MM, Mohr KJ, et al. The effect of tennis racket grip size on forearm muscle firing patterns. Am J Sports Med. 2006;34(12):1977–83.
Roetert EP, Brody H, Dillman CJ, et al. The biomechanics of tennis elbow: an integrated approach. Clin Sports Med. 1995;14(1):47–57.
Knudson DV. Factors affecting force loading on the hand in the tennis forehand. J Sports Med Phys Fitness. 1991;31(4):527–31.
Rogowski I, Creveaux T, Triquigneaux S, et al. Tennis racket vibrations and shock transmission to the wrist during forehand drive. PLoS ONE. 2015;10(7):e0132925.
Nesbit SM, Elzinga M, Herchenroder C, et al. The effects of racket inertia tensor on elbow loadings and racket behavior for central and eccentric impacts. J Sports Sci Med. 2006;5(2):304–17.
Hennig EM. Influence of racket properties on injuries and performance in tennis. Exerc Sport Sci Rev. 2007;35(2):62–6.
Blackwell JR, Cole KJ. Wrist kinematics differ in expert and novice tennis players performing the backhand stroke: implications for tennis elbow. J Biomech. 1994;27(5):509–16.
Reid M, Duffield R. The development of fatigue during match-play tennis. Br J Sports Med. 2014;48(Suppl 1):i7–11.
Kibler WB, Safran MR. Tennis injuries. Med Sport Sci. 2005;48:120–37.
Pluim BM, Staal JB, Windler GE, et al. Tennis injuries: occurrence, aetiology, and prevention. Br J Sports Med. 2006;40(5):415–23.
Rogowski I, Creveaux T, Genevois C, et al. Upper limb joint muscle/tendon injury and anthropometric adaptations in french competitive tennis players. Eur J Sport Sci. 2015;17:1–7.
Green BN, Johnson CD, Adams A. Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. J Chiropr Med. 2006;5(3):101–17.
Okholm Kryger K, Dor F, Guillaume M, et al. Medical reasons behind player departures from male and female professional tennis competitions. Am J Sports Med. 2015;43(1):34–40.
Hutchinson MR, Laprade RF, Burnett QM, et al. Injury surveillance at the usta boys’ tennis championships: a 6-yr study. Med Sci Sports Exerc. 1995;27(6):826–31.
Sell K, Hainline B, Yorio M, et al. Injury trend analysis from the us open tennis championships between 1994 and 2009. Br J Sports Med. 2014;48(7):546–51.
Maquirriain J, Baglione R. Epidemiology of tennis injuries: an eight-year review of davis cup retirements. Eur J Sport Sci. 2016;16(2):266–70.
McCurdie I, Smith S, Bell P, et al. Tennis injury data from the championships, wimbledon, from 2003 to 2012. Br J Sports Med. 2016:bjsports-2015-095552. (Epub 11 Jan 2016).
Pluim BM, Fuller CW, Batt ME, et al. Consensus statement on epidemiological studies of medical conditions in tennis, April 2009. Br J Sports Med. 2009;43(12):893–7.
Lynall RC, Kerr ZY, Djoko A, et al. Epidemiology of national collegiate athletic association men’s and women’s tennis injuries, 2009/2010–2014/2015. Br J Sports Med. 2016;50(19):1211–6.
Reece LA, Fricker PA, Maguire KF. Injuries to elite young tennis players at the Australian Institute of Sport. Aust J Sci Med Sport. 1986;December:11–5.
Reid M, Elliott B. The one- and two-handed backhands in tennis. Sports Biomech. 2002;1(1):47–68.
Genevois C, Reid M, Rogowski I, et al. Performance factors related to the different tennis backhand groundstrokes: a review. J Sports Sci Med. 2015;14(1):194–202.
Gaw CE, Chounthirath T, Smith GA. Tennis-related injuries treated in united states emergency departments, 1990 to 2011. Clin J Sport Med. 2014;24(3):226–32.
Bahr R. No injuries, but plenty of pain? On the methodology for recording overuse symptoms in sports. Br J Sports Med. 2009;43(13):966–72.
Rettig AC. Wrist problems in the tennis player. Med Sci Sports Exerc. 1994;26(10):1207–12.
Futami T, Aoki H, Tsukamoto Y. Fractures of the hook of the hamate in athletes: 8 cases followed for 6 years. Acta Orthop. 1993;64(4):469–71.
Loosli AR, Leslie M. Stress fractures of the distal radius. Am J Sports Med. 1991;19(5):523–4.
Maquirriain J, Ghisi JP. Stress injury of the lunate in tennis players: A case series and related biomechanical considerations. Br J Sports Med. 2007;41(11):812–5 (discussion 5).
Rettig AC. Stress fracture of the ulna in an adolescent tournament tennis player. Am J Sports Med. 1983;11(2):103–6.
Kox LS, Kuijer PP, Kerkhoffs GM, et al. Prevalence, incidence and risk factors for overuse injuries of the wrist in young athletes: a systematic review. Br J Sports Med. 2015;49(18):1189–96.
Kibler WB, Safran MR. Musculoskeletal injuries in the young tennis player. Clin Sports Med. 2000;19(4):781–92.
Fragnière B, Landry M, Siegrist O. Stress fracture of the ulna in a professional tennis player using a double-handed backhand stroke. Knee Surg Sports Traumatol Arthrosc. 2001;9(4):239–41.
Balius R, Pedret C, Estruch A, et al. Stress fractures of the metacarpal bones in adolescent tennis players: a case series. Am J Sports Med. 2010;38(6):1215–20.
Bell RH, Hawkins RJ. Stress fracture of the distal ulna: a case report. Clin Orthop Relat Res. 1986;209:169–71.
Bollen SR, Robinson DG, Crichton KJ, et al. Stress fractures of the ulna in tennis players using a double-handed backhand stroke. Am J Sports Med. 1993;21(5):751–2.
Montalvan B, Parier J, Brasseur JL, et al. Extensor carpi ulnaris injuries in tennis players: A study of 28 cases. Br J Sports Med. 2006;40(5):424–9 (discussion 9).
Campbell D, Campbell R, O’Connor P, et al. Sports-related extensor carpi ulnaris pathology: a review of functional anatomy, sports injury and management. Br J Sports Med. 2013;47(17):1105–11.
Guha AR, Marynissen H. Stress fracture of the hook of the hamate. Br J Sports Med. 2002;36(3):224–5.
Stark H, Jobe F, Boyes J, et al. Fracture of the hook of the hamate in athletes. J Bone Joint Surg Am. 1977;59(5):575–82.
Nakamura T, Kambayashi J, Kawasaki T, et al. Hypothenar hammer syndrome caused by playing tennis. Eur J Vasc Endovasc Surg. 1996;11(2):240–2.
Jung J, Baek G, Kim J, et al. Changes in ulnar variance in relation to forearm rotation and grip. J Bone Joint Surg Br. 2001;83(7):1029–33.
Riek S, Chapman AE, Milner T. A simulation of muscle force and internal kinematics of extensor carpi radialis brevis during backhand tennis stroke: implications for injury. Clin Biomech. 1999;14(7):477–83.
Giangarra CE, Conroy B, Jobe FW, et al. Electromyographic and cinematographic analysis of elbow function in tennis players using single- and double-handed backhand strokes. Am J Sports Med. 1993;21(3):394–9.
Hennig EM, Rosenbaum D, Milani TL. Transfer of tennis racket vibrations onto the human forearm. Med Sci Sports Exerc. 1992;24(10):1134–40.
Knudson DV, Blackwell JR. Upper extremity angular kinematics of the one-handed backhand drive in tennis players with and without tennis elbow. Int J Sports Med. 1997;18(2):79–82.
Wu S-K, Gross MT, Prentice WE, et al. Comparison of ball-and-racquet impact force between two tennis backhand stroke techniques. J Orthop Sports Phys Ther. 2001;31(5):247–54.
Baker J, Cobley S, Fraser-Thomas J. What do we know about early sport specialization? Not much! High Abil Stud. 2009;20(1):77–89.
Jayanthi NA, Dechert A, Durazo R, et al. Training and sports specialization risks in junior elite tennis players. J Med Sci Tennis. 2011;16:14–20.
Jayanthi N, Pinkham C, Dugas L, et al. Sports specialization in young athletes: evidence-based recommendations. Sports Health. 2013;5(3):251–7.
Ellenbecker TS, Roetert EP, Riewald S. Isokinetic profile of wrist and forearm strength in elite female junior tennis players. Br J Sports Med. 2006;40(5):411–4.
Jayanthi NA, LaBella CR, Fischer D, et al. Sports-specialized intensive training and the risk of injury in young athletes: a clinical case-control study. Am J Sports Med. 2015;43(4):794–801.
DiFiori JP, Benjamin HJ, Brenner JS, et al. Overuse injuries and burnout in youth sports: a position statement from the american medical society for sports medicine. Br J Sports Med. 2014;48(4):287–8.
Johnson JH. Overuse injuries in young athletes: cause and prevention. Strength Cond J. 2008;30(2):27–31.
Myer GD, Jayanthi N, Difiori JP, et al. Sport specialization, part i: does early sports specialization increase negative outcomes and reduce the opportunity for success in young athletes? Sports Health. 2015;7(5):437–42.
Reid M, Crespo M, Lay B, et al. Skill acquisition in tennis: research and current practice. J Sci Med Sport. 2007;10(1):1–10.
Brenner JS. Overuse injuries, overtraining, and burnout in child and adolescent athletes. Pediatrics. 2007;119(6):1242–5.
Nunome H, Lake M, Georgakis A, et al. Impact phase kinematics of instep kicking in soccer. J Sports Sci. 2006;24(1):11–22.
Creveaux T, Dumas R, Cheze L, et al. Influence of racket polar moment on joint loads during tennis forehand drive. Comput Methods Biomech Biomed Engin. 2013;16(Suppl):99–101.
Miller S. Modern tennis rackets, balls, and surfaces. Br J Sports Med. 2006;40(5):401–5.
Rogowski I, Creveaux T, Chèze L, et al. Effects of the racket polar moment of inertia on dominant upper limb joint moments during tennis serve. PLoS One. 2014;9(8):e104785.
Rossi J, Berton E, Vigouroux L. Effects of racket weight distribution on forehand strokes in tennis. Comput Methods Biomech Biomed Engin. 2015;18(Suppl):2044–5.
Rossi J, Vigouroux L, Barla C, et al. Potential effects of racket grip size on lateral epicondilalgy risks. Scand J Med Sci Sports. 2014;24(6):e462–70.
Young CC, Raasch WG, Geiser C. Ulnar stress fracture of the nondominant arm in a tennis player using a two-handed backhand. Clin J Sport Med. 1995;5(4):262–3.
Inoue G, Tamura Y. Recurrent dislocation of the extensor carpi ulnaris tendon. Br J Sports Med. 1998;32(2):172–4.
Xarchas K, Leviet D. Non rheumatoid closed rupture of extensor carpi ulnaris tendon: report of a case in a professional athlete. Acta Orthop Belg. 2002;68(4):399–402.
Rettig AC. Athletic injuries of the wrist and hand: part ii: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med. 2004;32(1):262–73.
Faraj A, Rahman H, Norton R. Acute calcific tendinitis of abductor pollicis longus in a tennis player. Occup Health Ind Med. 1999;2(40):94.
Dawson WJ. Sports-induced spontaneous rupture of the extensor pollicis longus tendon. J Hand Surg Am. 1992;17(3):457–8.
Winge S, Jørgensen U, Lassen NA. Epidemiology of injuries in danish championship tennis. Int J Sports Med. 1989;10(5):368–71.
Hjelm N, Werner S, Renstrom P. Injury profile in junior tennis players: a prospective two year study. Knee Surg Sports Traumatol Arthrosc. 2010;18(6):845–50.
Pluim BM, Loeffen FGJ, Clarsen B, et al. A one-season prospective study of injuries and illness in elite junior tennis. Scand J Med Sci Sports. 2016;26:564–71.
Koob E, Steffens K. True trigger wrist (a case report). Handchir Mikrochir Plast Chir. 1988;20(5):288–90.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
No sources of funding were used in the preparation of this article
Conflicts of interest
Max Stuelcken, Daniel Mellifont, Adam Gorman and Mark Sayers have no conflicts of interest relevant to the contents of this review.
Rights and permissions
About this article
Cite this article
Stuelcken, M., Mellifont, D., Gorman, A. et al. Wrist Injuries in Tennis Players: A Narrative Review. Sports Med 47, 857–868 (2017). https://doi.org/10.1007/s40279-016-0630-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40279-016-0630-x