Tennis Injuries

What racquet sport injuries are

A tennis stroke is a chain. Force starts at the ground, passes up through the legs and hips, rotates through the trunk, and is delivered through the shoulder, elbow and wrist to the racquet. When every link does its share, no single tissue is overloaded. When one link is stiff, weak or poorly timed, the links downstream absorb more, and the tissue that gives way is often not where the problem started. This is why racquet sport injuries are usually overuse rather than accident.

Certain sites recur. At the elbow, repeated gripping and backhand impact irritates the tendons attaching the wrist extensors to the outer bump of the humerus, known as lateral epicondylitis and commonly called tennis elbow; the same process on the inner side involves the flexor tendons. At the shoulder, serving and overhead strokes load the rotator cuff, often alongside altered movement of the shoulder blade. The wrist takes the shock of off center contact and heavy topspin. Lower down, the abrupt starts, stops and lateral cuts of court play load the patellar tendon, twist the knee, and put the outer ligaments of the ankle at risk. Court surface, racquet setup and playing volume all influence how these loads arrive.

Symptoms that often bring people in

• Pain on the outer or inner side of the elbow with gripping or shaking hands.
• Shoulder pain during the serve, sometimes with a loss of power late in a match.
• Wrist pain on the little finger side, or clicking when the forearm is rotated.
• Pain just below the kneecap that is worst on push off, landing or stairs.
• Pain that begins after play, then appears during play, and finally lingers at rest.

How it is evaluated

An assessment looks past the sore spot. The examiner localizes tenderness, tests the muscles involved, and reproduces the movement that hurts, but also checks the links above and below: shoulder blade control for an elbow complaint, hip and trunk flexibility for a shoulder complaint, calf and ankle motion for a knee complaint. Your playing history is part of the examination, since a change in volume, surface or technique is often what turned tolerated load into injury. Imaging answers a specific question: X-rays show bone, while ultrasound and MRI show tendon, ligament and cartilage when a tear is suspected. Not every overuse injury needs a scan.

Treatment options in general terms

Most are managed without surgery, addressing both the irritated tissue and what overloaded it.

• Load modification. Adjusting playing volume so the tissue is not repeatedly re-injured.
• Rehabilitation. Progressive strengthening of the affected tendon and of the links that were doing too little.
• Equipment and technique review. Grip size, string tension and stroke mechanics may be worth reviewing with a coach.
• Bracing and injections. Counterforce straps or ankle braces for particular problems; corticosteroid injection and platelet rich plasma may be discussed for selected tendon problems.

Surgery is a smaller part of the picture, generally raised when a structural tear is present or symptoms persist despite well conducted non-surgical care.

• Arthroscopic procedures. Used for meniscal tears, cartilage damage, loose fragments or rotator cuff injury.
• Tendon procedures. Debridement or repair of chronically degenerated tendon tissue at the elbow, shoulder or ankle.
• Ligament reconstruction. Considered for injuries that leave a joint unstable during the cutting and pivoting court sports demand.

What to expect when you consult Dr. Wolfson

Dr. Wolfson treats sports injuries in competitive athletes and recreational players alike, and looks for the most conservative treatment that will actually solve the problem. He will examine the painful area and the joints around it, ask about your playing pattern, and explain which findings matter. Where surgery is indicated, he favors minimally invasive techniques.

This page provides general information about tennis and racquet sport injuries and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]