Injuries

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Wrist & Hand Injuries

While the lower back has been found to have more injuries, the wrist is a significant site of potential injury - especially if you hit lots of balls and/or practice frequently. Similar to the lower back it is often swing mechanics that lead to injuries, however the repetitive ball striking of practice can eventually lead to micro-traumas, tendonitis, or even fractures of the wrist or hand.

While torso and leg muscles might power the swing, your hands and wrists are its business end.

During a golf swing (with a driver) a right handed golfer will move their right wrist more than 100 degrees of flexion and extension and 45 degrees radial and ulnar deviation, the left wrist undergoes less flexion/extension (about 70 degrees), but more radial and ulnar deviation.

Tendonitis is the most common category of wrist injury seen in the golfer - as only 4% of stretch potential exists for collagen fibers, beyond which micro-tears occur, and the inflammatory cycle begins. Other types of wrist /hand injuries may be due to the impaction force, ganglia, sprains, compression syndromes - involving nerve and vascular structures, as well as fractures.

An injury to the muscles of the thumb is possible, the two muscles responsible joint together to form part of the "snuff box" that you make at your wrist when you stick your thumb up into the air. This condition known as De Quervain tenosynovitis will result in tenderness at the radial (thumb) side of your wrist - a test for this is to put your thumb into your fist and bend your wrist towards your little finger, pain in the tendon indicates a problem.

Treatment is rest, perhaps in a thumb splint, non steroidal anti-inflammatories if tolerated, perhaps with two or three steroid injections. Symptoms resolve in about 6 weeks, then rehabilitate with stretching and eccentric exercises (see muscle actions). Icing may also help. You could return to golf when it's not tender and strength is normal. A less serious problem for these tendons is a localised bursitis. Wrist roll over may be in some way responsible. Rest, NSAID's (non steroidals), and icing will effectively treat this. During the backswing the wrist (especially the left) moves into positions that can irritate joints just under the thumb. This can also be painful just as you are about to hit the ball. There will be pain, weakness, and tenderness of the wrist just under the thumb. There may be evidence of wrist damage or wear in X-rays. Slowing down the backswing may help.

At the top of the backswing, the hand stops, but the club keeps going back - increasing the force on the thumb while the movement itself stresses your wrist-bones near both your thumb and little finger at this time. If you have a slight fault in your swing i.e.. "casting at the top" this further increases stress on tendons.

"Try gripping something strongly with your wrist bent in a dropping action and compare the strength you will find when the wrist is either flat or slightly raised"

"Casting" will place stress on a tendon vital for the stability of your wrist, (extensor carpi ulnaris) but striking the ground too hard - the so called "fat" shot, or clubhead striking a tree root or similar can dislocate the tendon. Expect one month in a cast and another month of splinting, followed by a gradual return. This tendon is required for any strong gripping action, it acts in combination with the tendons on the underside of the wrist when providing a strong grip, as well as providing the "uncocking" action just prior to ball strike.

Try gripping something strongly with your wrist bent in a dropping action and compare the strength you will find when the wrist is either flat or slightly raised. A cyst (or ganglia) can develop between the tendons in the back of the wrist, this will probably need to be aspirated. Arthritis and conditions like diabetes mellitus, mild carpal tunnel or gout could mean special care needs to be taken. Golfers suffering these conditions should not grip the club too firmly, or place the grip in a "strong" position, a right handed player would move their left hand counterclockwise. Re-gripping your clubs each year will provide "softer" impact and is recommended.

Think seriously about declaring the ball unplayable before your chance your arm, or in this case wrist, should you find the ball against a rock or tree root. The "tip" of striking a tyre with your club when swinging (at about 160 kph or 100 mph) should be viewed as pretty stupid - don't do it is my advice, and think twice about accepting advice from such a source.

A small bone in the wrist (the hamate) can be fractured, commonly due to incorrect placement of the grip, or due to a single traumatic incident - the club striking the ground or rock (or tyre!). If you are worried as to your grip - get a pro to look at it.

Some people have a longer ulna than is normal - this is seen on X-ray, and unfortunately they just should not play golf - or they can have the bone shaved away to equal length if they really want to be a golfer.

Overall, wrist injuries are rare, are generally related to overuse, or a larger than expected impact force. The left wrist in the right handed golfer is most common site of injury. Many problems are related to the "strong grip" position - left hand positioned clockwise on the club handle, gripping too tightly, grips in poor repair, or poor swing techniques.