What are the most common golf-related hand injuries?
Golf has become one of the world’s most popular professional and recreational sport. In 2004, there were approximately 27.8 million golfers in the United States alone serviced by over 16,000 golf facilities in the country. Statistics have further shown that an average adult golfer spends more time practicing than actually playing. The increasing playing time and practice time exposures has resulted in an injury rate of 15 -20% among all golfers.
Although generally considered as a safe sport compared to contact sports, golfers worldwide have their own shares of woes when it comes to sporting injuries of the wrist, hand and elbows.
The following golf-related injuries of the arm are commonly seen on the golf course. This narrative will further discuss causes, symptoms, preventions and how they should be treated:
- The Golfer’s Elbow
- DeQuervain Tenosynovitis
- TFCC ligament injuries
- Carpal Tunnel Syndrome
- Cubital Tunnel Syndrome
The Golfer’s elbow
This represents the second most common golf-related injury on the golf course after back pain. This is clinically referred to as medial epicondylitis, meaning an inflammation of the inner bony protrusion of the elbow. This is often caused by improper swinging techniques that hit the ball “fat” (hitting the ground first before the ball).
The sudden resistance generated by the club amplifies a powerful tonic pressure in the muscles and tendons of the elbow causing small tears on its surface. A good pre-round stretching of the upper lead arm and a comprehensive strengthening exercise program may avert this accident. Golfers often feel an acute pain in the inner elbow after the swing.
Swollen elbows may benefit from a warm gauze and adequate rest. A supportive elbow brace may limit the joint’s range of movement to reduce the pain of epicondylitis. Physiotherapy has been found to be effective in treating golfer’s elbow by restoring normal range of motion, reduction of elbow pain, and facilitates the normalization of upper arm neurodynamics. Your doctor may directly inject corticosteroids around the affected area to instantly control the pain symptoms.
Persistent pain of more than 6 to 12 months may require prompt surgery to remove those damaged muscles and tendons for pain control and functionality. Patients may also benefit from post-surgical physical therapy.
De Quervain Tenosynovitis
This is a fairly common golf-related injury associated with an overused wrist of the lead hand (usually involves the left wrist amongst right-handed golfers). This may be caused by the over-cocking or over-pinching action of the leading thumb during each backswing.
Golfers may complain of gnawing pain with swelling of the wrist near the base of the thumb. The snug gripping of the club by the handle during the backswing will prevent this kind of wrist over-usage. This injury is usually treated through splinting and routine exercises by the thumb during occupational therapy sessions. Ibuprofen pain killers may also be used to subdue the discomfort. It is imperative to visit your surgeon if pain persists despite conservative medical management.
Thumb immobilization may be opted by your surgeon using thumb spica splints for up to two months to facilitate its fast recuperation. Corticosteroid injection at the base of the thumb may also offer instant relief of the chronic gnawing pain of the tenosynovitis. Surgeons may surgically explore your wrist and release the flexor tendon to release the pressure symptoms and restore the smooth gliding mobility of the tendons.
TFCC ligament injuries
The triangular fibrocartilage complex (TFCC) is a cartilaginous and ligamentous triangular structure at the small finger (ulnar) side of the wrist that supports the bending, straightening, twisting, and side to side movement of the wrist.
The repeated pronation of the wrist during short puts in golf and the hyperextension of the wrist during a forceful swing to the back before a long driving shot can cause tears on this structure. Older golfers with long hours on the greens are more prone to this kind of wrist overuse injury. The main symptom in TFCC ligament injuries is localized pain on the ulnar side of the wrist or diffuse pain all over the wrist area.
Pain is aggravated by wrist rotation movements like turning the doorknobs or using a can opener. Patients may complain of wrist instability and may feel crackling during wrist rotations (crepitations) with accompanying swelling of the entire wrist area.
TFCC ligament injuries are prevented by pre-golf stretching and wrist rotation exercises. Strengthening exercises may be implored on the wrist to reinforce the ligaments and cartilaginous support of the joint. This condition should be brought in for medical attention where your doctor might splint the whole wrist for 4 to 6 weeks to immobilize the joint until it heals.
Oral anti-inflammatory medications and Corticosteroid injections to the affected joint may be given to relieve the pain and discomfort. For unstable wrist joints and ulnar fractures, an arthroscopic or open surgery may be performed to debride the damaged tissue and repair tore ligaments with the use of screws and wires. Post-surgical rehabilitation may improve the wrist and bring it back to its pre-injury state.
Carpal Tunnel Syndrome
This syndrome refers to the persistent numbness of the hand with pain and burning sensation at the lower ridge of the affected hand.
This is considered as a type of overuse injury of the hand due to chronic repetitive hand gripping of the club handle. This syndrome is caused by the compression of the median nerve in the narrow carpal tunnel formed by the carpal bones and fibrous retinaculum of the hand. This type of overuse injury may be attributed to the golfer’s dedicated long hours of practice and actual playing.
The chronic inflammation of the wrist due to other injuries like accidental falls may also constrict the carpal tunnel and cause the syndrome. Splinting of the hand may offer temporary relief. However, persistent symptoms with signs of muscular atrophy of the palmar prominence may already require surgical treatment. Hand reconstructive surgery approach for Carpal Tunnel Syndrome requires the surgical release of the flexor retinaculum of the tunnel to relieve the median nerve and other nearby tissues of the impending pressure to relieve the unnecessary discomfort of the hand.
Cubital Tunnel Syndrome
This peculiar syndrome is clinically characterized by numbness and discomfort of the medial edge of the elbow, the 5th digit, and the inner half of the ring finger. This is caused by the compression of the ulnar nerve that passes through the cubital fossa of the elbow. During the repetitive driving exercises and swinging of the lead arm during actual play or practices, the arm muscle gliding movements by the forearm sheath permits the ulnar nerve to slide back and forth the medial epicondylitis (inner bony protuberance) of the elbow.
The chronic rubbing of the ulnar nerve branch to the bony surface may result in the discomfort and numbness in the affected nerve distribution mentioned earlier. The paresthesia of the fingers may lessen the power of the golfer’s grip on the club and affect game performance significantly.
Physical or occupational rehabilitation is the preferred non-surgical approach to Cubital Tunnel Syndrome. When a conservative medical approach becomes futile, reconstructive surgery of the elbow is performed. Popular reconstructive approaches to this include the transposition of the ulnar nerve or by means of medial epicondylectomy (removal of the epicondyle) to allow more space for the ulnar nerve to move and restore hand functionality in golfers.