May 4, 2005

ACC Sports Sciences Main Page

Larry Bowman, M.D.
Team Orthopaedic Surgeon, Clemson

Danny Poole, MA, ATC
Director of Sports Medicine and Head Athletic Trainer, Clemson

Golf has become increasingly popular in the United States. There are an estimated 25 million participants of all ages and skill levels. Because of the lack of physical contact and low impact appearance, most people feel there is a low potential for injury. Unfortunately, this is not the case. The large majority of injuries are from overuse in professional golfers and poor swing mechanics in recreational golfers. Approximately one-third of golf injuries in the professional golfer are related to the wrist, compared to twenty percent in the amateur golfer. The most common injuries to the wrist are related to overuse. De Quervains syndrome, an inflammation of the tendons and the synovium in the tendon sheath of the first dorsal compartment of the wrist, is secondary to repetitive sliding of the tendons on the thumb side of the wrist. Forceful gripping with ulnar deviation which is the essential position in the golf swing, is responsible.

The treatment is rest, along with physical therapy and nonsteroidal anti-inflammatory drugs (NSAIDS). Injecting corticosteroids in the first dorsal compartment sheath may be needed followed by surgical release if all else fails.

Dorsal impingement syndrome (pain on the top of the wrist) occurs especially in recreational athletes with poor swing mechanics. Correcting the swing along with NSAIDS, physical therapy, and occasional injection with corticosteroids will usually correct the problem. Wrist arthroscopic surgery is rarely necessary.

Triangular fibrocartilage complex injuries (TFCC) and extensor carpi ulnaris dislocation (ECU) occur from ulnar overload. The mechanism of injury can be acute (hitting the ball fat) or from repetitive, improper swing mechanics. Arthroscopic surgery for TFCC tears is the treatment of choice. There is still controversy among sports medicine professionals whether casting or open surgical repair is indicated for acute ECU sheath ruptures.

Fractures in the wrist are rare in golfers. Injury to the hook of the hamate (golfer's wrist) accounts for only two percent of all wrist fractures but thirty-three percent of all hamate fractures are found in golfers. It is the most common fracture in golf and can be undiagnosed for weeks or months. The hamate is situated at the base of the palm on the ulnar (little finger) side and is injured by hitting the ball "fat". When the club head strikes an immovable object; rock, root, or too much ground, the butt of the club is forced into the ulnar side of the palm of the hand. The fracture is not seen on standard x-ray views and requires a special carpal tunnel view or even a CT scan or MRI to make the diagnosis. Cast treatment for acute injuries or surgical excision of the fracture fragment in the late diagnosed cases is the treatment of choice. To prevent this injury, proper club length (butt should extend beyond the palm of the leading hand) and proper size and padded grips are necessary.

In conclusion, golf is a popular sport enjoyed by millions of athletes in the USA with a high concentration of participants in the geographical region of the ACC. With proper equipment, warm-up, and swing mechanics, injuries can be minimized. If overuse and poor swing mechanics can be avoided, chronic and more serious wrist problems will be the source of discussion and not surgery.

REFERENCES
1. McCarrol JR, Rettig AC, Shelbourne KD: Injuries in the amateur golfer. Phys Sportsmed 1990;18(3):122-126
2. Rettig AC: Athletic Injuries of the Wrist and Hand. The American Journal of Sports Medicine 2004; 32(1):262-271.
3. Murray PM, Cooney WP: Golf-induced injuries of the wrist. Clin Sports Med 1996;15(1):85-108.
4. Skolnick AA: 'Golfer's wrist' can be a tough break to diagnose. JAMA 1998;279(8):571-572.