Injuries in Tennis Players

Tennis, and other racquet sports, are popular sports played throughout the world by athletes of all ages.  Injuries are not uncommon in tennis players.  Upper extremity injuries are typically overuse problems, whereas lower extremity injuries are more commonly acute injuries.  Here are some of the most common tennis injuries, and information about what you can do to manage these conditions.

Shoulder Pain

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Shoulder motion in tennis players can be abnormal, with athletes having excessive shoulder external rotation, and lacking normal internal rotation.  This pattern of altered shoulder mechanics can lead to conditions of the shoulder including internal impingement and SLAP tears of the labrum.

Most often, these symptoms are experienced in the dominant shoulder with overhead motions including serving and overhead hits, although in more severe cases symptoms may be experienced with normal groundstrokes.

Elbow Injuries

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The most common elbow problems in tennis players are tendon conditions.  In fact, one of the conditions, lateral epicondylitis, is so common in racquet sport players that most people refer to this condition by the name tennis elbow.

The tendons irritated in these conditions are actually tendons that move and stabilize the wrist joint.  While the pain occurs around the elbow, it is typically movements of the wrist that cause these conditions. 

When symptoms occur in the wrist extensor tendons (outside of the elbow), it is called lateral epicondylitis.  Pain is more common with backhand strokes.  When symptoms occur in the wrist flexor tendons (inner side of the elbow), it is called medial epicondylitis.  This typically causes pain with forehand strokes.

Wrist Problems

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Many tendons pass along the front, back, and sides of the wrist joint, but one tendon is particularly susceptible to irritation.  This tendon, called the extensor carpi ulnaris (ECU tendon), is located on the outside of the wrist, below the pinky finger.  This tendon is used in racquet sports because of the side-to-side motion necessary for the sport.

ECU tendon problems can either be limited to inflammation and irritation (typical tendonitis), or the tendon can snap out of its normal location (tendon subluxation).  ECU tendonitis usually resolves with simple treatments, where subluxation may require a surgical solution.

Abdominal and Groin Strain

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Abdominal strains and groin strains are common problems in tennis players.  Significant trunk rotation occurs as part of the normal swing motion and can lead to acute injuries to the core musculature of the body.

While these injuries almost always recover with simple treatment steps, there are ways to prevent these conditions from occurring or becoming recurrent problems.  Core strength is important for all athletes, especially tennis players.

Low Back Pain

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Muscle strains are also the most common problem in the low back.  Low back pain is extremely common in tennis players, again because of the significant trunk rotation, as well as repeated, sudden flexion and extension of the spine.  The paraspinal muscles, the muscles that run up and down along the spinal column, are the most often involved.

Spinal disc herniation can also occur, but is much less common.  Typical symptoms of disc herniation are not back pain, but symptoms that occur in the legs as a result of the disc pushing on nerves in the spine.  Numbness, tingling, and weakness may be found in patients with a lumbar disc herniation.

Leg & Ankle Injury

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The most common acute injury in tennis players is an ankle sprain.  Sudden, side-to-side movements with rapid starting and stopping create many opportunities for ankle sprain injuries.

The other common leg condition is medial tibial stress syndrome.  Often called 'shin splints' this condition is the result of irritation of the muscle attachment on the shin bone. 

Dines JS, et al. "Tennis Injuries: Epidemiology, Pathophysiology, and Treatment" J Am Acad Orthop Surg March 2015 ; 23:181-189.

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