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By Dr. Chris McCarthy

Hand, Wrist and Arm Golf Injuries

 

Finally, spring has arrived and golf season is upon us! What an exhilarating sport that keeps us lovers of the game coming back weekend after weekend. I began playing regularly during weekends in medical school in Cincinnati and that’s when my love for the game flourished. There is nothing more disappointing than having a wrist or arm injury that keeps you off the course. One of the very best parts of my job is getting patients back to the game they love after recovering from a hand, wrist or arm injury.

3 Common Areas for Golf Injury

The Ulnar Wrist  The most common region of the upper extremity susceptible to a golf injury. This encompasses the myriad of structures on the small finger side of the wrist. Most of these injuries come from the golf swing itself due to the intense demands on the wrist for torque and impact. There is a complex cartilage and ligament complex on that side of the wrist that helps keep the wrist stable, called the triangular fibrocartilage complex (TFCC). This structure can be torn either acutely or chronically and cause symptoms such as, pain in the ulnar wrist, clicking, or instability.

  • Treatment:  Usually consists of approximately 1-3 months of rest and immobilization, anti-inflammatory medicines, and sometimes steroid injections.  If the symptoms fail to resolve with non-operative measures or for reasons specific to the patient, an MRI may be warranted to see if a wrist arthroscopic procedure is necessary. If TFCC tears are present, it may just need cleaned up (debridement), or with more extensive tears, it may need repaired.  Recovery after a repair typically involves about 6 weeks of immobilization, followed by therapy. Recovery after debridement is much quicker. The type of tear and timeframe of the injury will dictate if a tear needs debrided or repaired.

Post-procedure time until back to putting/chipping:  Approx. 6-8 weeks

Post-procedure time until back to irons/driving:  Approx. 10-12 weeks

The Extensor Carpi Ulas (ECU)  A long tendon on the ulnar side of the wrist that is larger and more robust. It rests in a groove on the end of the ulna bone and held in place with ligamentous structures. This tendon is highly active in strong grip forces and also with wrist torque. It can become inflamed (tendonitis), have tears, or even become unstable.

  • Treatment: Typically, with tendonitis or small tears, initial management consists of a period of rest, immobilization, anti-inflammatories and steroid injections(s). The same management is used for unstable tendons. If the instability persists, it can be addressed with a procedure to repair or re-create the stabilization ligaments that hold the tendon in alignment. Recovery from this procedure involves about 6 weeks of immobilization, followed by therapy.

Post-procedure time until back to putting/chipping:  Approx. 6-8 weeks

Post-procedure time until back to irons/driving:  Approx. 10-12 weeks

The Hook of the Hamate  A literal hook portion of the hamate bone that lies in the small finger side of the palm. For power swingers, or those trying to reach the green in two but stuck in the rough off the fairway, a more acute injury to your wrist may be a fractured hook bone. As you can imagine, gripping it and ripping it, but suddenly striking the ground flat, can jar your palm and fracture this hook. Although less common, it can incur significant pain and inability to swing the club.

  • Treatment:  Treatment is based on a few factors: If there is continued pain (as these fractures commonly do not heal back), if the fractured hook is causing issues with the ulnar nerve that feeds sensation to your small and ring fingers, or if it is causing flexor tendon issues nearby.  If immobilization, padding, and anti-inflammatories do not help, then it may be necessary to surgically remove the fractured fragment.  These fractures are difficult to heal. Therefore, patients have a much better outcome and quicker return to activity with simple removal of the fragment.

Post-procedure time until back to putting/chipping:  Approx. 2-4 weeks

Post-procedure time until back to irons/driving:  Approx. 4-6 weeks

Testimony

There are several other rare entities of ulnar wrist pain that can plague a golfer, but most common are chronic hand and wrist issues that flare up while trying to get that perfect drive or approach shot. Arthritis of the small joints is most common (usually osteoarthritis or “regular arthritis”). Arthritis treatments, such as splinting techniques and steroid injections, can alleviate those ailments during golf swings.

I recently took care of a 67 year old patient who is a scratch golfer and spends a good portion of the winter in Florida. He has arthritis of his right index metacarpophalangeal joint (MCP, or index finger knuckle), which was hindering his swing on almost every impact.  We diagnosed him with an examination and X-ray, and treated him with a steroid injection.  For a day or so he had his normal pains, but on the third day as he got back to the tee in Florida. His pain was gone and he shot his first under par round in over a year!  Now, I’m not saying that treating your hand or wrist issue from golf will make you a scratch golfer. However, if your game is similar to mine, helping cure those ailments sure can point you in that direction!

If you are experiencing symptoms similar to these injuries or have questions about treatment options, please contact our office at (614) 262-4263 to request an appointment.

 

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