Marc Darrow MD,JD

Most golfers will try to play through a developing, worsening chronic pain. They will do so with wrist braces of varying types, hand wraps, anti-inflammatory medications, alterations to their grip and swings. A trip to their doctor will likely get them some stronger pain relivers and anti-inflammatories and a recommendation to a physical therapist. Some golfers may insist on a cortisone injection, such is their desire to return to play and resume normal pain-free daily activities. Eventually however all these remedies will not help keep them on the course and golf becomes one of those things they “use” to like. One last hope is that at the end of the treatment line is a surgical recommendation and the choice to go for surgery and maybe return to golf.

In fact, one study suggests the above guidelines as being the standard of care. This was published in the journal Hand Clinics🙁1)

“A thorough understanding of the swing phases and mechanisms of injury in golf allows accurate diagnosis, treatment, and future prevention of injuries. Recommended initial treatment starts with cessation of practice to rest the wrist, a splint or orthotic brace, and nonsteroidal anti-inflammatory drug medication with corticosteroid injection and swing modification.”

I know that these treatments can help a lot of people. I also know what I see in my office. The people who have tried these remedies and now that are looking to avoid surgery. Here we may be called the “alternative” end of the line. At our office we offer regenerative medicine injections not surgery. Let’s look at some research.

Hand and wrist injuries among pro golfers – striking the ground to get the spin

Golf is a physical sport. You can suffer from extensive injury, whether an acute injury or a wear and tear injury. A study published in the British journal of sports medicine (2) made these observations on the cost of taking up a divot to get the right spin.

Professional and low-handicap golfers tend to experience more wrist and hand problems than amateurs, which is likely to be related to technique. A highly skilled golfer will purposefully aim to ‘hit through the ball’ (taking a divot of turf with the club after ball contact) so that they can impart spin to the ball and thereby control its landing. This results in an increased contact force when the club hits the ball and ground, and this force is transmitted to the wrist and hand. . . most hand and wrist injuries occur in the leading, non-dominant limb (87% of all wrist injuries).

Some golfers may suffer from a Hamate bone fracture. This is a break in one of the small bones in the wrist when the club strikes the ground, the impact force jams the club handle into the base of the hand. Pain mostly being felt towards the pinky side.

Hand and wrist injuries among high handicap golfers

Having wrist and hand pain does not make you a better golfer as the above study can be interpreted by some who aspire to be called high level golfers can imply. According to a study in the Journal of science and medicine in sport (3) an investigation of differences in three-dimensional wrist kinematics and the angle of golf club descent between low and high handicap golfers revealed that in comparison with golfers with a low handicap, golfers with a high handicap have increased radial deviation during the golf swing and at ball contact.

Increased radial deviation – thumb side wrist pain – wrist cocking

This article is about the problems of hand and wrist pain in the golfer not golf tips on how to cock your wrist. As mentioned above to get that competitive edge golfers will drive their club into the ground knowing that this can hurt their wrists and hands. As golfers like to experiment with strong, neutral, and weak grips to get spin, speed, elevation and distance they can find themselves in a situation of pain not only from ground impact by from overuse injury trying to perfect these numerous nuances of their game. A study in the Journal of orthopaedic surgery (4) and research commented on injury from radial deviation.

“Radial-sided wrist pain from overuse injuries requires careful evaluation. . . .The most common tendinopathy in the athlete is de Quervain’s tenosynovitis. Repetitive thumb extension and abduction can lead to a thickening of the abductor pollicis longus and extensor pollicis brevis tendons (these tendons move the thumb) as they pass under the first extensor compartment retinaculum (the band at the wrist that help keep these two tendons in place).”

A diagnosis of De Quervain’s Tenosynovitis is usually made after a Finkelstein test. The test goes like this:

  • Your thumb is bent into your hand and you make a fist.
  • You then bend your wrist towards your pinky side.
  • If you have pain at the back of your thumb you will probably be diagnosed with De Quervain’s Tenosynovitis
  • This is probably why you are adjusting your grip.

Triangular fibrocartilage complex tear

Golfers will often suffer from a Triangular fibrocartilage complex tear of the wrist. They will have a lot of pain on the outside of the wrist, they may feel or hear a grinding noise coming from their wrist. They may also talk about instability. The problem is a problem of damaged ligaments. Ligaments being the strong connective tissue that holds bones to bones.

When ligaments do not hold bones in place, because they are injured by impact or wear and tear, golf can become a painful and less rewarding game. The sounds you hear from your wrist are the grinding and cracking of wandering bones, allowed to wander by the damaged ligaments. When pain is severe and an MRI cannot offer a clear cut understanding of what is happening in the wrist and hand, an exploratory arthroscopic wrist surgery may be recommended to “see what’s going on.”

We offer non-surgical treatment options

As opposed to an arthroscopic exploratory surgery, we offer patients a physical examination and review of their range of motion. If ligament injury is suspected then we look into injections of Platelet rich Plasma or stem cells.

PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the injured area to stimulate healing and regeneration. PRP puts specific components in the blood to work. Blood is made up of four main components; plasma, red blood cells, white blood cells, and platelets. Each part plays a role in keeping your body functioning properly. Platelets act as wound and injury healers.

Stem Cell therapy

In our practice, Stem Cell Therapy is a treatment for musculoskeletal disorders. We treat degenerative joint disease, degenerative disc disease of the spine, and tendon and ligament injury. We offer stem cells drawn from patient’s own bone marrow. Stem cells are “de-differentiated pluripotent” cells, which means that they continue to divide to create more stem cells; these eventually “morph” into the tissue needing repair — for our purposes, collagen, bone, and cartilage.

We have published numerous research papers on these treatments, you can find this research here.

Do you have questions? Ask Dr. Darrow

Marc Darrow, MD., JD. is the medical director and founder of the Darrow Stem Cell Institute in Los Angeles, California. With over 23 years experience in regenerative medicine techniques and the treatment of thousands of patients, Dr. Darrow is considered a leading pioneer in the non-surgical treatment of degenerative Musculoskeletal Disorders and sports related injuries. Dr. Darrow has co-authored and continues to co-author leading edge medical research including the use of bone marrow derived stem cell therapy for shoulder, hip, knee and spinal disorders.

Ask Dr. Darrow


A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

References

1 Woo SH, Lee YK, Kim JM, Cheon HJ, Chung WH. Hand and wrist injuries in golfers and their treatment. Hand clinics. 2017 Feb 1;33(1):81-96.
2 Hawkes R, O’Connor P, Campbell D. The prevalence, variety and impact of wrist problems in elite professional golfers on the European Tour. British journal of sports medicine. 2013 Nov 1;47(17):1075-9.
3 Fedorcik GG, Queen RM, Abbey AN, Moorman III CT, Ruch DS. Differences in wrist mechanics during the golf swing based on golf handicap. Journal of Science and Medicine in Sport. 2012 May 1;15(3):250-4.
4 Avery DM, Rodner CM, Edgar CM. Sports-related wrist and hand injuries: a review. Journal of orthopaedic surgery and research. 2016 Dec;11(1):1-5.

 

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