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 bone marrow stem cell therapy.
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.
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.