Golfing Wrist & Hand Injury

Hand, wrist, and elbow injuries are common for golfers of all skill levels. The golf swing is a complex, coordinated series of motions. Common golf injuries can result from poor technique, overuse, or a single event. Many single-event injuries happen when the club hits the ground by accident.

There are many ways to prevent golf injuries and enjoy the game:

Types of Golf Injuries

Golf injuries can affect any part of the upper extremity. Structures of the neck, shoulder, arm, elbow, wrist, fingers, and thumb can be irritated, stretched, or broken. The diagnosis and treatment of the most common golf-related upper extremity injuries are discussed below.

Diagnosis
Diagnosis of medial epicondylitis is often made by history and physical exam. In cases that are not responding to treatment, it may be helpful to obtain an imaging study. Ultrasound or magnetic resonance imaging (MRI) are the most common studies ordered.

Treatment
Medial epicondylitis will almost always be treated without surgery. Non-surgical treatments usually include:

Wrist Tendonitis

Golfers who play too much or too aggressively can develop tendon irritation at the wrist. This is called wrist tendinitis and is similar to medial epicondylitis (discussed above). This irritation can occur on either the front or back of the wrist. It is more common in the leading hand (left hand for a right-handed player and vice versa).

Signs and Symptoms

Diagnosis
Diagnosis of wrist tendonitis is made by history and physical examination by a doctor. X-rays do not show tendonitis but may be obtained to rule out other injuries. Other imaging such as ultrasound or MRI could be ordered.

Treatment
Wrist tendonitis is treated similarly to medial epicondylitis–almost always without surgery. Usual treatments include activity modification, anti-inflammatory medications, bracing, and therapy. If these do not work, your doctor may recommend injection of a stronger anti-inflammatory medication called a steroid.

Hamate Bone Fracture

The hamate is a small bone in the wrist. It is located on the outside of the wrist on the pinky side. It is shaped like a wedge with a hook sticking out of it (Figure 2). The hook is located on the palm side of the hand. It is narrow and can break off. This can happen when a club strikes the ground, forcing the hard handle to kickback against the hook and sometimes break or crack the hook (Figure 3).

Signs and Symptoms

Diagnosis
Diagnosis of hamate fracture starts with history and physical examination by a doctor. X-rays are often enough to show the fracture. However, it may be missed on common screening x-rays as the hook can be hard to see. Therefore, if the initial x-rays do not show the fracture your doctor, may order other specialized angled views. If these x-rays are still normal, but the surgeon is still suspicious, they may order a computerized tomography (CT) scan (Figure 2) or MRI.

Treatment
Some simple hamate fractures are treated without surgery. This involves a cast or splint for six weeks followed by hand therapy to regain range of motion. This may allow pain to improve, but the fracture may not have complete healing on x-rays. If the injury is not responding to non-operative care, the most common surgery is to remove the broken hook and smooth any remaining rough edges of bone. Without the hook, the hand, wrist, and fingers can work normally. Your surgeon can also consider trying to fix the fracture with a screw to get it to heal. However, fixing surgery has a lower success than many other fractures due to the small surface area available for healing and the high forces pulling on the hook that prevent it from healing.

Therefore, this problem can become a surgical emergency. The decrease in blood flow may also occur slowly so that the body has some time to adapt. If it occurs more slowly over time, then symptoms may be less severe while gradually there is no blood flow to the hand or fingers.

Signs and Symptoms

Diagnosis
Diagnosis of hypothenar hammer syndrome starts with history and physical examination by a doctor. An ultrasound is often the first test to check for vessel damage. If this is concerning, your doctor may order an angiogram. An angiogram injects dye into the vessels so they can be seen under x-ray (fluoroscopy), CT scan, or MRI.

Treatment
Treatment of hypothenar hammer syndrome depends on the severity. Some patients may get better with modification of their golf grip or swing. If your vessel is very damaged or has developed a clot, surgery may be required. Depending on multiple factors, surgery may include excision of the aneurysm with or without a graft to reconstruct the artery, blood clot removal (thrombectomy), or medical treatment with blood-thinning (anticoagulation and anti-platelet) medications.

Wrist Sprains

Some golfers develop wrist sprains from overuse or hitting the ground before the ball. A sprain is an incomplete injury to a ligament in the wrist. Ligaments are strong structures that hold bone together. A sprain can be anything from a mild stretch to a partial or complete tear. This usually causes pain and popping in the wrist. It may also cause swelling, motion, and loss of grip strength. Please refer to our article on wrist sprains for discussion of symptoms, diagnosis, and treatment of this condition.

Non-upper extremity injuries worthy of mention include sprains and strains of the back, especially the lower back called the lumbar spine. Proper warm-up and stretching is important to decrease the chances of injury. Gradual increase in length and intensity of play should be exercised as the season progresses.

Material modified from the American Society for Surgery of the Hand.