Golf Injuries to the Hand, Wrist, or Elbow
Patient education for common golf-related upper extremity injuries
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:
- Warm up and stretch before golfing.
- Gradually increase the length and intensity of play to avoid overuse injuries.
- Strengthen the upper body and core muscles to improve swing mechanics.
- Work with a golf professional to correct hand position and grip and focus on safer technique.
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.
Medial Epicondylitis
Also known as “golfer’s elbow,” medial epicondylitis is pain on the inside of the elbow caused by irritation of the tendons in the area. The muscles that flex the wrist and rotate the forearm palm down also cross the elbow joint. Repeatedly swinging a golf club for extended periods or having poor technique in golf club grip and hand position can irritate these muscles or tendons, causing pain.
Signs and Symptoms
- Pain on the inside corner of the elbow, often right on the bony prominence.
- Tenderness to touch.
- Worse pain with gripping or lifting.
- Lifting may be worse with a straight elbow than a bent elbow.
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:
- Activity modification: Limiting the activity that caused the condition can allow the irritation to resolve. Many tendinitis conditions can take months to improve, not days or weeks. A physical therapist or golf professional may be able to teach grip or swing modifications to relieve pain.
- Medications: Anti-inflammatory medications may help alleviate pain.
- Brace: A counterforce band worn over the muscle belly just below the elbow can improve symptoms in some patients.
- Wrist splint: Wearing a wrist splint can improve pain by limiting wrist flexion and extension.
- Therapy: Working with a therapist may help stretch and strengthen supporting muscles, maintain range of motion, and support recovery.
- Steroid injection: In patients who do not improve, injecting a stronger anti-inflammatory medication at the elbow may be beneficial.
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. This irritation can occur on either the front or back of the wrist. It is more common in the leading hand, such as the left hand for a right-handed player.
Signs and Symptoms
- Pain on the front or back of the wrist or forearm.
- Tenderness to touch.
- Worse pain with gripping, flexing, or extending the wrist.
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 and is almost always treated 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.
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 kick back against the hook and sometimes break or crack the hook.
Signs and Symptoms
- Pain in the heel of the hand.
- Pain with grip.
- Swelling.
- Bruising.
- Numbness or tingling in the pinky and ring fingers.
- Loss of small finger bending.
Diagnosis
Diagnosis of hamate fracture starts with history and physical examination by a doctor. X-rays are often enough to show the fracture. However, the hook can be difficult to see on common screening x-rays. If initial x-rays do not show the fracture, your doctor may order specialized angled views. If those x-rays are still normal but suspicion remains, a CT scan or MRI may be ordered.
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, but fixing surgery has a lower success rate than many other fractures due to the small surface area available for healing and the high forces pulling on the hook.
Hypothenar Hammer Syndrome
Hypothenar hammer syndrome is named for the action that causes it. The hypothenar area is the fleshy muscle on the outside part of the palm on the pinky side. There is a blood vessel that runs underneath this area called the ulnar artery. If this area is repeatedly “hammered” or struck, this blood vessel can be injured. For golfers, this can happen when the club handle repeatedly strikes the palm, which can weaken the blood vessel wall.
The weakened vessel wall can thin and stretch, enlarging part of the artery and creating irregular blood flow. The blood flow can slow down, become dilated, and even clot. If a blood clot fills the vessel or a piece dislodges and blocks a smaller vessel in the finger, blood flow to the hand or fingers can be interrupted. This can result in rapid tissue injury, loss, or death to part or all of a finger and may become a surgical emergency. If it occurs more slowly over time, symptoms may be less severe while blood flow to the hand or fingers gradually decreases.
Signs and Symptoms
- Pain in the palm.
- Pain in the fingertips on the pinky side.
- Numbness in the fingertips on the pinky side.
- Color changes in the fingertips on the pinky side.
- Cold sensitivity in the ring finger and pinky.
- Small fingertip wound that does not heal.
- Brown or red lines under the fingernails.
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 depends on severity. Some patients may get better with modification of their golf grip or swing. If the 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, or medical treatment with blood-thinning medications.
Sprained Wrist
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 range from a mild stretch to a partial or complete tear. This sprain usually causes pain and popping in the wrist. It might also cause swelling, motion changes, and loss of grip strength.