Common Golf Injuries with Dr. Jason Tarno

Many people in Southern Nevada participate in golf. Is golf considered a sport and do people actually get injured playing this game?

Webster defines the word “sport” as:

1. an athletic activity requiring skill or physical prowess and often of a competitive nature

2. diversion, recreation.

Therefore, by definition, golf is a sport, and people occasionally do get hurt playing this game. Studies have shown that golf is actually one activity that ranks high on the list for head injuries, depressed skull fractures being the number one type. Unfortunately this happens when someone swings a club and accidentally strikes a bystander in the head. These types of injuries are rare and purely accidental. More commonly, the injuries from playing the game tend to affect the wrist, elbow, shoulder, and low back. These injuries tend to be either acute or chronic.

How do acute injuries differ from chronic injuries?

Acute injuries tend to occur from missing the ball, taking a fall, slipping, etc. The injuries that are chronic in nature are most commonly due to overuse, and are often caused by having poor swing mechanics. In some instances golfers can injure themselves to the point of requiring surgery to return to the links.

How does someone injure their wrist playing golf?

The wrist is usually injured if there is significant or consistent impact of the club head with the ground. When this type of impact occurs, it is the left wrist (in a right-handed golfer) that takes most of the load, and becomes injured. Likewise, a tendonitis can occur in the thumb region of the left hand secondary the impact of the club with the ground. This is termed DeQuervain’s disease.

Rarely, a fracture of a small bone in the wrist called the hamate bone can occur during the actual golf swing. This injury occurs in the hand grasping the end of the club (the left hand of a right-handed golfer).

What types of elbow injuries are most common in golfers?

The most common problem for golfers at the elbow is pain to the medial (or inside) aspect of the elbow. This has been termed over the years “golfers elbow” because of the frequency of this complaint in golfers. The muscles that allow flexion in the hand and at the wrist have tendons that originate at the medial aspect of the humerus (the arm bone) termed the medial epicondyle. With overuse, or improper swing mechanics, these tendons can become inflamed, and very painful. Golfers elbow most commonly occurs in the back elbow (right elbow of a right-handed golfer). A golfer using his or her arms to generate acceleration of the club head through the swing instead of their legs and shoulders are at risk for developing this syndrome.

A rare complication can also occur along with golfers elbow called ulnar neuritis. The ulnar nerve lives in the same area of the elbow as the flexor tendon attachments. When the arms are used to accelerate the club head through the swing this nerve can be stretched, causing irritation of the nerve, and numbness down to the pinky finger.

What types of shoulder injuries are most common?

Rotator cuff injuries are the most common. Rotator cuff tendonitis, and even rotator cuff tears can occur in either shoulder. For the most part, cuff tendonitis tends to occur in the younger age golfers, while cuff tears tend to occur in the older age golfers. Again, the most common mechanism for these injuries is improper swing mechanics.

What types of back injuries are most common?

While it certainly is possible to injure a disc while golfing, the most common back injury is lumbar sprain or strain.

What is the difference between a sprain and strain?

A sprain generally refers to injury to ligaments (connectors of bone). Strains are injuries to the muscle itself. The lumbar area of the back is the lower section of the back made up of five lumbar vertebrae. During the golf swing, the lumbar vertebrae and the surrounding muscles are under a tremendous load. If a golfer suffers from improper swing mechanics it is possible to over-rotate this area increasing the load, resulting in a very painful injury.

It is obvious that mechanics play a vital role in the evolution of injury patterns in golfers. What advice do you have for someone that has played golf for many years versus someone that is just beginning to play golf?

Poor swing mechanics are the number one cause of injury to golfers. The key for any golfer, whether they are just beginning to golf or have been golfing for a number of years is to get proper instruction regarding hand placement, and proper swing mechanics. For someone who has golfed many years, if they begin to develop an overuse type of injury, they may be having a breakdown in their mechanics. Having a golf pro evaluate their swing would help to find any breakdowns in mechanics, and help to prevent injury.

Additionally, it is very important for any golfer to have a conditioning program that includes strengthening of the abdominal muscles, low back, upper and lower extremities and shoulders. Their conditioning program should also focus on flexibility of these same areas.

Is a warm up time important?

A time to “warm up” the muscles, tendons, and ligaments before each game of golf is vitally important. Start slowly with some gentle stretching, and easy walking, and then rotate the shoulders and back with a club for assistance. Eventually work up to hitting the ball. In doing so, you will increase blood flow into the muscles that will be used during the game. This will also aid in decreasing the risk of injury to those same areas.

- Jason M. Tarno, D.O., is Board Certified and Fellowship trained in Sports Medicine. Dr. Tarno is an associate of Crovetti Orthopaedics and Sports Medicine.

For further information call: 990-2290.

Or visit us at: www.CrovettiOrtho.com

Wrist Injuries with Dr. Jason Tarno

Southern Nevadans that are active in athletic activities often injure their wrists. What are some of the most common activities that cause wrist injuries?

Any activity can cause a wrist injury. However activities that subject the wrist to trauma such as volleyball or basketball expose the wrist to greater chance of fracture. In addition, repetitive activities such as tennis, or sports that place constant pressure on the wrist such as weight lifting can cause sprains or tendonitis.

Can you discuss fractures at the wrist?

The wrist itself is composed of eight carpal bones in addition to the two bones of the forearm, the radius and ulna. Wrist fractures can occur from a variety of mechanisms. In athletics, the most common mechanism for a fracture is a fall with on an outstretched hand.

What is the most common type of wrist fracture?

The most common wrist fracture is a fracture of the scaphoid bone. The scaphoid bone is one of the eight bones of the wrist and it is located at the base of the hand on the thumb side. Scaphoid fractures make up about 60 percent of wrist fractures. This injury occurs during a fall on an outstretched wrist, especially if the wrist is bent at an angle greater than 90 degrees. The next most common wrist fractures are of the radius and ulna. Of course, any bone of the wrist is subject to fracture.

What are the signs and symptoms of a scaphoid fracture?

Signs of scaphoid fracture include pain and tenderness on the thumb side of the wrist. Localized swelling may occur and gripping objects may be painful. In addition athletes will have pain when pressure is applied near the base of the thumb.

Are there any complications for an athlete that does not get proper treatment of a scaphoid fracture?

Scaphoid is latin for “boat shaped”. Unfortunately, because of the shape of this bone, it has a poor blood supply. Because of this poor blood supply, the possibility of avasular necrosis increases without proper treatment.

What is avascular necrosis?

Avascular necrosis (AVN) is a term that describes death of a bone after injury due to lack of blood supply. Bo Jackson, is probably one of the most famous people that has had this problem. Of course his problem was not at the wrist but at the hip.

Can you discuss tendonitis?

Tendons are fibrous cords that connect a muscle with bone. Tendonitis is the inflammation of the tendon which usually occurs as a result of repetitive use.

What are the signs and symptoms of tendonitis?

A pain in the front of the wrist is a common symptom of tendonitis. There may also be pain with gripping. Occasionally, thickening or swelling can be felt in the area where tendonitis occurs. Bending and extending the wrist is usually painful.

Can you give an example of an activity that commonly produces tendonitis?

Cyclists who ride for extended periods put pressure on their wrists while the hand is bent in an awkward position. A common injury seen in ten speed bike riders is tendonitis of the extensor carpi ulnaris (ECU). This tendon, which extends the wrist and fifth finger, is on ulnar (pinky) side of the wrist and can be compressed and irritated after chronic strain from bike riding.

What is DeQuervain's tenosynovitis?

This condition, which was named after a Swiss surgeon, is the irritation of the tunnel which houses two tendons of the thumb. It can be caused by an activity that places the thumb in an awkward position for an extended period of time. Because of the resulting swelling, the narrowing of the tunnel makes it difficult for the tendons to pass smoothly. Signs of this condition include pain on the thumb side of the wrist which can travel up the forearm, a ‘clicking’ or ‘clunking’ sensation as the tendons pass through the swollen tunnel and difficulty gripping.

How does a wrist sprain occur?

Much like the majority of wrist fractures, wrist sprains occur during falls onto outstretched hands. A sprain is an injury to a ligament. A ligament is a band of fibrous tissue which connects two bones.

Is a sprained ligament the same as a torn ligament?

Yes and No. Sprains are categorized by grades. In a Grade I tear, some of the fibers are torn, but the main ligament is still intact. The ligament is stretched, but not torn. On the other hand, a Grade III tear involves the complete tearing (or rupture) of a ligament. Ligaments tend to have a poor blood supply, which is why torn ligaments take a long time to heal.

What are the signs and symptoms of wrist sprains?

Of course the severity of symptoms will vary with the degree of sprain. However, wrist sprains typically present with wrist swelling, pain at time of injury, and with movement, local tenderness and warmth over the area of the sprain. In severe sprains, an athlete might feel a tearing sensation or even hear an audible pop.

- Jason M. Tarno, D.O., is Board Certified and Fellowship trained in Sports Medicine. Dr. Tarno is an associate of Crovetti Orthopaedics and Sports Medicine.

For further information call: 990-2290.

Or visit us at: www.CrovettiOrtho.com