Wrist pain in tennis players is common due to the significant forces transmitted from the racket to the arm. Pathologies in the wrist may include the tendons due to overload or structural pathologies due to altered mechanics in the wrist or mobility issues. Among all tendon pathologies the most common are De Quervain’s pathology and Intersection syndrome. The latter involve the tendons along the forearm to the side of the thumb or along the middle of the forearm. Pain will be increased whilst training or may present after the game. The overloading of the tendons is due to increased force in wrist extension.
Examination will reveal pain and you may have difficulty in positions of resisted wrist or thumb extension. There may be underlying shoulder or elbow weakness leading to more overload of the wrist tendons. Functional daily tasks may become difficult because of the inability to use the wrist as previously. Specific assessment manoeuvres will help guide the physiotherapist towards diagnosis. Contributing factors to the overload may be lack of mobility in the shoulder or elbow and/or muscle imbalances.
The early management of these pathologies includes rest, ice and pain medication with or without a wrist support. Following successful pain reduction, gradual loading of the tendons will create tissue tolerance and prevent recurrence. In addition, correcting issues in the elbow and wrist will also assist in preventing recurrence.
The use of a corticosteroid injection may be chosen in persistent cases or in cases of early return to sport. Following an injection a short complete rest period is advised and should be followed with rehabilitation to prevent recurrence. The outcomes after the injection are usually very good, however it should be noted that rehabilitation should still be used to address the latter.