American Society of Hand Therapists - California Chapter

Golfing Injuries to the Hand and/or Wrist

For most golfers, the hand and/or wrist is the 3rd most common body region injured, after the back and elbow. The wrist is injured 3 times more frequently than the hand. In golf, the action of the wrist is important for the “snap” of the shot in long shots, and the precision “feel” in short shots. Golfers who lack strength in their forearms are more prone to wrist and hand injuries. The leading wrist/hand (left side for right-handed players, right side for lefties) is most at risk. Injuries result either gradually from overuse, or from a traumatic blow (hitting a root or a rock, or hitting a fat shot off hardpan) causing sprains (ligament injuries) or fractures (“broken bones”).

The most common wrist/hand complaint is due to tendonitis (tendon inflammation) of any of the tendons that cross the wrist. Treatment usually consists of rest, splinting, ice, and non-steroidal anti-inflammatory medicines along with a Hand Therapy program of stretching / strengthening exercises and iontophoresis. If these initial treatments fail, cortisone injections may be used at the discretion of your doctor.

Another distinctive golf injury is a fracture of the hook of the hamate, one of the small bones of the wrist. It is vulnerable to injury from the club on a hard hit to the ground as the handle crosses right over the bony hook when gripping the club   Hook of the hamate fractures may cause pain in the heel of the little finger side of the palm. If it irritates the adjacent ulnar nerve, it may cause numbness and tingling in the ring and little fingers. The tendons that bend the ring and little fingers are also adjacent to the hook, and movement of these fingers may be painful and give a sensation of “catching” or “clicking” if these tendons are rubbing on the fractured bone. Left untreated, the tendons can even gradually fray and rupture. Treatment involves a combination of rest, ice, and splinting.

The elbow may be affected with “golfer’s elbow”, which is a painful tendonitis on the inner aspect of the elbow at the origin of the “flexor/pronator” muscles. They originate off of a bony prominence of the humerus (arm bone) called the medial epicondyle, and so this condition is also called “medial epicondylitis”. It can be caused by repeated swinging stress to the elbow, and may result from many other non-golfing activities, such as heavy lifting and hammering. Lateral epicondylitis, on the outer side of the elbow, is also commonly seen in golfers from repeated strain to the lead arm, similar to hitting backhands in tennis. Both these conditions are usually first treated with rest, iontophoresis treatment and hand therapy program of muscle stretching and strengthening, and non-steroidal anti-inflammatory medicines.

Another potential cause of injury when golfing is the unsafe use of golf carts. Golf cart accidents with fall-outs and tip-overs may cause very serious injury such as fractures to the wrist, forearm, elbow, arm, shoulder, tibia (shin bone), and ankle, among others. Proper care and caution must be exercised when driving golf carts.

Non-upper extremity injuries worthy of mention include sprains and strains of the back, especially the lower back called the lumbar spine.

Equipment

·         A smaller club and/or a tightly strung club may require more exertion from the forearm musculature and may cause the hamate fracture.  Try a mid-size to larger club in order to provide a larger impact area for the ball.  A lighter club may decrease stress on the arm as well.

·         Make sure your grip is not too small. Avoid gripping your club too tightly.

·         Grip size should be chosen by measuring the distance from the crease of the palm to the tip of the ring finger.

·         Wear a counterforce brace while playing golf. The counterforce brace gives external support to the involved muscles and relieves stress on the area.

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.

Stretches include but are not limited to

Before playing perform stretches by keeping the elbow straight, palm facing downward then bend the wrist down with the other hand, thus pointing the fingers down. Hold the position for a count of 10.

Then, keeping the elbow straight, palm facing upward then bend the wrist down, thus pointing the fingers down with the other hand.  Hold the position for a count of 10.