Injuries To The Wrist And Fractures In Golfers

Injuries To The Wrist And Fractures In Golfers

Skilled right-handed golfers predominantly suffer injuries to the left hand (the hand closest to the target) during the swinging motion. The left hand exhibits movements diagonally across the palm towards the thumb (radial deviation), known as cocking, and tilting back towards the pinky finger (ulnar deviation), also referred to as uncocking. These movements involve the bones of the wrist and bending of the hand. Improper swing mechanics or excessive practice can lead to injuries in the wrist area.

Severe injuries resulting in fractures are not common but can occur, especially in golf. Some refer to this as a Golfer's fracture since the golf club's handle can impact the bone of the wrist when it strikes the ground or when it is forcefully released from the grip. This particular bone in the wrist is called the Hamate bone, which has an extension similar to a hook on the palm side, known as the Hook of Hamate.

Image 1 illustrates the relationship between the Hamate bone and the flexor tendons, ulnar artery, and nerve.

Image 2 depicts an improper grip or incorrect swing, causing the golf club's handle to rub against the glove near the Hamate bone. If the impact is forceful, it can result in a fracture of the Hamate bone.

The significance of this type of fracture is that it often goes undiagnosed and receives inadequate treatment in the early stages. This is due to the mild and unclear symptoms experienced after the injury, which may not be visibly apparent externally. Some golfers may only feel slight discomfort, a lack of strength, and an inability to hit the ball properly. Many golfers attempt self-treatment without consulting a physician, and even if they do, the fracture may go unnoticed, and the treatment may not be followed up adequately. Leaving it untreated for an extended period, ranging from months to even longer, can lead to the bone becoming immobile or non-union. Some individuals may experience complications due to the fractured area compressing nerves or tendons, resulting in a weakened or absent little finger grip.

Image 3 shows a CT scan image indicating the fracture line of the Hamate bone (indicated by an arrow).

Prevention:

• Golf club handles should be appropriately sized for the hand, and the grip should avoid pressing against the glove near the Hamate bone, particularly for slightly smaller left hands.

• Proper grip techniques and studying correct swing mechanics should be practiced to prevent hitting the ground.

• Regular hand strengthening exercises should be performed, such as squeezing hand springs or tennis balls.

• Wrist flexibility exercises involving diagonal movements from the palm side to the pinky finger side (cocking - uncocking) should be practiced.

• Wrist exercises using dumbbells should be incorporated.

Image 4 shows front arm muscle management using weight lifting, wrist flexion, wrist extension, and wrist rotation.

Recommendations for Golfers:

• When injured, it is advisable to cease playing golf. If there is a tender area, grip instability, abnormal movements, such as a loose grip or weak golf swings, it is recommended to consult a physician. If the condition does not improve within a week, it is advisable to seek a second medical opinion for accurate diagnosis and appropriate treatment. Normal X-ray examinations may not detect fractures and may require specialized X-ray views, such as the Carpal Tunnel View, or a CT scan to identify bone fractures.

• The initial treatment for a fracture is immobilization for 6-8 weeks using a cast.

• If left untreated for more than a month or if the fractured bone does not respond to immobilization, surgical intervention is often necessary to remove the affected bone.

By Dr. Virayut Chaopricha

Orthopedic Surgeon at Vibhavadi Hospital

From Golf Lover's Magazine

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