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With spring just around the corner, many people are looking forward to getting on the tennis court again. Patients often ask me what the most common tennis injuries are and how they are treated.

As with other overhead sports, the upper extremities are usually affected by chronic overuse injuries, while there can be more acute injuries of the lower extremities. In tennis, serving places the highest physiological loads on the upper extremity, particularly of the shoulder, elbow, and forearm. As serving speed increases, these loads increase. However, players who more effectively utilize their lower body to generate force in their upper extremity can decrease the forces seen across the shoulder, elbow and forearm. Therefore, good preseason tennis conditioning should include exercises that improve leg strengthening exercises such as doing squats and core strengthening exercises.

As with skis, there has been significant changes in racquet technology over the years. Most racquets are made out of lighter weight but stiffer graphite composite materials. The racquet head sizes are larger. The strings are stiffer. As a result, there are higher torques generated on the upper extremity. There is increased vibrational stresses transmitted to the upper extremity as well. For those of us who may not hit the ball in the sweet spot of the racquet regularly, there can be increased racquet oscillation and this may predispose to the development of tennis elbow. Various grip positions can also transmit different loads to the upper extremity.

Shoulder injuries are common in tennis players. Due to increased external rotation on the arm, there can be internal impingement or pinching and eventual fraying and tearing of the rotator cuff tendons. Inflammation of the tendons can be painful and over time can lead to tendon tearing as the tendons weaken further. A physical exam in the office is used to diagnose inflammation vs. rotator cuff tearing. An MRI of the shoulder would also show the degree of inflammation or tearing. If there is simply rotator cuff inflammation, the treatment is nonsurgical and consists of physical therapy to restore normal internal rotation, scapular muscle strengthening, and restoring balance and function to the musculature about the shoulder.  If there is a rotator cuff tear, these tears will not heal and arthroscopic surgery is typically recommended to sew the tendon back to the bone so it can heal into the bone.

Elbow injuries are also common. Most people have heard of tennis elbow. In this, the extensor muscles and tendons of the forearm experience chronic overuse and develop chronic inflammation in the tendons at their origin site off the lateral side of the elbow. There is tenderness to the area and some patients report weakness when carrying or gripping objects. Most patients with this condition respond well to rest and physical therapy, including stretching and gentle strengthening. Wearing a counterforce brace around the upper forearm can help decrease pain and improve function. A steroid injection is sometimes needed to reduce pain. One could also consider an injection with platelet rich plasma (PRP).

One study looking at tennis players of all levels showed that lower extremity injuries were slightly more common than upper extremity injuries. Many tennis injuries are muscle strains. Abdominal muscle strains are quite common as these muscles are engaged while serving. Low back pain is also common as there are large axial rotational loads across the low back with tennis. Lumber spine microtrauma can also lead to annular tears in the intervertebral disc with subsequent degenerative changes developing. Again, rest, physical therapy, trunk and abdominal flexibility and strengthening exercises are the mainstay of treatment.