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Phys Med Rehabil Clin N Am 17 (2006) 609–631

Musculoskeletal Injuries in Tennis
Robert H. Perkins, MDa,b,*, Denise Davis, MDa
Department of Physical Medicine and Rehabilitation, The Ohio State University School of Medicine, Dodd Hall, 480 Medical Center Drive, Columbus, OH 43210, USA b Minimally Invasive Spine Laboratory, McConnell Spine, Sport, and Joint Center, 3773 Olentangy River Road,Columbus, OH 43214, USA

It is estimated that tens of millions of people play tennis in the United States [1,2]. More than half a million are adolescents [3], and growing number of seniors continue to play tennis [4]. The results of epidemiologic studies in tennis players have shown some variability in injury patterns [5–9]. The most common types of injury in tennis players of all ages aremuscle and ligament strains or sprains secondary to overuse. These are a particular problem in the adolescent group, because, in general, this group begins playing with a lower level of physical conditioning. Injuries in the younger players are usually not long-standing, and the overuse (chronic) problems seen in the older players, such as patellar tendinosis and tennis elbow, are less common inyounger players [10]. Lower limb injuries are twice as common as those of the upper limb or spine in young players, with ankle injuries being the most common [10]. Injuries to the back, neck, and groin occur at a rate roughly equal to that of upper extremity problems [11]. Virtually all the previous studies evaluating patterns of injuries in young tennis players have focused on male players[5,6,8,9,12]. The number of women participating in sports, including tennis, has risen dramatically since the 1970s, however. In general, injury patterns are observed to be more sports specific than gender specific. Nevertheless, female athletes do tend to have more frequent patellofemoral problems, have less upper extremity strength, and begin competition at a lower level of physical conditioning than maleathletes [10]. A preliminary study by Kibler and Safran [11] compared injury patterns in elite junior athletes during a 3-year period (1996–1998) at the United States

* Corresponding author. 3555 Olentangy River Road, Suite 1010, Columbus, OH 43201. E-mail address: (R.H. Perkins). 1047-9651/06/$ - see front matter Ó 2006 Elsevier Inc. All rights reserved.doi:10.1016/j.pmr.2006.05.005



Tennis Association (USTA) Tennis Championships. Sixteen- and 18-year-old boys sustained more new injuries during the USTA National Hard Court Championships compared with 16-year-old girls at the USTA Girls’ National Championships over the 3 years studied. There was no significant difference in the overall rate of injury (new and recurrent)between boys and girls, however. Boys and girls had similar incidence and prevalence rates of lower extremity injury; however, the number of lower extremity injuries was disproportionately greater in girls compared with boys. Injuries to the abdomen, back, and groin were significantly fewer in female athletes compared with male athletes. Girls had more injuries to the foot, leg, calf, and wrist.Boys sustained more injuries to the ankle, groin, and hand. Boys and girls had a high rate of injury to the back and shoulder. For boys and girls, strains predominated, followed by inflammation and then sprains. Boys had a greater incidence of contusions, abrasions, and lacerations. Shoulder injuries Tennis players are susceptible to developing disorders of the shoulder because of the repetitivenature of the game. The most common overuse injury in the upper extremity in young tennis players involves the shoulder, with rotator cuff inflammation being one of the most common injuries in tennis players of all levels [10]. In one study by Lehman [13], shoulder pain was present in 24% of 270 tennis players between the ages of 12 and 19 years. The incidence of shoulder pain increased to 50% in...
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