Ulnar-Sided Wrist Pain in the Athlete: Sport-Specific Demands, Clinical Presentation, and Management Options.

ABSTRACT: Ulnar-sided wrist injuries are common in sports that require repeated pronosupination, wrist radial/ulnar deviation, axial loading, and gripping equipment. Common anatomic structures affected include the triangular fibrocartilage complex, extensor carpi ulnaris tendon, distal radioulnar and ulnocarpal joints, and hamate bone. Presenting symptoms include pain with activity, swelling, possible snapping or clicking, and reproduction of symptoms with provocative maneuvers. Imaging may confirm or rule out pathologies, but abnormal findings also may present in asymptomatic athletes. Initial treatment is usually nonoperative with splinting, load management, activity modification, strengthening the components of the kinetic chain of the particular sport, and pain management. Surgery is usually indicated in ulnar-wrist pain pathology such as hook of hamate fractures and required in associated instability. Future research should address specific treatment and rehabilitation protocols, emphasizing the complete kinetic chain along with the injured wrist.

Effects of a One-week Vacation with Various Activity Programs on Metabolism and Adipokines.

This study was conducted as part of a larger study of East Tyrolean health tourism, and investigates the effects of an active seven-day vacation on metabolic parameters and adipokines. Fifty-two healthy vacationers participated in two types of vacation activities (golf vs. Nordic walking or e-biking [nw&eb]). In the former group, 30 subjects played golf for a mean duration of 33.5 h per week; in the NW&EB group, 22 persons performed Nordic walking or e-biking for a mean duration of 14.2 h per week. Metabolic parameters and adipokines, such as leptin, adiponectin, GF-21, irisin, omentin-1, betatrophin, and resistin, were measured one day before and one day after the stay. After one week, only the NW&EB group experienced a significant decrease of 1.0 kg in body weight. Significant changes in HDL-C, FGF-21, irisin, and omentin-1 were seen in the golf group; and in triglycerides, HbA1c, leptin and adiponectin in the NW&EB group. No significant changes in betatrophin or resistin were registered in either group. A seven-day vacation with an activity program for several hours per week causes favorable changes in metabolic parameters and adipokines known to be involved in the pathophysiology of the metabolic syndrome. The changes differed in their magnitude and significance, depending on the type of activity.

The effect of alterations in foot centre of pressure on lower body kinematics during the five-iron golf swing.

The research aimed to evaluate the effects of an intervention aimed at altering pressure towards the medial aspect of the foot relating to stability mechanisms associated with the golf swing. We hypothesised that by altering the position of the foot pressure, the lower body stabilisation would improve which in turn would enhance weight distribution and underpinning lower body joint kinematics. Eight professional golf association (PGA) golf coaches performed five golf swings, recorded using a nine-camera motion analysis system synchronised with two force platforms. Following verbal intervention, they performed further five swings. One participant returned following a one-year intervention programme and performed five additional golf swings to provide a longitudinal case study analysis. Golf performance was unchanged evidenced by the velocity and angle of the club at ball impact (BI), although the one-year intervention significantly changed the percentage of weight experienced at each foot in the final 9% of downswing, which provided an even weight distribution at BI. This is a highly relevant finding as it indicates that the foot centre of pressure was central to the base of support and in-line with the centre of mass (CoM), indicating significantly increased stability when the CoM is near maximal acceleration.

Acute Compartment Syndrome of the Forearm Secondary to Hematoma after Playing Golf.

Acute compartment syndrome of the forearm secondary to hematoma without direct trauma has been reported rarely. We report a case of acute compartment syndrome of the forearm following a hematoma after playing golf. A 55-year-old man felt pain in his left forearm while playing golf that gradually worsened. He could not continue to play and visited the emergency department of our hospital. The radial side of his left forearm was markedly swollen on presentation, and he suffered severe pain that worsened with ulnar flexion of the wrist; no paralysis or hypesthesia was observed. A hematoma in the brachioradialis was seen on magnetic resonance imaging, and radial compartment pressure was 120 mmHg. A diagnosis of acute compartment syndrome was made, and urgent fasciotomy was performed. The patient recovered with no dysfunction of the arm.

Cathodal Transcranial Direct Current Stimulation Over Left Dorsolateral Prefrontal Cortex Area Promotes Implicit Motor Learning in a Golf Putting Task.

BACKGROUND: Implicit motor learning is characterized by low dependence on working memory and stable performance despite stress, fatigue, or multi-tasking. However, current paradigms for implicit motor learning are based on behavioral interventions that are often task-specific and limited when applied in practice. OBJECTIVE: To investigate whether cathodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC) area during motor learning suppressed working memory activity and reduced explicit verbal-analytical involvement in movement control, thereby promoting implicit motor learning. METHODS: Twenty-seven healthy individuals practiced a golf putting task during a Training Phase while receiving either real cathodal tDCS stimulation over the left DLPFC area or sham stimulation. Their performance was assessed during a Test phase on another day. Verbal working memory capacity was assessed before and after the Training Phase, and before the Test Phase. RESULTS: Compared to sham stimulation, real stimulation suppressed verbal working memory activity after the Training Phase, but enhanced golf putting performance during the Training Phase and the Test Phase, especially when participants were required to multi-task. CONCLUSION: Cathodal tDCS over the left DLPFC may foster implicit motor learning and performance in complex real-life motor tasks that occur during sports, surgery or motor rehabilitation.

Quasi-stiffness of the knee joint in flexion and extension during the golf swing.

Biomechanical understanding of the knee joint during a golf swing is essential to improve performance and prevent injury. In this study, we quantified the flexion/extension angle and moment as the primary knee movement, and evaluated quasi-stiffness represented by moment-angle coupling in the knee joint. Eighteen skilled and 23 unskilled golfers participated in this study. Six infrared cameras and two force platforms were used to record a swing motion. The anatomical angle and moment were calculated from kinematic and kinetic models, and quasi-stiffness of the knee joint was determined as an instantaneous slope of moment-angle curves. The lead knee of the skilled group had decreased resistance duration compared with the unskilled group (P < 0.05), and the resistance duration of the lead knee was lower than that of the trail knee in the skilled group (P < 0.01). The lead knee of the skilled golfers had greater flexible excursion duration than the trail knee of the skilled golfers, and of both the lead and trail knees of the unskilled golfers. These results provide critical information for preventing knee injuries during a golf swing and developing rehabilitation strategies following surgery.

Development and validation of the Approach-Iron Skill Test for use in golf.

The primary aim of this study was to develop and validate a golf-specific approach-iron test for use with elite and high-level amateur golfers. Elite (n=26) and high-level amateur (n=23) golfers were recruited for this study. The 'Approach-Iron Skill Test' requires players to hit a total of 27 shots. Specifically, three shots are hit at each of nine targets on a specially constructed driving range in a randomised order. A real-time launch monitor positioned behind the player, measured the carry distance for each of these shots. A scoring system was developed based on the percentage error index of each shot, meaning that 81 points was the maximum score possible (with a maximum of three points per shot). Two rounds of the test were performed. For both rounds of the test, elite-level golfers scored significantly higher than their high-level amateur counterparts (56.3 ± 5.6 and 58.5 ± 4.6 points versus 46.0 ± 6.3 and 46.1 ± 6.7 points, respectively) (P<0.05). For both elite and high-level players, 95% limits of agreement statistics also indicated that the test showed good test-retest reliability (2.1 ± 7.9 and 0.2 ± 10.8, respectively). Due to the clinimetric properties of the test, we conclude that the Approach-Iron Skill Test is suitable for further examination with the players examined in this study.

The effects of postactivation potentiation on golf club head speed.

In golf, an increase in club head speed (CHS) has been shown to increase driving distance and is correlated with handicap. The purpose of this study was to investigate the effect of a postactivation potentiation (PAP) intervention on CHS. A FlightScope launch monitor was used to record CHS in 16 golfers (aged 20.1 ± 3.24 years, handicap 5.8 ± 2.26) during 2 testing sessions that were separated by 1 hour, using a counterbalanced design. The mean CHS of 3 swings was recorded with (experimental) and without (control) 3 preceding countermovement jumps (CMJs). An increase in CHS of 2.25 mph (effect size, 0.16; p < 0.05) 1 minute after the CMJ intervention was recorded. Therefore, acute enhancements in CHS are possible when performing a CMJ before a golf drive. This may have implications for training and on-course performance enhancement as a result of increased driving distance and possible reductions in handicap; this PAP intervention is practically viable.

Analysis of the 5 iron golf swing when hitting for maximum distance.

Most previous research on golf swing mechanics has focused on the driver club. The aim of this study was to identify the kinematic factors that contribute to greater hitting distance when using the 5 iron club. Three-dimensional marker coordinate data were collected (250 Hz) to calculate joint kinematics at eight key swing events, while a swing analyser measured club swing and ball launch characteristics. Thirty male participants were assigned to one of two groups, based on their ball launch speed (high: 52.9 ± 2.1 m · s(-1); low: 39.9 ± 5.2 m · s(-1)). Statistical analyses were used to identify variables that differed significantly between the two groups. Results showed significant differences were evident between the two groups for club face impact point and a number of joint angles and angular velocities, with greater shoulder flexion and less left shoulder internal rotation in the backswing, greater extension angular velocity in both shoulders at early downswing, greater left shoulder adduction angular velocity at ball contact, greater hip joint movement and X Factor angle during the downswing, and greater left elbow extension early in the downswing appearing to contribute to greater hitting distance with the 5 iron club.

Golf after total knee arthroplasty: do patients return to walking the course?

BACKGROUND: Golf provides an opportunity for relatively low-impact exercise for nearly all age groups and is considered a recommended activity for patients after total knee arthroplasty. HYPOTHESIS: We hypothesized that total knee arthroplasty would afford patients increased ability to participate in and enjoy golf, allowing a large percentage of these patients to walk the golf course. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Surveys were sent to 151 golfers who had undergone primary total knee arthroplasty from 1995 to 2000. The detailed survey included 33 questions specific to the patients' golf performance, enjoyment of golf, frequency of participation, timing of return to play, presence of pain, use of a cart, and related golf-specific issues. RESULTS: We received and evaluated 93 responses (62%). Fifty-seven percent reported they had returned to golf within 6 months after total knee arthroplasty. Eighty-one percent of respondents reported golfing as frequently, or more frequently, than before knee replacement. Notably, golfers reported less pain while golfing after total knee arthroplasty than before (13% vs 83%; P < .0001), and 94% of respondents reported currently enjoying golf as much as or more than before surgery. Twenty-eight percent of respondents stated that they walked the course, rather than using a motorized golf cart, before surgery, while only 14% walked the course after surgery (P = .02). CONCLUSION: In this population of golfers, total knee arthroplasty reliably relieved pain that had been previously experienced while golfing, and increased or maintained this group's enjoyment of playing golf. However, 86% of these patients reported using a cart while golfing. Further patient education is needed regarding the potential health benefits of walking during golf after total knee arthroplasty.

The lumbar spine and low back pain in golf: a literature review of swing biomechanics and injury prevention.

BACKGROUND CONTEXT: The golf swing imparts significant stress on the lumbar spine. Not surprisingly, low back pain (LBP) is one of the most common musculoskeletal complaints among golfers. PURPOSE: This article provides a review of lumbar spine forces during the golf swing and other research available on swing biomechanics and muscle activity during trunk rotation. STUDY DESIGN: The role of "modern" and "classic" swing styles in golf-associated LBP, as well as LBP causation theories, treatment, and prevention strategies, are reviewed. METHODS: A PubMed literature search was performed using various permutations of the following keywords: lumbar, spine, low, back, therapy, pain, prevention, injuries, golf, swing, trunk, rotation, and biomechanics. Articles were screened and selected for relevance to injuries in golf, swing mechanics, and biomechanics of the trunk and lumbar spine. Articles addressing treatment of LBP with discussions on trunk rotation or golf were also selected. Primary references were included from the initial selection of articles where appropriate. General web searches were performed to identify articles for background information on the sport of golf and postsurgical return to play. RESULTS: Prospective, randomized studies have shown that focus on the transversus abdominus (TA) and multifidi (MF) muscles is a necessary part of physical therapy for LBP. Some studies also suggest that the coaching of a "classic" golf swing and increasing trunk flexibility may provide additional benefit. CONCLUSIONS: There is a notable lack of studies separating the effects of swing modification from physical rehabilitation, and controlled trials are necessary to identify the true effectiveness of specific swing modifications for reducing LBP in golf. Although the establishment of a commonly used regimen to address all golf-associated LBP would be ideal, it may be more practical to apply basic principles mentioned in this article to the tailoring of a unique regimen for the patient. Guidelines for returning to golf after spine surgery are also discussed.

The application of force-sensing resistor sensors for measuring forces developed by the human hand.

Most attempts to measure forces developed by the human hand have been implemented by placing force sensors on the object of interaction. Other researchers have placed sensors just on the subject's fingertips. In this paper, a system is described that measures forces over the entire hand using thin-film sensors and associated electronics. This system was developed by the authors and is able to obtain force readings from up to 60 thin-film sensors at rates of up to 400 samples/s per sensor. The sensors can be placed anywhere on the palm and/or fingers of the hand. The sensor readings, together with a video stream containing information about hand posture, are logged into a portable computer using a multiplexer, analogue-to-digital converter and software developed for the purpose. The system has been successfully used to measure forces involved in a range of everyday tasks such as driving a vehicle, lifting saucepans and hitting a golf ball. In the latter case, results are compared with those from an instrumented golf club. Future applications include the assessment of hand strength following disease, trauma or surgery, and to enable quantitative ergonomic investigations.

Three-dimensional knee joint kinetics during a golf swing. Influences of skill level and footwear.

This study characterized knee joint kinetics during a golf swing and determined the influence of shoe type and golfer skill on the peak knee joint loads. Thirteen golfers each hit a golf ball using a five iron under two footware conditions: spiked and spikeless golf shoes. Data from a video-based motion capture system and force plates were used to compute the knee joint kinetics. Mean peak forces and moments differed significantly between the lead and trail knees, but these peak loads were not significantly affected by shoe type. Only the lead knee flexion and internal rotation moments were significantly correlated to skill level. The magnitude of some of the peak loads at the knee during the golf swing approached those reached during activities prohibited until late-stage knee rehabilitation. We concluded the following: The type of shoe worn and the skill level of the golfer need not be considered in deciding time to return to golfing; however, the leg that is recovering from surgery or injury should be considered. The most stressful phase of the golf swing, relative to the knee, is the downswing. There is probably no "normal" swing; each golfer seems to possess consistent, characteristic, patterns of knee loading.