Risk Factors for Upper Limb Injury in Tennis Players: A Systematic Review.

Afxentios Kekelekis,Beat Knechtle,Pantelis Theodoros Nikolaidis,Isabel Sarah Moore,Thomas Rosemann

doi:10.3390/ijerph17082744

Abstract

Studies in tennis injuries have successfully identified the incident rate, the location, and the type of the injury. The majority of the studies have multiple perspectives (epidemiology, biomechanics, performance), however only a few studies were able to identify risk factors or mechanisms that contribute to tennis injuries. Until now, there has not been a systematic literature review that identifies risk factors for tennis injuries. The objective of this review was to identify and critically appraise the evidence related to risk factors for upper limb injury in tennis players. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, using a research question developed by the Patient Problem, (or Population) Intervention, Comparison or Control, and Outcome (PICO) methodology. The quality of the studies included was moderate to low, indicating prolonged tennis (exposure to tennis), scapular dyskinesis, muscle fatigue, scapulothoracic properties, shoulder kinetics or kinematics, skill level, and technique as risk factors for upper limb injury in tennis players. In this review, it is evidenced that the majority of tennis injuries are associated with overuse and a chronic time course, however, tennis injuries do not arise from a linear combination of isolated and predictive factors. Therefore, the multifactorial and complex nature of tennis injuries has to be further examined. The necessity of more randomized control trial studies is highly recommended.

Highlights

Participation in tennis places players at risk of injury—independently of performance level—while tennis injury profile remains unique in comparison to other racquet and overhead sports, regarding physical demands, biomechanical loads, and equipment [1].Tennis differs from other sports in terms of match duration, surface of play, and equipment [2]and is characterized by high-velocity repetitive upper limb movements, leading to overuse injuries, while sprinting, stopping, jumping, landing, and pivoting place high linear and rotational loading forces onto the joints of the lower extremity, increasing the risk for acute injury [3]
Following the removal of studies not meeting inclusion criteria based on abstract review, articles remained for assessing eligibility
A total of 124 articles were excluded for the following reasons: the title and the content of the abstract were not relevant (n = 80); failed to identify risk factor for upper limb injury (n = 18); examining potential tennis injuries according to their anatomical location (n = 5)

Summary

Introduction

Participation in tennis places players at risk of injury—independently of performance level (i.e., competitive or recreational)—while tennis injury profile remains unique in comparison to other racquet and overhead sports, regarding physical demands, biomechanical loads, and equipment [1]. Is characterized by high-velocity repetitive upper limb movements, leading to overuse injuries, while sprinting, stopping, jumping, landing, and pivoting place high linear and rotational loading forces onto the joints of the lower extremity, increasing the risk for acute injury [3]. Data from one of the most recent epidemiological studies on tennis injuries reported upper limb injuries to account for. 28% of all injuries for male adult players and 23% for female players, while the shoulder joint was reported to be the most frequently injured site of the upper limb [4].

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Conclusion