Triangular Fibrocartilage Complex Tears, Extensor Carpi Ulnaris Subluxation and the Impact of Modern Topspin Technique on Wrist Injuries in Tennis: A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.71.74804Keywords
triangular fibrocartilage complex, TFCC, ECU subluxation, ulnar-sided wrist pain, tennis, biomechanics, topspinAbstract
Background. Injury to the triangular fibrocartilage complex (TFCC) and instability of the extensor carpi ulnaris (ECU) tendon are both sources of ulnar-sided wrist pain in tennis players, yet compared with elbow and shoulder pathology they receive relatively little research attention. One proposed contributing factor is the shift toward Western and semi-Western grips used to generate heavy topspin.
Aim. This narrative review synthesizes the available evidence on the anatomy, biomechanics, epidemiology, diagnosis, and management of TFCC and ECU pathology in tennis players, focusing in particular on how modern topspin-oriented stroke technique may contribute to these injuries.
Material and methods. Twenty-eight sources covering the anatomy, biomechanics, epidemiology, diagnosis, and management of TFCC and ECU pathology in tennis players were reviewed, drawing on the biomechanical, clinical, and surgical-outcomes literature.
Results. Grip style and topspin-oriented stroke mechanics measurably alter wrist kinematics and loading, increasing the ulnar deviation and pronation-supination demands implicated in TFCC and ECU pathology. Diagnostic accuracy is a persistent concern, as conventional imaging correlates only imperfectly with symptomatic status in elite players. Conservative management succeeds in most cases, and surgical repair or reconstruction achieves consistently high success rates among patients who fail nonoperative treatment.
Conclusions. Ulnar-sided wrist injuries emerge as a mechanistically credible and clinically significant consequence of modern tennis technique. Conservative and surgical management both produce favorable outcomes when appropriately indicated, but the evidence base for tennis-specific conservative rehabilitation and diagnostic protocols remains thin.
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