At the Open

Dr. David Dines at the USTA Billie Jean King National Tennis Center

Dr. Joshua Dines (left) and Dr. David Dines (right)
These pictures were taken before the rains came on Saturday.

Hydration in all forms

This is traditionally one of the best day of tennis at the US Open with both men's semifinal matches and the women's final match scheduled. Unfortunately, the weather hasn't been cooperating. We were able to finish Roger Federer's match, but unfortunately the Nadal-Murray match and the women's final had to be postponed due to torrential downpours of rain and wind. Even during the Federer match, the weather wasn't ideal. Not due to rain, but due to heat and humidity. Just sitting in the stands we were sweating. We can only imagine how much the players were perspiring. They were drinking a tremendous amount of fluids during each changeover. It got us talking about the fact that most amateur players don't hydrate appropriately when playing. In fact, it isn't just when playing....players need to hydrate before and after a match as well. There are tons of different sports drinks availble now, some of which are even low calorie. Make a habit of drinking a sufficient amount when playing. Hopefully this rain will stop so we can watch some more great tennis.

Career saving techniques

Great doubles action today. the Bryan Brothers won the championship in a tightly contested match. It made us think about the advances within the field of sports medicine over the last few years. One of the players has a history of hip pain that as recently as 10 years ago could have been career ending. The power that todays' players generate when hitting groundstrokes or serves doesn't just come from their arms or shoulders; no, it is a full body motion. The hip actually plays an important role in generating the strength. So, pain in the hip can be problematic. In the past, pain in the hip was usually attributed to arthritis and treatment options consisted of rest and/or antiinflammatories. Then, down the road, one could have a hip replacement.....not a viable option for a young tennis player. As MRI technology has improved over the years, we have been able to delineate an entire new subset of pathologies in the hip that can respond to newer treatment options. Intraarticular injections of cortisone into the hip can be beneficial, but an even more dramatic advance has been the use of arthroscopy to treat hip pain. Arthroscopy, which is a minimally invasive form of surgery that uses a small camera to see into the joint obviating the need for a big incision, has been used in the shoulder and knee for years. But, until recently, its use in the hip was limited. Now, surgeons are able to clean up and/or repair structures in the hip joint arthroscopically, enabling players to get back to tennis for injuries that may have previously ended careers.

Sun exposure and skin protection

A nice perk of going to the tennis tournament this time of year is the weather. It has been beautiful. In fact, some may argue that it has almost been too nice in terms of sun and warmth. During Andy Roddick's match today, a large cheer went up from the crowd during a changeover. It didn't have anything to do with what was happening on the court, or even on the scoreboard. No...it was because sudden cloud cover over the court provided some shaded relief. Players are well aware of the constant sun exposure that they get. The ATP Medical services actually started an awareness program regarding skin protection and throughout the year, there are several dermatology screening sessions available to players. Most players wear sunscreen constantly. And, many more players today are wearing hats (and it isn't just for the fashion statement). Recreational players should take note of this. Even though they may only be on the court for an hour or so during a hot afternoon, that is plenty of time for one to get sun burned! Sunscreen and hats shouldn't be reserved for the competitors....spectators and recreational players alike need to protect themselves.

Common elbow injuries

Up until this point we couldn't have asked for better weather at the tournament. Unfortunately, the rain came today delaying the start of the night matches. That left us with lots of time to talk, and one of the things we realized was that despite hitting thousands of tennis balls a week, professional tennis players probably develop "tennis elbow"or lateral epicondylitis less frequently than recreational tennis players. This may seem counterintuitive, but it speaks to the importance of conditioning and proper technique when playing tennis. Below we wanted to review some of the more common elbow injuries that can affect tennis players and discuss treatment options.

"Tennis elbow" or lateral epicondylitis can be a common cause of lateral sided (or "thumb sided") elbow pain in the tennis player. This condition is an overuse injury involving the muscles that originate on the lateral side of the elbow, which are used during backhand strokes. The onset of pain is usually gradual and is typically localized to the lateral elbow during resisted wrist extension. Treatment is usually conservative and involves rest, ice, anti-inflammatory medications, bracing, and, occasionally, a corticosteroid injection. Surgery is rare and only indicated in cases where conservative measures have failed.

The ulnar nerve is a nerve that originates in the neck and travels down the inside of the arm to provide motor strength to the forearm and wrist muscles as well as sensation to the small and ring finger. The repetitive motion of the tennis stroke can lead to compression of the nerve at the elbow termed "ulnar neuritis". The initial presentation of ulnar neuritis can be pain along the inside of the forearm with numbness and tingling involving the small finger and a portion of the ring finger. Hand and/or muscle weakness can also be noticed. Conservative treatment can be successful and consists mainly of splinting; surgical intervention is indicated in cases of progressive muscle weakness, persistent muscle weakness longer than 4 months, and chronic neuropathy.

Posterior elbow pain (pain in the back of the elbow) can be caused by a condition known as "impingement." Posterior impingement is due to repetitive hyperextension and stress along the medial and posterior aspect of the elbow. The repetitive forces lead to the formation inflammed soft tissue and possibly bone, both of which can cause a mechanical "block" in the back of the elbow. Symptoms may include swelling and "locking" or "catching" during elbow motion. Many players will notice an inability to completely straighten the elbow. Posterior impingement can be associated with ligamentous instability of the elbow so it is very important to seek evaluation at the first sign of posterior elbow pain. If conservative treatment of posterior impingement is not successful, arthroscopic debridement of the elbow can be a very successful option provided the elbow is otherwise stable.

Elbow injuries in tennis players are very common and most often the result of overuse and improper technique. Prevention should begin with proper exercise, good stroke technique, and appropriate grip size. However, if a new, persistent elbow pain develops, the one should consult a medical professional for aid in the appropriate diagnosis and treatment.

Day 3 of the tournament

Day three of the tournament and there have been some great matches and big upsets already. Tonight's match in Arthur Ashe stadium featured Andy Roddick versus Fabrizio Santoro, who is nicknamed the magician. It was a classic US Open-type night with lots of celebrities in the crowd including Kelsey Grammar and golfer Sergio Garcia. Santoro's racket skills are truly amazing and Andy's big serve always wows the crowd. Roddick won in 3 sets, with one of his serves reaching 147 MPH.

Andy missed some time earlier this year with shoulder problems, but when you are serving 147 MPH it probably means that your shoulder is feeling okay. That being said, I think that as these players are serving harder, they are subjecting their shoulders to the same stresses that baseball pitchers generate. Maria Sharapova isn't playing in this Open due to a shoulder injury, and there are probably a significant number of other players with milder degrees of the same problem. It really highlights the importance of staying in shape with a workout program that includes a sufficient amount of shoulder stretching and rotator cuff strengthening.

Main draw - Day 1

Today was the first day of the 2008 US Open main draw. So far, knock on wood, no real injuries. The temperature has cooled a bit, which makes the heat less of a potential issue during long, 5 set matches. What many amateur players don’t realize is the importance of maintaining ones’ hydration during play. Players and their coaches put together dozens of sports/electrolyte drinks to be used during a match. I see tons of weekend warriors who have a small bottle of water at the end of an hour of hitting and think that is sufficient.

Another thing that should be stressed to amateur players in the importance of pregame stretching and warming up. Spectators attending the matches see the players hit for a few minutes before the match starts, but what most don’t realize is that these players have practiced on another court for at least 30 minutes to get warm, and they stretch for another 10 to 15 minutes before playing. As an orthopedic surgeon, a large portion of the injuries I treat can readily be traced back to improper warming up before playing.