The most common upper extremity injuries in tennis players are rotator cuff tendonitis and tennis elbow (humeral epicondylitis). Injuries to the rotator cuff in tennis players can occur from the overhead stresses during the serve and overhead motions, where the rotator cuff becomes pinched or rubs against the bone on top of the shoulder, technically called impingement. Rotator cuff tendonitis (inflammation and degeneration of the rotator cuff) is also common. This often occurs due to instability or looseness in the shoulder from the stresses of playing, as well as fatigue of the primary muscles that support the shoulder. Tennis elbow is also an overuse injury involving a degeneration of the tendon on either the inside (medial) or outside (lateral) aspect of the elbow.


Some of the most important exercises for tennis players focus on strengthening the rotator cuff and scapular stabilizers. Research has shown that tennis players often have a muscular imbalance from playing tennis, where the anterior muscles of the chest and arm become stronger than the muscles in the upper back and posterior rotator cuff. Therefore, exercises that simulate the motions used in tennis, as well as strengthening of the posterior shoulder muscle groups are essential. Additionally, trunk exercises are of critical importance, especially strengthening of the lower back and abdominal obliques. Additional tennis-specific exercises include wrist and forearm strengthening to increase local muscular endurance. Finally, research has also identified a loss of shoulder internal rotation range of motion in tennis players. Proper shoulder stretching is critically important to maintain and improve flexibility to prevent injuries.
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