Risk factors for upper limb injury in tennis players: A systematic review

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.