At the Aussie Open two weeks ago Emma Raducanu made a welcome return to top flight competition after two years of injury frustration caused by carpal bosses on her wrists. Although she exited to Wang Yafan in the second round, there were signs of the Raducanu who first burst onto the tennis scene so dramatically.
But what exactly are carpal bosses? What treatment did she receive? And what are her prospects for getting back to the top and staying injury free over the longer term?
For some expert insight we spoke to one of London’s premier wrist and hand surgeons Maxim Horwitz. Mr Horwitz is a consultant orthopaedic surgeon at the hand unit of Chelsea and Westminster Hospital and while he didn’t work on Ms Raducanu’s case he has plenty of experience dealing with young and budding tennis professionals.
What are Carpal Bosses?
“The Carpal Boss is a little bump between the hand bones – the metacarpals and the carpal bones.” says Mr Horwitz. “Lots of people in the general population have those bumps but for people who repetitively load that joint, the bumps can grow bigger and inflame the tendon and the joint.”
Such repetitive load injuries appear to be soaring in the modern game with high profile cases including Juan Martin Del Potro – who finally quit after years of wrist issues in 2022 – and more recently Nick Kyrgios who a few weeks ago threatened to retire at just 28.
Mr Horwitz confirmed that carpal bosses and related wrist and hand conditions such as ECU tendinitis, TFCC sprains and stress oedemas seem to be on the rise in younger players too. And he suspects the increase in power in the modern game has something to do with it.
“I treat a lot of younger 16-22 year olds who are just emerging or just making it onto either a GB tour or a college tour in America and I think it’s a combination of lots of hitting, hitting harder and also people are just wanting to do well so they’re pushing and pushing and just overtraining.”
In Raducanu’s case the result of all that overhitting was painful surgery, shaving down the bumps to restore a normal action to the wrist and prevent irritation to the tendons. And as Mr Horwitz notes, recovery is not straightforward.
“It’s long and slow and if there’s no damage to the joint, if the cartilage hasn’t been injured, then they do recover but it takes a while for the wounds to heal, for the scar tissue to settle down.”
Raducanu knows that only too well having faced a number of setbacks on the road back.
“I was just worried.” she said. “I started hitting in August and after that, I’d say, the first eight, nine days, I was feeling pain and then it just didn’t go away.”
She was forced to hit with lightweight red practice balls while she rebuilt her strength, only graduating to yellow balls a few weeks before the start of the Australian Open.
But with a wild card for the Abu Dhabi Open this week, what are her chances of staying fit and avoiding relapse? A lot will depend on how she’s adapted her technique. According to Horwitz the cause of carpal bosses often lies with the grip.
“You’ll often see when people change rackets or grip size or they change how they hold their grip they start to load the index finger metacarpal and instead of the load going up through their whole body they’re gripping the racket so hard that everything’s going through the hand.”
Timing of shots is another factor. Players approaching the ball too late can put extra strain on the joints. Which is why he insists that prevention has to start with coaches.
“There’s a great guy I work with who’ll spend hours videoing his players to make sure they’re coming onto the ball at the right time so not all the forces are going through that index finger metacarpal.”
Raducanu has noticeably adjusted her technique – particularly on the forehand – a few times over the last couple of years. Whether that’s in response to the injuries is unclear but there’s no doubt it’s something that Raducanu’s ever changing team will have to be aware of.
Of course, that raises its own dilemmas. It’s a brave coach who’ll advise a player to reinvent a technique that swept them to US Open victory at the age of 18.
Horwitz stresses that although occasionally a second operation is required to fuse the joint, for the most part tennis players respond well to the treatment. “Certainly patients I’ve treated are one and done for the vast majority of them. But I would never to say to any patient this operation’s going to sort you out for ever and ever.”
Raducanu’s growing army of fans will be praying that she’s able to adapt and prolong her career – without losing the magic that made them fall in love with her in the first place.