RICHARD BERGER,, the Mayo Clinic's leading hand surgeon, wasn't surprised when top-10 aces Juan Martin del Potro and Novak Djokovic both withdrew from tournaments this spring with wrist injuries. In 2001, the Mayo Clinic warned that world-class players were already nearing the limits of human physiology by striking serves packing rotational velocities of 1,500 degrees per second. And now that the top-seeded men can deliver 150 mph serves that crack 1,800 DPS, wrists are reaching the breaking point.
When a racket strikes a ball, the wrist -- a collection of eight bones and two cable systems that move the inside and outside of the hand -- absorbs all the force generated by the rest of the body. The outside, or ulnar side, of the wrist is the most vulnerable because it has fewer bones than the thumb side, so the free-floating ligaments beneath the pinkie are susceptible to twists and tears.
Berger, who operated on del Potro and 20-year-old British sensation Laura Robson this year, blames fitter athletes and faster rackets for creating "excessive force that is overwhelming the body's ability to tolerate its loads." Caroline Wozniacki and Sloane Stephens also sat out tournaments with wrist injuries this season.
Until recently, most pros battling wrist pain relied simply on rest to heal damaged ligaments. But in 2007 came Berger's breakthrough: He began finding microscopic "split tears" hidden by bloody tissue, too small to be picked up by an MRI. When he sewed them back together, athletes' ligaments began to repair themselves. His patients spend six weeks in a cast and 10 rehabbing. And because the joint is restored, he says he rarely, if ever, sees them again for the same issue.
According to the ATP, 3.7 percent of medical treatments during tournaments last year were wrist-related -- hardly an epidemic. However, Berger estimates that 70 percent of his patients have split tears without knowing it, so he expects the number of surgeries to continue to rise. "Players out there are pushing the limits of human capabilities," he says.
Eventually, it seems, they're going to have to start pulling back.
Earlier this year, Berger discovered that the dorsal ligament in del Potro's left wrist had lifted off the bone. The surgeon reattached it.
When Berger rules out other diagnoses, he often searches for tenderness in a collection of ligaments known as the TFCC, which he repairs arthroscopically.
On A Tear
After three months of rest didn't cure Robson's ailing wrist, Berger diagnosed a tear of the ulnotriquetral ligament. He operated in April. Robson hopes to play again by the end of 2014.
In 2010, del Potro came to Berger with a split extensor carpi ulnaris tendon in his right wrist. His ranking fell to 485 after surgery but rebounded to 11 by the end of the year.