Tennis players fear wrist injuries more than any other. Carlos Alcaraz is no exception

A certain look appears in tennis players’ eyes when the pain and discomfort they can manage in so many other parts of their bodies arrives in one of their wrists.

Carlos Alcaraz had it during a changeover at the Barcelona Open in April, on a court named for another Spanish great, Rafael Nadal. Nadal managed to win 22 Grand Slam titles with chronic injuries to his foot and knees that persisted through his career — as well as wrist injuries of his own.

Alcaraz, already a seven-time Grand Slam champion at 23, knows what every other tennis player knows.

Some ailments can be managed. Others are existential.

Ever since the Spaniard announced last month that a wrist injury would sideline him through the end of the clay-court season, the sport’s ever-simmering terror around them has threatened to boil over. Now that Alcaraz, one of the most gifted players in history, has confirmed that he will miss Wimbledon, it has.

A wrist injury is about the worst a tennis player can suffer, especially in their playing hand, where it sits at the end of the kinetic chain that powers just about every shot. Even once the pain and swelling of an injury is gone, the psychological impact can linger longer; the feeling that the joint is unstable, even if it is not, can be as destabilizing as the injury itself.

“Historically that seems to be the worst,” Bill Mallon, a now-retired orthopedic surgeon and Olympic sports historian, said during a recent interview. “ACL (Anterior cruciate ligament) wouldn’t be good either, with all the twisting and turning, but I don’t hear of tennis players tearing their ACL very often.”

For Sebastian Korda, the 25-year-old American who has suffered through a nightmare series of injuries the past three years, the pain that shot through his wrist in the early stages of an Australian Open quarterfinal in 2023 was unlike anything he had experienced.

“Trusting it wasn’t easy. It was just a lot of pain. Then every practice you were hesitant and just always thinking about it,” Korda said of his recovery during an interview a year later.

He didn’t pick up a racket for nearly three months, his longest stretch since he started playing tennis as a small boy. At the time, he was still wondering whether he would ever comfortably make a forehand stab at an opponent’s 130-mph serve, or stick a forehand volley with his old mix of touch and power.

The wrist is a complex assembly of eight bones, three principal joints, ligaments and tendons, with scant muscle around them. Its moving parts, and connection with the hand and fingers, makes it comparable to the ankle — but the ankle has muscles to help it perform. Tennis players can build muscle around other joints, like knees and shoulders, which also come under great strain.

The wrist’s smaller, more delicate components are on their own.

“People often say tennis players who have prevented wrist injuries for their career thus far, they’re actually really lucky,” Dr. Melissa Leber, the director of player medical services at the U.S. Open and sports physician, said during a recent interview. “It has to do with your form and how you hit. But in general wrist injuries plague the majority of tennis players.”

The composition of the wrist makes an injury extremely hard both to prevent and to treat, especially for people who play a sport that requires players to torque their wrists to help generate more topspin. The shoulder and the rest of the arm are more responsible for the velocity of shots, but they get a lot of assistance from the entire kinetic chain.

The power of a forehand begins in the back ankle and runs up the legs, through glutes and hips. That drives the arm. It functions like a whip, with the wrist providing the last bit of snap at the end.

The current trajectory of tennis doesn’t help.

“Everyone is chasing speed and spin,” Jim Courier, the former world No. 1 who is now a highly respected tennis commentator, said during a recent interview. And while the rate of wrist and hand injuries on the ATP and WTA Tour experienced a slight decline compared with the previous seven years, according to survey data from the Professional Tennis Players Association (PTPA), overall injuries to “upper extremities” including the forearm, elbow and shoulder, are up significantly.

Players have long complained about less-lively balls that force them to swing harder to hit them through the court. Tour officials have continued to study the performance of the balls, but players still have to hit them, over and over again.

There are plenty of recovery stories, but also horror ones, of promising careers derailed by too-quick comebacks or just imperfect treatment. Andre Agassi had a buildup of scar tissue that caused tendonitis. Surgeons removed the tissue. Kim Clijsters had surgery to repair torn tendons in her left wrist, her non-dominant hand. Emma Raducanu suffered from growths on her wrist bones that caused pain. All three returned from injury; Agassi and Clijsters both won majors after they did.

Dominic Thiem and Juan Martín del Potro, who both won a single Grand Slam title in careers that promised more, top the list of horror stories.

A lot of their opportunities were lost to facing the Big Three of Roger Federer, Nadal and Novak Djokovic, but Thiem and del Potro were both unable to build on their first major wins — del Potro in 2009 and Thiem in 2020, both at the U.S. Open — due to wrist injuries. During an interview in 2024, Thiem said that the violence he inflicted on his body in trying to keep up with the three greatest men’s players in the sport was, eventually, too much for it to bear.

He injured his wrist hitting a forehand during a match against Adrian Mannarino in 2021. The prodigious, whipping swing that he used to bludgeon balls past opponents also accelerated the end of his career.

The most common wrist injuries occur in two places. The first is the triangular fibrocartilage complex, also known as the TFCC. It’s the intricate collection of ligaments and cartilage on the pinky side of the wrist. The TFCC provides stability and cushioning to the joint and nearby bones.

The second is the extensor carpi ulnaris tendon, known as the ECU. The ECU tendon extends from the forearm, runs through the wrist and attaches to the bone that runs up through the little finger. The ECU helps provide power and stability to the joint and the hand.

Tennis players with wrist pain are often enduring tendonitis, which is inflammation of the tendons, or tenosynovitis, when fluid accumulates in the sheath that protects that tendon. Alcaraz is managing the latter.

More serious injuries involve tears of the ligaments or tendons or a fracture in the bone; Thiem’s injury was a detachment of the sheath of the ECU, while Nick Kyrgios, the 2022 Wimbledon finalist, underwent experimental reconstructive surgery after rupturing a scapholunate ligament.

Unless reconstruction or repair is required, most people do not have to undergo surgery to reduce their discomfort. Dr. Leber said the wrist responds well to immobilization. The components get to rest. The inflamed tendons calm down. The fluid can dissipate.

That’s why Alcaraz has been wearing a splint in public appearances since his injury at April’s Barcelona Open in Spain, and why Amanda Anisimova, who reached two Grand Slam finals last year, has been training with support on her left wrist ahead of this year’s French Open, where she too is carrying an injury.

This is where the wrist’s lack of muscle becomes an advantage. When knees, ankles and other joints with muscles around them are immobilized, those muscles can atrophy. With a wrist injury, a player can move and exercise their forearm, as well as their thumb and fingers.

“It’s not hard to come back after being immobilized for a month or two,” Dr. Leber said, though the psychological leap the brain has to make to tell the arm and wrist to to blast a 90-mph forehand and put 3,000 RPMs of spin on the ball is another story.

“Once you’ve had pain in the wrist you don’t want to get it again,” she said. “You’re trying to protect it.”

And therein lies the challenge. Players have to figure out what they can and can’t do with that most essential of tennis joints. Karolína Muchová, one of the most touch-oriented players in the women’s game, underwent wrist surgery in early 2024 and missed nine months. She gives a wry smile whenever she is asked whether she is pain-free. Even when the injury is visibly long gone, its impact can still be felt.

“Basically, I had to relearn how to play tennis again,” Korda said.

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