Team Player

Terry Francona, manager of the Cleveland Guardians MLB team, called him the “Godfather of care for athletes’ hands.” Kingdom caught up with Dr. Thomas Graham to ask him about life between the training room and the operating room, and to learn how all golfers can avoid and treat hand and upper-extremity injuries

You may have heard his name on ESPN or read it in Sports Illustrated or Golf Digest. Perhaps, you read his bestselling book on medical innovation, Innovation the Cleveland Clinic Way, or watched him patrol the sidelines of an NFL game or sit courtside at an NBA tilt. Even if you haven’t encountered Dr. Thomas Graham, you are familiar with his clientele. Dr. Graham’s practice has been the premier destination for the care of the professional athlete’s hand and wrist for three decades. Throughout that time, he has saved or extended the careers of more than 2,000 players who rely on their hands.

Dr. Graham has served as the medical director, team physician or hand-surgery consultant for teams in every major sport (NFL, MLB, NBA and NHL). He also shared a deep and special friendship with Kingdom co-founder Arnold Palmer. Their relationship originated from Graham’s roots in western Pennsylvania and influenced the healthcare landscape when they collaboratively launched the Arnold Palmer SportsHealth Center in Baltimore.

For 30 years, Dr. Graham’s calendar has included attending over 100 professional sports contests annually, yet this former collegiate golfer has always concentrated his efforts to help fellow golfers—pro and amateur—remain on the links.

How did you become the “go-to” hand surgeon in professional sports?

I got a head start by deciding to be a hand surgeon before I was 10 years old, but the real answer is a powerful combination of mentorship and serendipity. I worked with some of the grandfathers of sports medicine, and I was quickly assumed into the small enclave of surgeons taking care of professional sports teams. At first, having a hand surgery consultant was somewhat novel, and my experience with teams across the entire country exploded.

A true catalyst was my relationship with Arnold Palmer. When I started my career at Cleveland Clinic in the early 1990s, Mr. Palmer and Mark McCormack— having founded the Cleveland-based management company, IMG—made me the unofficial “Team Doctor”. With their endorsement I went from seeing dozens of athletes a year to hundreds.

It is exceptionally gratifying when a player you have cared for is traded to a different team, and then suddenly you start receiving calls about other players on the new team. I’m humbled to have the trust of the athletes and of other participants in this unique ecosystem.

What makes golf unique from the perspective of a hand surgeon?

Here are three things that fascinate me about golf:

1. The hand-wrist unit serves as the “final common pathway” that contacts the club and influences the flight of the ball.

2. In terms of medicine, golf is the only sport played in essentially the same manner by both professionals and recreational athletes.

3. In golf there is no consistency of playing field. Courses not only vary in elevation and length, but the conditions during the same contest may vary. These factors, among others, conspire to present an array of injuries that can result from acute or chronic etiologies.

What are the common injuries in the amateur golfer?

Because the equipment and actions of the game are shared between the professional and recreational player, there is no real exclusivity of injury portfolio to one cohort. But in my experience, amateurs are more prone to an acute injury from attempting the “hero” shot, and they have a general tendency to over-swing. Not only do weekend golfers tend to find themselves in more tenuous circumstances, but they also seem to have a proclivity to try the impossible recovery, involving proximity to roots, shrubs, steep inclines and bunker lips.

Are professional golfers susceptible to different injuries?

The injury profiles for tour golfers deviate from amateurs’ in one fundamental way: the extraordinary dedication and hours of practice of elite players translates into overuse injuries. Coupled with extreme conditions, considerable travel and the fitness regimens accompanying the game at the highest level, tissue breakdown from attrition is simply more common in the professional golfer.

Additionally, we’ve learned a great deal about managing degenerative conditions (osteoarthritis) of the hand and wrist in the professional athlete through our association with the PGA Tour Champions. Athletes in other major sports simply don’t participate at the professional level into their fourth or fifth decade, so keeping players competitive with that portfolio of injuries presented new challenges and fostered creative solutions we now employ for the recreational golfer who is over 50 years old.

What are the signs that golfers should heed, sending them to see a physician?

I prefer to keep this simple. Knowing the dedication most golfers have to their sport—whether in high-level tournament play or the weekend game—when a player is forced to walk off the course or feels they can’t start a round, I take it seriously. Obviously, the acute onset of discomfort after hitting a root or hearing a pop on the awkward bunker swing should alert a golfer to injury.

What can golfers do to prevent the severity of injuries to their hands and wrists?

This is tricky because strength and endurance of the small muscles of the hand and forearm don’t translate as directly to injury prevention as core or lower extremity conditioning in contact sports. The nexus of good swing mechanics, proper equipment, and realistic expectations about quantity and quality of play go a long way to extend the career and enjoyment of most golfers.

What are the most frequent golf-related injuries you treat as a hand surgeon?

There are five:

1. Golfer ’s/Tennis Elbow. Technically medial and lateral epicondylitis, respectively, this is discomfort from inflammation at the origin of the large muscle groups from the small bony prominences on either side of the elbow. And yes, golfers suffer from tennis elbow.

2. Ho ok of the Hamate Fracture. Any “stickand-ball” athlete (baseball, tennis, etc.) risks fracturing the bony projection in the palm where the end of the club resides. If acute pain in this area is experienced with a swing that possibly contacted the ground or an object, take it seriously.

3. Extensor Carpi Ulnaris Tendon Issues. The strong wrist extensor and elevator residing on the small finger side of the wrist is prone to chronic and acute injury in sport. Inflammatory tendinitis or instability resulting from injuries to the investments of the tendon can present with discomfort or mechanical “snapping” of the tendon out of its bony groove.

4. Triangular Fibrocartilage Tears. The “bumper” cartilage that separates the end of the prominent ulna bone and the bones of the wrist can be thinned or perforated with chronic use or an acute incident.

5. Golfer’s Thumb. “Golfer’s Thumb” is how I have described a phenomenon in the thumb of the top hand (the left hand for a right-handed golfer), where the heel of the bottom hand compresses and torques the metacarpophalangeal (MCP) joint. A chronic attenuation results that acts like the “gamekeeper’s” or “skier’s” thumb, that contact athletes frequently sustain.

Golf is a lifelong sport, including professionals playing into their 60s on the PGA Tour Champions. How can golfers extend their playing careers?

The often-overlooked ingredients for those of us with a few birthdays behind us are flexibility, core strength and balance. In sports like golf, where consistency is the mark of the champion, taking care of these fundamentals will contribute to longer, happier careers.

Tell us more about your relationship with Arnold Palmer?

Over more than four decades my relationship with Arnold Palmer enriched my life immensely. Growing up not far from Latrobe, Pennsylvania, I was first a fan in the 1960s and ’70s. Later I was privileged to become one of his physicians and friends. Together we launched the Arnold Palmer SportsHealth Center in 2006, sharing the level of care we delivered to professional athletes with anyone pursuing an active lifestyle.

Being around Mr. Palmer reinforced the best lessons of humility, sportsmanship, entrepreneurship, accountability and courtesy. What a role model, for athletes and for anyone with aspirations. I think about him every day and conduct my affairs in a way that I hope would make him proud.

What aspirations remain for you?

I truly appreciate what I learned from that special “laboratory” of caring for professional athletes, and translating that knowledge and experience into advancing surgical science for all patients.

In team sports I still have hopes to be part of a world championship. I was with great organizations that lost three World Series (1995, 1997 and 2016 with the Cleveland Guardians, previously known as the Indians) and one Stanley Cup (2010 with the Philadelphia Flyers).

As for golf, beside the interpersonal experiences we savor, the wonderful thing about this sport is that we always believe we can improve. Very few endeavors have that inherent optimism that drives us. Maybe that’s why I’m so humbled to assist so many professionals and amateurs on their journey to “better.”

Dr. Graham is personally dedicated to helping athletes with hand and wrist problems to reach their potential, regardless of their level of play. He can be reached at athleteshand@gmail.com