Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
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We wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\n
Throughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\n
We wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
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In recent years, the amount of diversified hazardous materials and/or potentially hazardous materials, such as cleaning products, medicines, personal care products, packaging and container products, phthalates, and antibacterial agents, poses a serious threat to the environment and public health. As a result developed countries have adopted well-functioning policy measures and innovative technologies to deal with HHW. On the other hand, developing countries have weak institutional structures and poor policy performance and have adopted ad hoc approaches to manage HHW. The book contains five chapters covering topics of household hazardous waste management and exposure assessment. This book will be useful to many research scientists, solid and hazardous waste managers, administrators, librarians, and students in the scope of development in solid and hazardous waste management program including sources of household hazardous waste, exposure assessment, and government policies on waste generation and treatment and processing of HHW.",isbn:"978-953-51-2910-3",printIsbn:"978-953-51-2909-7",pdfIsbn:"978-953-51-6693-1",doi:"10.5772/62793",price:100,priceEur:109,priceUsd:129,slug:"household-hazardous-waste-management",numberOfPages:92,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"64bad707f9b21195de508888574722f7",bookSignature:"Daniel Mmereki",publishedDate:"February 1st 2017",coverURL:"https://cdn.intechopen.com/books/images_new/5415.jpg",numberOfDownloads:8458,numberOfWosCitations:14,numberOfCrossrefCitations:17,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:27,numberOfDimensionsCitationsByBook:0,hasAltmetrics:1,numberOfTotalCitations:58,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 31st 2016",dateEndSecondStepPublish:"April 21st 2016",dateEndThirdStepPublish:"July 26th 2016",dateEndFourthStepPublish:"October 24th 2016",dateEndFifthStepPublish:"November 23rd 2016",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"176512",title:"Dr.",name:"Daniel",middleName:null,surname:"Mmereki",slug:"daniel-mmereki",fullName:"Daniel Mmereki",profilePictureURL:"https://mts.intechopen.com/storage/users/176512/images/5130_n.jpg",biography:"The editor, Dr. Daniel Mmereki, is a research associate of solid and hazardous waste management in the National Centre for International Research of Low-carbon and Green Buildings, Chongqing University, People’s Republic of China. He was awarded PhD and postdoctoral degrees in Environmental Engineering from Chongqing University. He was also awarded an MSc degree in Environmental Science from the University of Botswana, Botswana. His research interests include innovative economic and environment-friendly techniques for management of solid and hazardous wastes. He has regularly published good-quality journals and conference proceedings and book chapters, and he is a book editor and reviewer of different journals related to valuable international publishers. He was honored with the Iraj Zandi Award for his contribution to the field of solid waste technology and management at The Thirty-First Conference on Solid Waste Technology, Philadelphia, PA, USA.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Chongqing University",institutionURL:null,country:{name:"China"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"780",title:"Ecological Engineering",slug:"ecological-engineering"}],chapters:[{id:"53048",title:"Introductory Chapter: Overview of Household Hazardous Waste Management in the African Context",doi:"10.5772/66307",slug:"introductory-chapter-overview-of-household-hazardous-waste-management-in-the-african-context",totalDownloads:1395,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:1,abstract:null,signatures:"Daniel Mmereki, Baizhan Li, Liu Hong and Andrew Baldwin",downloadPdfUrl:"/chapter/pdf-download/53048",previewPdfUrl:"/chapter/pdf-preview/53048",authors:[{id:"176512",title:"Dr.",name:"Daniel",surname:"Mmereki",slug:"daniel-mmereki",fullName:"Daniel Mmereki"}],corrections:null},{id:"53046",title:"Dose Response and Exposure Assessment of Household Hazardous Waste",doi:"10.5772/65955",slug:"dose-response-and-exposure-assessment-of-household-hazardous-waste",totalDownloads:1353,totalCrossrefCites:2,totalDimensionsCites:4,hasAltmetrics:0,abstract:"This study was conducted to assess the risk of health hazards to employees working in local authorities in Malaysia especially workforce involved in waste management. Therefore, the four steps process of Health Risk Assessment has been identified, which include hazard identification, exposure assessment, dose response assessment and risk characterization. It was estimated approximately 22,388 tons of wastes generated every year in Malaysia and around 2.2 % out of that amount were consisting of hazardous household waste (HHW) with mean average generation for each person per day was around 0.02 kg. The waste generation is expected to increase 2 to 3 % per year and estimated to reach approximately 31 million of tones per day in the year 2020. In this study, the household hazardous wastes (HHW) were analyzed for their permissible dose level and the existing hazard level, hazard index and cancer index. Cancer Index for dermal exposure is found to be 5.8 × 10–7 mg/m3, for Inhalation dust 1.4× ×10–1 mg/m3, which falls under Low Risk and for Inhalation aerosol is 5 × ×10–2 mg/m3, under Medium Risk. Extra care must be taken for the management of HHW as if it is improperly managed, it will fall into High Risk.",signatures:"Johan Sohaili, Shantha Kumari Muniyandi and Rosli Mohamad",downloadPdfUrl:"/chapter/pdf-download/53046",previewPdfUrl:"/chapter/pdf-preview/53046",authors:[{id:"188010",title:"Dr.",name:"Johan",surname:"Sohaili",slug:"johan-sohaili",fullName:"Johan Sohaili"},{id:"195086",title:"Dr.",name:"Shantha Kumari",surname:"Muniyandi",slug:"shantha-kumari-muniyandi",fullName:"Shantha Kumari Muniyandi"}],corrections:null},{id:"52833",title:"Chemical Recycling of Household Polymeric Wastes",doi:"10.5772/65667",slug:"chemical-recycling-of-household-polymeric-wastes",totalDownloads:1735,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"This chapter provides insights on the disposal of household polymeric wastes and chemical recycling of household polymeric wastes for chemical feedstock. Waste generated may cause environmental, economic and health problems. In 2012, the EU (European Union) generated 2514 million tons of waste, of which 213,410 million tons is household waste. Household waste has lots of polymeric materials. The two most important of the polymers are polystyrene (PS) and low-density polyethylene (LDPE). In this study, the results of PS and LDPE obtained from various processes related to polymeric wastes’ chemical recycling were given. Main products of PS chemical recycling were obtained as follows: styrene monomer, toluene, ethylbenzene, α-methyl styrene and other valuable chemicals. When LDPE undergoes thermal degradation in a solvent setting in autoclave, oil like diesel can be obtained.",signatures:"Ali Karaduman",downloadPdfUrl:"/chapter/pdf-download/52833",previewPdfUrl:"/chapter/pdf-preview/52833",authors:[{id:"187780",title:"Prof.",name:"Ali",surname:"Karaduman",slug:"ali-karaduman",fullName:"Ali Karaduman"}],corrections:null},{id:"52793",title:"Polystyrene as Hazardous Household Waste",doi:"10.5772/65865",slug:"polystyrene-as-hazardous-household-waste",totalDownloads:2139,totalCrossrefCites:12,totalDimensionsCites:20,hasAltmetrics:1,abstract:"Polystyrene (PS) is a petroleum‐based plastic made from styrene (vinyl benzene) monomer. Since it was first commercially produced in 1930, it has been used for a wide range of commercial, packaging and building purposes. In 2012, approximately 32.7 million tonnes of styrene were produced globally, and polystyrene is now a ubiquitous household item worldwide. In 1986, the US Environmental Protection Agency (EPA) announced that the polystyrene manufacturing process was the fifth largest source of hazardous waste. Styrene has been linked to adverse health effects in humans, and in 2014, it was listed as a possible carcinogen. Yet, despite mounting evidence and public concern regarding the toxicity of styrene, the product of the polymerisation of styrene, PS, is not considered hazardous. This chapter draws on a series of movements called the ‘new materialisms’ to attend to the relational, unstable and contingent nature of PS, monomers and other additives in diverse environments, and thus, we highlight the complexities involved in the categorisation of PS as ‘hazardous’ and the futility of demarcating PS as ‘household waste'. While local examples are drawn from the New Zealand context, the key messages are transferrable to most policy contexts and diverse geographical locations.",signatures:"Trisia A. Farrelly and Ian C. Shaw",downloadPdfUrl:"/chapter/pdf-download/52793",previewPdfUrl:"/chapter/pdf-preview/52793",authors:[{id:"188595",title:"Dr.",name:"Trisia",surname:"Farrelly",slug:"trisia-farrelly",fullName:"Trisia Farrelly"}],corrections:null},{id:"53069",title:"Household Hazardous Waste Management in Sub‐Saharan Africa",doi:"10.5772/66292",slug:"household-hazardous-waste-management-in-sub-saharan-africa",totalDownloads:1837,totalCrossrefCites:3,totalDimensionsCites:3,hasAltmetrics:1,abstract:"Household hazardous wastes (HHWs) have not been given serious attention in sub‐Saharan Africa. There is little or no information on HHWs in many developing countries of the world. This is regardless of the fact that they are very toxic and contain constituents which are persistent in nature. Once released into the environment, they can remain stable for exceptionally long periods of time. They have the potential to be harmful to public health and the environment if not handled, used, and disposed properly. This study reports the level of knowledge and management of HHWs in three tertiary institutions in sub‐Saharan Africa. Several factors were found to be responsible for poor management of HHWs. These include lack of awareness, inadequate treatment technologies, financial constraints, lack of realistic policies and legal frameworks, and unplanned settlements, among others.",signatures:"Joshua N. Edokpayi, John O. Odiyo, Olatunde S. 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1. Introduction
Golf participation has exploded in the past 2 decades. In the early part of the century, it was calculated that Golf is played by over 55 million people throughout the world. In 2018 there were 38,864 golf courses in 290 of the world’s 449 countries [1]. Golf has a particular traditional home in Great Britain and Ireland with 494 courses populating the island of Ireland. The majority of golfers reside in America, where over 23.4 million golfers were recorded in the USA in 2018. This had risen to 34.2 million by January 2021, with 9 million participating in golf at ranges and using indoor simulators. There are approximately one million individuals playing golf twice a week in England and have done so for the past five years [1, 6].
The Golf Industry is an $84 billion economic engine that drives nearly 2 million jobs in the USA producing a total economic output in California alone of $15.1bn in 2019.
Golf is both a recreational pastime and a competitive sporting pursuit. Golf started to thrive as a spectator sport in the 1920’s and boomed in earnest in the 1960’s with the arrival of live golf on TV. Its charm and allure might be the lack of age and gender barriers. Fundamentally, it is a game of skill and guile requiring some athletic ability.
The rise in popularity of golf is multifactorial. Golf as a sport has a dedicated viewing population unlike many sports and many non-golfers happily enjoy the trials and travails of professional golfers which appear on TV channels on a weekly basis. In many ways a 4 day professional sporting event is like a drama or soap opera with villains and heroes in equal measure performing on perfectly manicured fairways. Golf is peculiar in spawning a dedicated TV channel, The Golf Channel, watched by millions of viewers on a weekly basis. The recent pandemic delayed Masters played in Augusta, Georgia, USA in the Autumn of 2020 which had a viewership of over 15 million. The exercise associated with golf is of great health benefit [2] providing the perfect physiological work out to sustain health and longevity [3].
Golf too may be considered the perfect exercise for improving health and longevity. Recent recommendations have suggested that the perfect exercise would involve aerobic activity intermingled with resistance activity and anaerobic activity [3]. It is reported that this exercise prescription positively affects all cause and specific cause mortality in American adults. It appears that carrying or pushing golf clubs around an 18-hole course provides an almost perfect exercise prescription [2]. The association of golf participation and improved physical health and mental well-being and the contribution to increased life expectancy has prompted a number of experts to recommend policy makers encourage golf as a beneficial pastime [4].
The worldwide reach of golf and its ability to transcend barriers of age, race and gender and its general appeal has seen the reintroduction of golf to the 2016 Olympic Games.
In parallel with increased participation, injury rates among golfers have also increased. Research has suggested that almost 7 in 10 amateurs and 9 in 10 professionals will suffer a golf-related injury at least once in a lifetime of golf participation [5].
2. Golf injury incidence
Increased participation, just short of a million people play golf twice a month in England for the past 5 years [6] has resulted in increased injury rates more frequently in elite golfers. [7] Annual Injury incidences of between 2 and 4% are reported among golfers. Put more simply a golfer can expect to sustain an injury for every 100 hours of golf participation with an overall incidence rate of injury of 15.8 injuries per 100 golfers and with a range of 0.36 to 0.60 injuries per 1,000 hours per person. 46.2% of injuries are reportedly sustained during the golf swing, and injury is most likely to occur at the point of ball impact (23.7%) [8]. Golf carries a significant injury rate with levels exceeding other non- contact sports. Perhaps golf is in fact a contact sport, with contact being made with turf and ball through a metal implement, frequently in a ferocious and repetitive manner.
There is a significant variation in the incidence and type of injury suffered by amateur or recreational golfers in comparison to their professional counterparts. In a review of over a thousand amateur golfers, the survey confirmed that more than 60% of amateur golfers sustained one or more golf related injuries over the course of their playing career. The injury rate was higher in the over 50 year old amateur with a 65% injury rate in comparison to the under 50 group, which had an injury incidence of 58% [9]. There was a slightly higher incidence of injury at 67.5% among single figure handicappers rather than their double-digit colleagues. A typical injury resulted in the amateur golfer missing five weeks of playing time [5, 6, 7].
More than 80% of professional golfers report a golf-related injury at some point in their career. It is estimated that between 10% and 33% of professional golfers are actually playing while they are carrying an injury during their professional career. Most professional golfers will experience 2 significant golf-related injuries during their career. Over a career, 9 weeks for professional men and 3 weeks for professional women are lost due to injury. On returning from injury more than 50% of professional golfers are compromised by their injury and often play through pain [10, 11, 12].
Recent research has indicated that general exercise has an injury rate of 5.3 per 1,000 persons, golf having a similar injury rate to rugby at 1.5 per 1000 persons [13]. The injury rate is significant but the over-arching benefits of playing golf outweigh the risks, particularly to physical and mental well-being [2, 3].
3. Types of golf injury
All golfers are prone to injury. Amateur golfers have a lifetime incidence of injury ranging from 25.2% to 67.7%. Professionals golfers have higher rates between 31% to 88.5% over a lifetime.
Many studies on golf injuries have found that low back injuries account for 15.2% to 34% of all golf injuries, followed by injuries to the elbow (7% to 27%) and shoulder (4% to 19%). The wrist accounts for 10% of all golf injuries. In professional golf, wrist injury incidence has been reported to be up to 54% (7), the leading wrist being most commonly compromised [14].
The change in the injury profile is associated with increased playing hours as well as the nature of golf. Newer golf clubs with composite heads and lighter shafts have allowed the golfer to swing faster in the constant and increasing race by club manufacturers to achieve greater distance.
The majority of golf injuries are referred to as “over-use injuries” caused by the repeated action of swinging the golf club and hitting the golf ball and turf. This activity not only takes place on the golf course where the average long shot golf rate is 40 to 50 swings per round but also on the practice tee and driving range where 100’s of balls are hit. Lighter clubs and the availability of golfing practice facilities have also impacted the increased injury rate. Specific risk factors for overuse golf injuries are age, ability, and swing mechanics [15].
4. Overuse injuries
Overuse injuries affecting the musculoskeletal system are caused by repetitive trauma which result in micro trauma to soft tissue structures such as tendons, muscles ligaments as well as bones. The factors pertaining to these overuse injuries can be divided simply into: 1) Intrinsic causes; 2) Extrinsic causes.
Intrinsic risk factors can be modifiable or non-modifiable. Modifiable factors in golfers would include fitness, skill level and patterns of practice session. One of the major issues for a golfer is that often he or she is their own coach. In many cases this type of practice reinforces an intrinsic mistake in the swing biomechanics rather than corrects the imperfection. In these cases, “practice makes permanent rather than perfect”. Non-modifiable factors would include age, gender and body morphology, general health and joint or spine pathology. Quality of practice and play is always preferable to quantity. In golfers a faulty grip is frequently a fundamental flaw leading to overuse injury.
Extrinsic factors include the conditions a golfer is exposed to. These include equipment and coaching. If either is inappropriate injuries will result. All golf coaches should take golf biomechanics, prior injury and skill level into account. Practicing in the cold or when not warmed up will increase the risk of injury. Training error is a frequent culprit. Failure to warm up, hitting too many balls, hard surfaces, inappropriate equipment or an alteration in swing mechanics can all result in excessive loading and injury. This coupled with insufficient or inadequate recovery time, (golfers frequently play when injured) causes inflammation to tissues and injuries. A trained PGA golf professional will ensure that these common mistakes are avoided, however, most golfers are their own coaches and training errors mixed with other extrinsic and intrinsic issues result in injury.
Swing mechanic and alteration in technique on the quest for greater distance off the tee are probably the greatest causes of overuse injuries in the modern golfing population.
4.1 Physics of a Golf swings
The golf swing is a means of transferring energy to a stationary ball. The energy is transferred to the ball which then travels down the fairway.
The modern golf swing can be broken up into a number of components (Figure 1):
Set-up
Back swing
Transition
Down swing
Impact
Follow-through
Figure 1.
The phases of a golf swing.
The function of the golf swing is to apply the face of the golf club in a consistent, stable and square fashion allowing force to be impacted onto the golf ball from the club face producing linear momentum which is transmitted to the ball. The force applied to the ball is a function of the mass of the object (golf club) and its velocity (mass × velocity = momentum). The rules of golf remove the first variable [the mass of the club), the second element has amused and exercised golf teachers and technologists for centuries.
At first look the conundrum of a golf swing appears simple. However, it involves a number of complex laws of physics:
Newtons 3rd Laws of Motion
Potential and Kinetic Energy Transfer
Circular motion and its constituent parts
4.1.1 Newton’s 3rd law of motion
In the first instance energy is transmitted from the golf club to the golf ball based on Newton’s 3rd Law of Motion i.e. The Law of Action and Reaction.
One object exerts a force on a second object, the second object exerts an equal opposite force on the first object. As club hits ball it applies force causing it to go in motion. In return, the ball also applies a reciprocal and equal force back to the club. This force slows your club down. The interplay of these actions and reactions result in a golf ball flying towards a target. Not all the energy is transmitted to the ball, with some being diverted up the club to the wrist. This is further increased by imperfect or missed shots.
During a golf swing energy is transferred between both potential and kinetic. The back swing creates kinetic energy which is converted into stored or potential energy at the top of the swing and then converted back to kinetic energy on the down swing. This happens because of the law of conservation of energy.
4.1.2 Energy transfer
Potential Energy (PE) is stored energy. It is energy an object possesses due to its position or the arrangements of its parts. This potential or stored energy is created at the top of the golf swing.
PE=mass×gravity×height.E1
Hence the higher the hands and the club head from the ball the greater the stored energy in the swing.
Kinetic Energy (KE) is energy that occurs when an object is in motion.
This is the energy created by the golf club descending towards the golf ball.
KE=1/2mass×velocitysquared.E2
The Law of Conservation of Energy states that: Energy is neither created nor destroyed, it is conserved. Hence the back swing creates kinetic energy at the top of the swing. This is stored as Potential energy during the transition phase and then transferred back to kinetic energy on the down swing before it is transmitted to the golf ball at impact.
4.1.3 Circular motion of a golf swing
Unlike other ball hitting sports such as cricket, hurling, tennis and baseball the golf swing is a circular motion attacking a stationary object, the golf ball.
The circular motion is subject to other physic parameters:
Double pendulum Effect
Centipedal forces
Torque
4.1.3.1 The double pendulum effect
A physical pendulum is a solid object that swings back and forth on a pivot under the influence of gravity. The golfer has 2 anchors, the shoulder and the wrists. In a golf swing, the connection between arms and club creates a double pendulum effect. The arms make up one pendulum that pivots around the shoulders, while the club makes a second pendulum that pivots around the wrists, which acts as the pivot. The two pendulums can swing independently but work together to make the swing feel effortless.
4.1.3.2 Centripetal force
Centripetal Force is a force that makes an object move in a curved motion, like a rollercoaster hugging the curve around a loop. The golf club swinging in an arc from the shoulder to the ball. The hands hold the club and prevent it flying off in a straight line, in a centrifugal fashion. In essence the golfer pulls the wrists and club handle inward while swinging the golf club and golf head outward.
The faster the club curves and the bigger the arc in a golf swing (radius) the greater the force of the club on the ball, and the farther the golfer should be able to hit the ball.
The mass and velocity are also a function of gravity.
4.1.3.3 Torque
In physics Torque is a measure of the force that can cause an object to rotate about an axis. It is a rotating force in a circular motion as opposed to a simple force which causes an object to accelerate linearly. Torque is the force that causes an object to acquire angular acceleration in a golf swing.
Torque is the rotating force in circular motion as you swing back, coiling your body, and then start the downswing. This creates the stored or potential energy at the top of the swing. If you hold the club and prevent it releasing on the down swing you increase this stored energy. The hands and wrists are resisting the angular acceleration of the golf club. Increased torque and stored energy are ultimately released by the club face at the bottom of the swing.
Torque=Force×distance.E5
These elements of classical physics have fascinated golfers who seek greater distance in their golf shots. The mass dynamics and weight of golf clubs and their structure are subject to the rules of golf (1) and can be considered a constant. Velocity is the variable element.
Golfers have pondered on this singular element for centuries. Swinging faster or manipulating the club in the down swing through releasing the club later will add greater speed. Similarly firing the right side of the body or manipulating the club face through the hands remain the other options available to the golfer seeking greater distance. Each augmentation compromises the leading wrist and are associated with injury.
5. Biomechanics of the modern golf swing
Modern biomechanics techniques have allowed a clear understanding of the physical requirements of the body for the execution of a golf swing. Simply put, a golf club made up of a stick or shaft attached to a heavier head hits a ball towards a target by swinging the stick.
The motion involves a complex manipulation of shaft and club by the golfer to promote maximum force on the ball in an effort to propel the ball towards a target. Once described by Winston Churchill as” a game whose aim is to hit a very small ball into an even smaller hole with weapons singularly ill-designed for the purpose”.
The golf club exerts a force on the golf ball by creating a greater force on the down swing which is transferred to the ball. This force is a function on the mass of the club and the speed it is travelling at. This in turn is a function of the distance travelled to the ball and gravity. Extra speed can be generated by the double pendulum affect. Holding the wrist angle for a long as possible in the down swing increases stored energy by a concept referred to as lag. As the stored energy is released in the down swing at 30 degrees the club is released towards the ball greater speed is created. This results in a greater force being applied to the ball.
Newton’s second law of motion, the acceleration of an object is dependent upon both force and mass. Thus, if the colliding objects have unequal mass, they will have unequal accelerations as a result of the contact force that results during the collision.
Newton’s laws of motion are naturally applied to collisions between the golf club and the golf ball. In this collision both ball and club experience forces that are equal in magnitude and opposite in direction.
The force experienced by the club head is equal to the force experienced by the golf ball.
The forces upon the ball and club head are equal, but accelerations are unequal due to the size of the two objects at the moment of contact or collision. In simple terms club head and ball experience equal forces, yet the ball experiences a greater acceleration due to its smaller mass.
Golfers are well aware of this and refer to it as the “Smash Factor”. This relates to the amount of energy transferred from the club head to the golf ball. The more efficiently energy is transferred the greater the acceleration. Smash Factor is ball speed divided by club speed.
The higher the smash factor the better the energy transfer. A golf swing of 100mph and a smash factor of 1.5 would create a ball speed of 150 mph. This can be affected by a number of other elements such as club lift and grip size, but ultimately the greater the club head speed the greater the Smash Factor and the further the ball travels. Hence for the same 100 mph club, a ball speed of 10mph speed difference will affect ball distance. A 10 mph in ball speed equates to a 20-yard increase in distance hitting a driver.
The upshot of Newton’s laws of motion and the golf swing are simple. The greater the force applied to the smaller golf ball by the bigger golf club, the greater the acceleration, and the further a ball will travel. The acceleration of the club is produced by two pendulums working in concert i.e. the shoulder element and the wrist element.
6. Biomechanics of the leading wrist
The leading wrist is placed on the upper golf grip and the trailing wrist on the lower element. Both hands are joined together by either interlocking or overlapping the index finger of the leading and small fifth finger of the trailing hand.
The leading wrist is placed in different anatomical positions to achieve a consistent contact on the golf ball. Each phase of the golf swing puts specific stresses and strains on the leading wrist and hand, which can result in different types of injuries [16, 17, 18].
There are 3 basic wrist motions during the golf swing. They are subtle and subject to significant variation [19] of motions from player to player (Figure 2).
Ulnar/Radial Deviation
Flexion/Extension
Supination/Pronation
Figure 2.
Directions of leading wrist motion during a golf swing.
At address the leading wrist is positioned in an ulnar deviated flexed position. It is pronated in strong grips (showing 3 or more knuckles), supinated in weak grips (showing one or less knuckles), (Figure 3) Classical teaching advises a neutral grip showing 1.5 or 2 knuckles.
Figure 3.
Classic left-hand grip showing less than one and a half knuckles (left) and a strong left-hand grip showing 3 or more knuckles (right).
In the back swing the leading wrist travels into a radial deviated, flexed and pronated position.
In the down swing the leading wrist travels into an ulnar deviated, supinated and extended position.
7. Leading wrist ulnar/radial deviation in the golf swing
At address, the leading wrist is usually held in ulnar deviation of the order of 17%.
During the backswing, the left wrist transitions to a radial deviated position and then travels back to the ball transitioning again from radial to a predominant ulnar deviated position at impact (Figure 4).
Figure 4.
Leading wrist ulnar deviation at address and impact (right) and radial deviation at the top of the back swing (left).
Modern golf coaches often teach their pupils to hold the wrist in a radial deviated position for as long as possible on the down swing. This is referred to as a cocked position (Figure 5). When held in this position stored energy is increased. This cocked or radial deviated wrist position is created by maintaining an angle between the shaft and the left forearm in the downswing. The longer the wrists can maintain this angle, the greater the lag and resulting stored energy. This referred to “lag” as the club head is lagging behind the shaft caused by the wrist position, which is called wrist torque by golf teachers (Figure 6).
Figure 5.
The angle between the shoulder, wrist and club head is maintained close to a right angle in the down swing to 30 degrees below the horizontal line through the shoulder joint, at which point the hands are released.
Figure 6.
The leading wrist in a flexed and radial deviated position maintains the angle between club shaft and arm to the bottom of the down swing, resulting in the head of the club “lagging” behind the hands storing energy.
This manoeuvre is based on research which has shown that greater club head speed is achieved if an active wrist torque is applied to the club during the latter stages of the downswing [19]. To produce a club head speed of 100 miles per hour, the optimal timing of the activation of wrist torque occurs when the arm segment is at approximately 30° below the horizontal line through the shoulder joint [20].
Therefore, significant timing of the shot is required to manoeuvre in releasing club head back square to the ball. This requires a careful return of the leading wrist from radial to ulnar deviation prior to impact.
8. Leading wrist flexion/extension in the golf swing
Flexion/Extension motion of the leading wrist is a significantly individual watermark of every swing. Elite golfers also vary dramatically from player to player.
Classical golf swing teaching suggests that the wrist is placed in a neutral or slightly extended position at address (Figure 7).
Figure 7.
Wrist positions at the top of the Back swing.
At the top of the back swing it stays in a neutral flexion/extension pattern. This referred to as” square at the top”.
In classical teaching the leading wrist descends in the down swing to the ball in a flexed position in which it impacts the ball. Not everyone follows this teaching.
9. Figure leading wrist flexion on down swing and impact
Consistent players such as Jack Nicklaus was “square at the top” for most of his career. Ben Hogan placed his leading wrist in an extended or “cupped “position (Figure 7) at the top of his swing before transitioning to a flexed position at impact. This has been replicated by current touring pro Mathew Perry and is seen as a way of avoiding placing hook spin on the ball. Dustin Johnson is in a more extreme flexed or “bowed” position (Figure 7) at the top of the swing and maintains that position on the down swing using the large trunk muscles to return the club face square to the ball at impact. This move has been followed by many golfers looking for extra distance.
10. Leading wrist pronation/supination in the golf swing
Classical golf teaching used the wrist and hands to generate club head speed at impact. In the back swing the leading wrist pronated turning the back of the leading wrist and forearm to face towards the sky at the top of the backswing. At the top of the back swing the 1st row of carpal bones are held in a pronated position at the top of the swing. During this downswing phase the leading wrist is adjusting back towards a neutral position, with the 1st carpal row of bones traversing from a bowed, pronated position towards supination. The leading wrist rotates towards supination and continues in this motion through impact where the palm of the leading wrist motions to face towards the sky in the follow through phase.
At impact the club head makes contact with the ball and the leading wrist accelerates allowing the leading wrist to unhinge into further supination in a whip-like motion, the right hand frequently rolling over the left hand and wrist thus creating extra club head speed at impact. This move is referred to as “rolling the wrists” at impact.
These pronation and supination motions are not commonly seen in modern golfers. These “handsy” moves are considered to be inconsistent. They are regularly seen in good wind players who need to manipulate the face of the golf club in relation to changing wind directions. The majority of modern elite players and coaches tend to manipulate the radial, ulnar and flexion and extension motions.
11. Elite golfers at the top of the back swing
There are many versions of the wrist flexion/extension pattern in modern golf swings, ultimately returning the leading wrist to a flexed position at impact. Each technique creates greater swing speeds and allows individual players square the club face at impact. All place varying degrees of stress on the leading wrist. These can be summarised into 3 patterns employed by leading professional golfers [21]. All have one thing in common; a flexed wrist at square club face at impact, the body moving at speed providing the acceleration to square the club face.
11.1 Flex and maintain
John Rahm has a weaker grip or neutral grip at address showing 1 and ½ knuckles in his leading hand. He flexes his wrist at the top of the swing and maintains that flexed position on the down swing and rotates his body to square up the club face at impact.
11.2 Flex, flex and rotate
Dustin Johnson has a stronger grip at address showing 3 knuckles with his wrist held in flexion. At the top of the swing he further flexes his leading wrist. On the way down he turns his body aggressively to square up the club face at impact.
11.3 Extend and flex
Matt Wolff has a weak to neutral grip at address, extends his wrist at the top of the swing and with great skill and co-ordination rapidly converts his lead wrist to a flexed position on the down swing before he releases the club face into a square position at impact.
Bryson De Chambeau who is considered the longest hitter on the PGA tour has very specific statistics [22].
11.4 Flexion/extension
13 degree of flexion at address, 11 degrees of extension at the top of the swing and 20 degrees of flexion at impact.
11.5 Ulnar/radial deviation
20 degrees of ulnar deviation at address, 14 degrees of radial deviation at the top of the swing and 15 degrees of ulnar deviation at impact.
12. The effect of wrist manipulation on the medial aspect of the leading wrist
At impact the golf ball, club and ground collide resulting in a counter force that is transmitted up the shaft of the club to the wrist and hands which are on the golf club grip. The majority of golf injuries occur on the downswing and at impact [23].
The golf swing requires complex movement of many components of the body. The co-ordination of muscle sequencing is particularly important and is noted to be the most efficient in the elite golfer. The manipulation of the leading wrist has been a source of a crusade for many golfers as they seek the perfect golf swing. The leading wrist has the ability of storing the kinetic energy which is released at impact, thus resulting in greater power delivery to the ball and greater accuracy [20, 21, 22, 23, 24], but it comes at a cost.
With a late hit, skilful golfers apply torque to the leading wrist in an effort to store more energy prior to impact with the golf ball. This stored energy by holding the leading wrist in a forced flexed and ulnar deviated position throughout the first part of the down swing could be considered a compensatory methodology and an effort to compensate for faulty swing mechanics. This may be a purist view, however, the manipulation of the wrist to improve stored energy prior to impact places further extreme pressure onto the leading wrist and particularly the lateral aspect of the wrist. The rapid transitions from a radial deviated, flexed pronated position through a relatively neutral position at impact and onwards to a supinated and ulnar deviated position is the cause of trauma to this anatomical location.
Many skilled golfers manipulate the club face with the hand and wrists as the face of the club impacts with the golf ball. These subtle variations impart different spins onto the golf ball affecting its flight and trajectory as it seeks it target on the green. A “hold off “shot imparts a left to right spin on the ball in a right-handed golfer. This is achieved by holding the left wrist firm (holding it off) at impact, preventing the natural supination of the left wrist as it transitions to impact and the follow through phase of the swing. Resisting this natural movement places great stresses on the medial structures of the left wrist which are activated to resist this natural anatomical motion.
Golfers who have quiet hands and wrists during the golf swing rarely sustain wrist injuries. Wrist manipulation may be a trade off between distance and injury.
13. Anatomical site of injuries in elite and professional golfers
The anatomical site and specific location also varies between professional and elite golfers and their amateur counterparts. There are also gender differences. For professional male golfers, the most frequently injured site is the low back at 25% of injuries, with the left wrist accounting for 16% and the left shoulder accounting for 11%. Among female professionals, the most commonly injured site is the left wrist (in 31% of cases) and the low back in 22% of cases. In general terms, therefore, the leading wrist is the most commonly affected structure among professional and elite golfers with a combined incidence of 37%, the low back at 24%, the shoulder at 10%, the elbow at 7%, the knee at 7%, the ankle and foot at 5% and the neck at 3% [25].
14. Anatomical site of injuries for amateur golfers
In amateur golfers, the low back is the most commonly injured site with an incidence in males of 36%, the elbow causing injuries in 33% of cases, the wrist or hand 21% and the shoulder 11% with the knee accounting for only 9% of injuries. In female amateur golfers, the elbow is the most commonly injured anatomical site at 36% of all female injuries, the low back accounts for 27% of injuries, the shoulder 16% and the wrist and hand 15%, the knee accounting for only 11% of injuries. When combining the data, it suggests that the most commonly injured site for amateur golfers is the lumbar spine accounting for 35% of all injuries, whereas the wrist or hand is the most common location for elite or professional golf injuries.
15. Cause and pattern of injury in elite and amateur golfer
There is also a difference between amateur and professional golf injury aetiology. In amateur golfers, excessive play or practice, direct trauma from hitting the ground or an object during a golf swing are common causes. The most common cause, however, in amateur golfers, and particularly high handicap golfers, is injuries that result from poor swing mechanics [24, 25, 26]. Professional and elite golfers are particularly prone to overuse injuries due to repeated and repetitive swinging of a golf club. This can be further complicated by alteration in swing techniques. The changes and improvement in golf equipment, with lighter shafts and composite heads on drivers and fairway metals, have also contributed to increased swing speeds. This, in association with alteration in swing techniques, can make the elite golfer more prone to injuries. In simple terms, the sheer number of swings that an elite golfer takes every week is a multiple of that of an amateur golfer. It would not be uncommon for a professional golfer to hit two or three hundred golf balls on a daily basis. This is a combination of practice, warm up and almost daily playing schedule.
16. Upper limb injuries in a golfer
The upper limb is the most commonly injured anatomical site in elite golfers. An injury site can be devastating for the competitive amateur golfer, or the professional golfer, as it can result in time away from the game, as damage to shoulder, elbow or wrist makes coordinated swinging of a golf club difficult and occasionally impossible The majority of golf injuries are overuse injuries of the wrist flexor or extensor tendons. However, the reminder of the shoulder joint accounts for between 4% and 19% of all golf injuries with similar rates among the professional and amateur players. Elbow injuries account for 7% to 27% of all golf injuries. Amateur golfers frequently injure this structure with reports as high as 33% in comparison to professionals whose injury rate for the elbow is 7% injuries [25, 26, 27, 28].
17. Shoulder injuries
The shoulder itself is made up of three bones, namely the humerus, the scapula and the clavicle. The rotator cuff is made up of four different muscles: the supraspinatus, infraspinatus, subscapularis and biceps muscles. Each muscle is intimately involved in the golf swing and is liable to injury. Outside of the rotator cuff, the strong deltoid muscle stabilises the shoulder and is an essential component in creating normal shoulder abduction during the golf swing. The pectoral muscles are also particularly involved in the golf swing in both the takeaway and downswing motion. The latissimus dorsi muscle is also a critical muscle for the initiation of the downswing. Each structure can be injured directly or in combination during the golf swing and this joint accounts for 10% of professional injuries and 12% of amateur golf-related injuries.
Elbow injuries are particularly common among amateur golfers where they account for a third of all injuries but less than 10% in the professional ranks. The elbow joint is a hinge joint formed between the humerus, the radius and the ulna. It can only be flexed and extended. During the golf swing it also pronates and supinates. Extensor and flexor tendons are inserted to the elbow. The extensor apparatus is located on the outside or lateral aspect of the elbow and the extensor tendon can frequently be injured. This injury is known as a tennis elbow but is in fact more common in the golfing population than its counterpart, the golfer’s elbow. The flexor tendon is inserted into the inside or medial aspect of the elbow and inflammation of this area is referred to as a medial epicondylitis or Golfer’s elbow. Unusually, a tennis elbow is more common than a golfer’s elbow in the golfing population.
Other tendons can also be injured around the elbow and the triceps tendon can be injured directly due to trauma from poor impact with the ground or from overuse. In cases of chronic medial epicondylitis, the ulnar nerve can be compromised resulting in pins and needles into the 4th and 5th digit of the hand. In cases of poor playing technique, the supinator muscle can become inflamed. This lies just below the elbow joint. The radial nerve runs through this structure and if the muscle becomes hypertrophied or injured it can result in local entrapment of the radial nerve. This often results in sensory alteration in the 1st webspace of the hand and weakness in wrist extension. When the radial nerve and its branch (the posterior interosseous nerve) become involved the condition can mimic tennis elbow. In these instances, surgical release of the nerve is often required. This condition is often referred to as “resistant tennis elbow” as the symptoms mimic the classical tennis elbow which is inflammation of the extensor tendon.
18. Functional anatomy of the wrist joint
The bony wrist joint (Figure 8) is made up of the articulation of the distal radius and ulna bones with the carpal bones. The carpal bones are arranged in two rows, the 1st or proximal row and the second or distal row.
Figure 8.
Bony anatomy of the wrist, showing the 2 carpal rows.
The proximal row comprises of the scaphoid, lunate triquetrum and trapezoid bones.
The second carpal row consists of the pisiform, trapezium capitate and hamate bones.
The first row of bones is a more mobile articulation in comparison to the second row which acts as one. The scaphoid communicates through both rows.
There are 3 axes of motion at the wrist joint; Flexion/Extension; Ulnar/Radial deviation; Pronation/Supination (see Figure 2). According to the “link” concept of wrist biomechanics a chain of communication exists between the radius, lunate and capitate bones, with the head of the capitate bone acting as the centre of rotation. The proximal row in the form of the lunate can act as an intercalated unit as it has no direct tendon attachment. The distal row of carpal bones act as a complete unit. The scaphoid bridges both rows. When the wrist is in ulnar deviation the scaphoid is pushed into extension, and radial deviation pushes it into flexion.
The bones are held together in a lattice of extrinsic and intrinsic wrist ligaments.
The extensor tendons at the level of the wrist are divided into six extensor compartments (Figure 9) that are designated by Roman numerals from lateral to medial:
The 6th compartment is the most compromised during the golf swing. The first extensor compartment is most affected in skiing, fishing and racket sports with a common occurrence of De Quervain’s Tenosynovitis.
The flexor tendons of the wrist are divided into two main structures: 1) the flexor digitorum profundus (FDP) and the flexor digitorum superficialis (FDS) tendons.
FDP tendons help bend the index, middle, ring, and small fingers at the fingertip joint. FDS tendons help flexes the index, middle, ring, and small fingers at the middle finger joint. 9 of these flexor tendons travel into the wrist through the carpal tunnel. Each of the flexor tendons perform an important function in gripping the golf club in a consistent fashion to allow a natural swing of the club.
19. Wrist injuries in golf
Wrist injuries are common [25, 26, 27] and particularly prevalent in elite golfers [28, 64].
Golfers who sustain injuries to their wrist regularly fail to rest after practice sessions and do not allow adequate time for soft tissue recovery and adaptation after a heavy practice session. It is not uncommon for an elite golfer to hit balls every day. Enthusiastic amateurs can be seen hitting “buckets” of balls in an effort to groove a repetitive swing. A standard bucket of balls in a driving range contains 50 to 60 balls when a round of golf rarely exceeds 40 full shots. This simple training error often under pins wrist injuries.
These wrist injuries are often extended and exacerbated by “playing through the pain” which must always be discouraged. This behaviour is most prevalent in men who outweigh injuries in female golfers by 2 to 1 [12, 27]. This area is also more frequently affected in the professional ranks as the golf swing is a means of income, much in the same way as other manual occupations such as painters and decorators [29] suffer from overuse injuries to the upper limb (11). In a 30-person cohort 43% of hairdressers reported overuse injury symptoms to hands and wrists form their work activity [30].
In golf it is almost impossible to consistently hit a golf ball with an injury to the wrist or hand which is the second most common site for golf injuries and a result of impacting the ball incorrectly due to poor swing mechanics [8, 9, 10].
Patterns of injury differ based on level of play and time spent playing or practicing golf. Among golf professionals, the hand/wrist is the most commonly injured upper extremity structure. The elbow is more commonly injured than the wrist in amateur golfers [31].
20. Common leading wrist pathologies in a golfing population
The medial aspect of the leading wrist in a golfer is particularly prone to injury due to the forces and stress applied to this location during the modern golf swing. The most common structure to be injured is the Extensor Carpi Ulnaris tendon and its tendon sheath and sub-sheath.
20.1 Extensor carpi ulnaris tendon Injuries in golfers
The extensor carpi ulnaris tendon (Figure 10) originates from the lateral epicondyle of the humerus and the dorsal surface of the ulna, passes through the groove dorsally at the ulnar head within a fibro-osseous tunnel of extensor retinaculum in the 6th compartment (Figure 11). It has its own tendon sub-sheath for its stabilisation there and inserts on the base of the 5th metacarpal medially angled to its position in the groove of ulnar head. It acts to adduct (or ulnar deviate) and extend the wrist joint.
Figure 10.
ECU muscle and tendon origin and insertion.
Figure 11.
The double pendulum effect of the golf swing. The first pendulum is the arm acting around the pivot of the shoulder joint and torso. The second pendulum is the golf club acting around the wrist joint.
The Extensor Carpi Ulnaris tendon (ECU) is particularly vulnerable to injury in the golfing population because of the complex nature of the golf swing. During the golf swing the leading wrist goes through a complex motion involving ulnar and radial deviation i.e. extension and flexion and pronation and supination. These manoeuvres send forces through the wrist joint culminating with the impact of club on ball (Figure 1). The anatomical location of the ECU tendon in the 6th extensor compartment (Figure 12) held in a tendon sheath makes it liable to injury due to the excessive tensile loading and subsequent breakdown of the loaded tendon [32, 33]. ECU Tendinopathies, and tendon injuries account for significant time away from sport and lost time in practice and competition [9, 10, 11, 34, 35].
Figure 12.
ECU tendon, tendon sheath and sub sheath in the 6th extensor compartment of the wrist.
20.1.1 Types of ECU tendon injury
ECU tendon injuries come in many varieties and severities but can be simply divided in to 3 major categories of injury.
There are 3 types of injury that occur to the ECU tendon in the golfing population. Each is associated with overuse caused by excessive play and practice accompanied by poor swing technique [36].
ECU tenosynovitis or tendinitis
ECU Tendinosis
ECU Subluxation, (of which there are 3 varieties)
Injury to the ECU tendon in the leading wrist of a golfer is common due to the forceful return of the ball as the leading wrist travels from a radial deviated position at the top of the backswing to an ulnar deviated position at impact with the second carpal row transitioning into a supinate position. Injury and subluxation of the ECU tendon are exacerbated by ulnar deviation and supination [37], which is the classical position of the leading wrist at impact during a golf swing. Hence the frequency of this injury in golfers.
20.1.1.1 ECU tendinopathy
Tendinopathy or tendinosis refers to the breakdown of collagen in a tendon. Tendinopathy is often the long consequence of long-term inflammation caused by tendinitis. This causes burning pain in addition to reduced flexibility and range of motion. The collagen loss being a function of tenocyte malfunction secondary to chronic and reoccurring inflammation and injury. ECU tendinopathy occurs over time due to repetitive insults. The Tendinopathy is a pathological adaptive response resulting in degeneration due to the tendon’s collagen loss in response to chronic overuse. Loss of function as well as pain on activity are cardinal complaints.
20.1.1.2 ECU tendinitis
Tendinitis is the inflammation of the tendon and results from micro-tears that happen when the musculotendinous unit is acutely overloaded with a tensile force that is too heavy and/or too sudden. ECU tenosynovitis can occur when the extensor retinaculum tears. It can result in mechanical friction between the ECU tendon and the ulnar groove [36, 37]. It usually starts as tendon irritation manifesting as pain and can progress to friction between the tendon and the ulnar grove. In the golf swing the ECU is irritated by the motion to and from ulnar and radial deviation with the wrist in a supinated position. Symptoms include wrist pain and loss of grip strength.
20.1.1.3 ECU tendon subluxation
If the tendon sheath and sub sheath rupture or stretch, the ECU tendon can then migrate to the medial or ulnar side of the wrist. This is caused by a rupture on the ulnar or radial side of the tendon sub-sheath, or if the sub-sheath is stretched due to stripping of the periosteum (Figure 13). Each type results in subluxation and relocation producing a snapping sensation at the wrist during the golf swing. There are 3 types of ECU tendon sub-sheath injury.
Figure 13.
Axial MR and graphic image of split ECU tendon tear with partial rupture of sub-sheath with medial subluxation of the tendon.
Type 1 (Figure 14) rupture occurs on the lateral side of the sub sheath. The tendon subluxes through the radial side of the sheath and returns to rest on the ulnar grove on top of the remaining sheath.
Figure 14.
The 3 types of ECU sub sheath injury resulting in tendon subluxation.
Type 2 (Figure 14) rupture occurs on the medial side resulting in a tendon subluxing in an ulnar direction before returning to the ulnar groove without resting on top of the sheath.
Type3 (Figure 14) subluxation occurs if the ECU sheath does not rupture but the force causes ulnar periosteum stripping: The ECU sheath pulls the periosteum off the ulna on the ulnar side and forms a false pouch into which the tendon dislocates before relocating back onto the ulnar groove (Figure 15).
Figure 15.
Coronal MR image showing ECU tear and tenosynovitis.
21. Differential diagnosis of ECU tendon injury in a golfing population
Injury to the ECU tendon is a challenging diagnosis and great care is needed in confirming the pathology. This is in part due to the symptomatology and presentation of injury with players reporting pain on the ulnar aspect of the wrist and hand accompanied by a loss of dexterity and occasionally sensory alteration affecting the fingers. Other conditions to consider in the differential diagnosis include:
Triangular Fibro-cartilage injury
Hook of Hamate injury
Guyon’s Canal Syndrome
Carpal Tunnel Syndrome
21.1 Diagnosis
The diagnosis of ECU tendon pathology in a golfer requires a high index of suspicion as many patients battle on through the pain thereby worsening the pathology. Excluding the other common injuries can be achieved by a combination of careful history, clinical examination and the use of special tests such as Electrodiagnostic Medicine and radiology.
Dynamic ultrasound is very useful in diagnosing and differentiating the type of tendon pathology. It is the ideal tool to confirm a subduing tendon as it observes the subluxation during ulnar and radial deviation and in flexion and extension motion [38]. The direction of subluxation and the type of sub-sheath injury being confirmed by dynamic imaging. In cases of significant subluxation in professional golfers, surgery is often warranted to repair ECU and its supporting structures.
21.2 Treatment
Treatment for these varieties of ECU tendon injury should initially follow the normal treatment for tendinitis such as rest NSAID medication and splinting. Deep Oscillation Therapy has also been shown to be a promising treatment in swelling and symptom reduction] [39]. Ultrasound guided injections may also be required in resistant cases. In cases of tendinosis a similar approach is made with the addition of Platelet-Rich Plasma (PRP) injections in resistant cases. This is a minimally invasive surgical alternative that uses components from a patient’s own blood to regrow tissue and relieve pain and promotes tendon regeneration by reducing inflammation and promoting the expression of anabolic genes and proteins [40].
Rest and splinting are the cornerstone for treating a subluxing ECU tendon, with regular revaluations with Ultrasound. If the subluxing ECU tendon fails to respond to conservative therapy, surgical reconstruction of the roof of the 6th dorsal extensor compartment using a portion of the flexor carpi ulnaris is performed [41]. Type I subluxation frequently requires surgery.
Return to play will require appropriate alteration in golf grip and swing biomechanics. Therefore, the return to play protocol for this injury in the golfing population should always include an assessment from a registered golf professional. In some instances, customised splinting of the wrist will prevent reoccurrence and allow a golfer return to a bespoke practice regimen. The message of qualitative rather than quantitative practice should be reinforced to avoid a training error reoccurrence, with 30–40 balls a good rule of thumb per practice session.
21.3 Conclusion
Wrist injuries in golf are common and significantly interfere with a player’s ability to play and enjoy this common sporting pursuit. The ECU tendon is a frequent cause of wrist pain in the golfer. The sports medicine physician should have a high index of suspicion when dealing with this patient population. A combination of detailed history of injury and golf activity coupled with ultrasound, radiology and electrophysiological evaluation will result in a high diagnostic yield. Treatment should encompass alteration and improvement in golf swing and grip biomechanics as well as any practice or training errors.
22. Other common leading wrist pathologies in a golfing population
22.1 The triangular fibrocartilage injury of the wrist
The triangular fibrocartilage complex (TFCC) (Figure 16) is a load-bearing structure between the lunate, triquetrum, and ulnar head. It is a hammock-like structure made up of cartilage and ligaments. It stabilises the bones in the wrist, acts as a shock absorber and enables smooth movements. Forced ulnar deviation and positive ulnar variation are associated with injuries to the TFCC. A “weak” golf grip and swing biomechanics abnormalities makes injury to this structure more common.
Figure 16.
Triangular fibrocartilage (TFCC).
The TFCC complex is prone to degeneration and wear-and-tear injuries. Injury occurs when compressive loads are placed on the TFCC during marked ulnar deviation. This occurs in the golf swing when the radial deviation of the wrist at the top of the back swing converts into ulnar deviation under significant force at impact. The triangular fibrocartilage disc attachment on the radial side is to hyaline cartilage. This makes the area vulnerable to injury as it is weaker when compared to the ulnar side whose attachment is bony.
Injury to the TFCC can lead to pain, weakness and instability. Patients with TFCC injury will present with ulnar-sided wrist pain that may present with clicking or point tenderness between the pisiform and the ulnar head.
The TFCC can be strained or torn from over-swinging or from “hitting down on the ball”. Hitting out of heavy rough or on hard practice matts are also extrinsic culprits in the development of this injury in the golfing population.
Diagnosis is confirmed by assessment of the sixth extensor compartment. At this location, the TFCC is examined in combination with the ECU tendon. The ECU relies on the TFCC for movement and hence both structures can be injured in combination.
Radiology may reveal avulsion of ulnar styloid, and ulnar variance in cases of the TFCC injury. High-resolution dynamic ultrasound (US) has emerged as a useful and valid tool for the diagnosis of this disorders [36, 37, 38].
22.2 Hook of the hamate
The hamate bone (Figure 17) is one of the largest carpal bones and is located on the ulnar side of the palm of the hand and forms part of the distal carpal row. It has a protrusion called the “hook of hamate” which with the pisiform bones form the bony boundaries of Guyon’s Canal through which the ulnar nerve enters the wrist joint. Hook fractures can occur from a direct injury to the bone or from an indirect blow that occurs most commonly in sports [42].
Figure 17.
Hook of the hamate bone.
In golf, most hook of hamate fractures occur because of the position of the golf club resting on the hook when hitting “down” on the ball, when it is buried in rough or embedded in a divot. These injuries are also common when hitting buckets of balls from a mat at the driving range. Many of the older ranges are built on concrete and injuries occur when the club head stops abruptly on the matt covering the concrete. The force of the impact is conducted through the club shaft and grip into the base of the hand and hamate bone, resulting in injury. That force is transmitted directly to the wrist and can cause a fracture of the hook of the hamate. These injuries occur more commonly in the following wrist [right hand in a right-handed golfer]. While fractures are rare and underreported, they are also frequently misdiagnosed as the initial trauma may seem trivial and present with a working diagnosis of a wrist sprain. Palpation of the hamate with or without ulnar nerve symptoms are cardinal findings. Plain radiology will confirm the diagnosis and conservative treatment such as rest and splinting usually resolves the problem.
22.3 Carpal tunnel syndrome [CTS]
Carpal Tunnel Syndrome (Figure 18) is the entrapment of the median nerve and repetitive use of the hands and wrists seen in golf contribute to the development of CTS. Repetitive activity such as golf swinging and practicing can result in flexor tenosynovitis as one or more of the 9 flexor tendons that travel through the Carpal Tunnel in the company of the median nerve become inflamed. Inflammation in the affected tendons in the wrist result in swelling of the sheath. This fluid will compromise the function of the nerve resulting in the symptoms of distal median neuropathy.
Figure 18.
Carpal tunnel syndrome.
Golfers can be difficult to convince that the tingling fingers, numb hands or aching thumb or wrist pain is a result of Carpal Tunnel Syndrome. CTS is considered a disorder that only affects those who do intense repetitive activities all day long at work [43, 44], such as block laying, hairdressing [26] or computer keyboard work. However, in modern society golf driving ranges and facilities are readily available and frequently recreational golfers work harder on their golf than many other vocational pursuits.
Sports, pastimes and hobbies can play a major role in contributing to this repetitive strain induced hand and wrist condition. The repetitive activity causes inflammation to some of the 9 flexor tendons that travel through the Carpal Tunnel. This inflammation results in swelling which ultimately affects the function of the median nerve. CTS diagnosis is made by a combination of electrodiagnostic nerve conduction studies and ultrasound examinations. Treatment of this common condition which affects between 5% and 21% of the population [43, 44, 45, 46, 47, 48, 49] involves a combination of treatments including splinting the wrist, injection therapy and surgery. In the golfer, correction of golf biomechanics and golf club customization are helpful in preventing reoccurrence.
22.4 Guyon’s canal syndrome
Guyon’s canal syndrome (Figure 19) is a condition where there is compression and irritation of the ulnar nerve at the wrist. The ulnar nerve is responsible for strength and sensation on the little finger’s side of the fourth finger and the entire fifth finger. Golfers with this condition may present with pain at the base of the wrist, loss of finger function and grip pressure as well as sensory alteration in the 4th and 5th fingers.
Figure 19.
Guyon’s canal syndrome.
The hand may become clumsy when the muscles controlled by the ulnar nerve become weak. Weakness can affect the small muscles in the palm of the hand and the muscle that pulls the thumb into the palm.
Golfers are prone to irritation at Guyon’s canal from local trauma to the nerve associated with an improper golf grip and trauma from the butt of the golf club impacting at the base of the wrist [50].
Hard playing surfaces and hitting down on the ball are risk factors.
Diagnosis is made by Electrodiagnostic testing of the distal ulnar nerve. Ultrasound is also used to out rule other space occupying lesions such as a ganglion cyst or schwannoma.
This syndrome is much less common than carpal tunnel syndrome (CTS), yet both conditions can occur at the same time. The numbness by Guyon’s syndrome usually spares the thumb, index and long fingers.
23. Less common wrist related pathologies in a golfing population
23.1 Dupuytren’s contracture
Dupuytren contracture (Figure 20b) is a benign, myeloproliferative progressive disease of the palmar fascia which results in shortening, thickening, and fibrosis of the fascia and aponeurosis of the palm. It results in nodular formation on the palmar fascia which creates fibrosis resulting in one or more fingers become permanently bent in a flexed position. Dupuytrens contracture is caused by progressive thickening and shorting of the palmar fascia. This occurs due to slowly progressing fibrosis in the fascia that results in a flexion deformity at slowly the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints usually affecting the 4th and 5th digits. The disease begins in the palm as painless nodules that form along longitudinal lines of tension. The nodules form cords that produce contracture deformities within fascial bands and tissues of the hand.
Figure 20.
Dupuytren’s contracture caused by shortening, thickening, and fibrosis of the fascia and aponeurosis of the palm, results in nodular formation and a flexion deformity at the 4th and 5th digits, making a consistent grip of a golf club difficult.
The disorder has varying pattern of genetic predisposition across different regions and populations and is also known as the Viking disease, and Celtic hand, with 30% of the over 60-year-old male Norwegian population and 20% of a similar British population suffering from this condition [51].
It is expressed in an autosomal dominant fashion. This condition is most commonly seen in populations of Northern European/Scandinavian descent [52]. It is relatively uncommon in Southern European and South American populations. Males are affected by a 2:1 ratio compared to women.
The condition is associated with diabetes, seizure disorders, smoking, alcoholism, HIV, and vascular disease Ectopic manifestations beyond the hand can be seen in Ledderhose disease of the plantar fascia Peyronie disease (Dartos fascia of the penis), and Garrod disease (dorsal knuckle pads) [51, 52, 53].
Numerous authors going back as far as the 17th century have noted the association between traumatic events and the appearance of Dupuytren’s contracture. Initially by Plater in 1614, Goyrand in1835 and, Guillaume. Dupuytren, a French Surgeon in 1833 who the condition is named after [53, 54, 55, 56].
Golf has never specifically been cited as a caused of the condition but is a common disability encountered in the older golfer population. The disability causes technical issues gripping and swinging a golf club due to its anatomical location at the base of the wrist and the role of the 4th and 5th digit in gripping a club. Fatigue and hand pain has been reported in elite golfers with this condition and an inability to grip the club consistently.
In a 2017 survey of 504 Dupuytren’s sufferers, the Dupuytren’s society reported a significant proportion described difficulty golfing due to the pathology. In this observational study 8% of sufferers without a contracture reported a difficulty, 11% of single hand contracture and 23% of bilateral contracture suffers reported disfunction while golfing [57].
Up to one-fifth of patients seeking treatment for primary Dupuytren’s contracture were reported to suffer from an injury-induced Dupuytren’s contracture. It was noted that the injury to the wrist and hand seems to trigger the development of less progressive form Dupuytren’s contracture in younger age group [58].
In diagnosing Dupuytren Contracture the clinician needs to distinguish the condition from other diseases of the hand including stenosing flexor tenosynovitis, ganglion cysts, ECU tendon subluxation, Guyon’s Canal Syndrome and soft tissue masses. Diabetes, seizure disorders, smoking, alcoholism, HIV, and vascular disease should be considered during a careful history due their association with this condition.
Clinically the condition usually progresses at a slow rate over the course of several years and individuals may not be aware of the condition until it starts to cause functional disability. Pits and grooves in the palm of the hand are an early sign followed by the development of nodules in the medial palm. These nodules are often painless. Pain may be present distally at the knuckles pads of the proximal interphalangeal (PIP) as contracture evolve. The disorder is not always progressive and in at least 50–70% of patients, it may stabilise or even regress.
Investigations include radiology, which is usually normal and serology to out-rule metabolic or infective pathologies which are associated such as Diabetes Mellitus, Alcoholism and HIV infection, if there is a clinical suspicion.
Ultrasound [38] is the diagnostic tool with the highest yield as it confirms the presence of thickening of the palmar fascia and nodule formation.
Treatment includes physical therapy during the early stage of the disease. Some patients may also benefit from a brace to stretch the digits and maintaining range of motion of the fingers is necessary to prevent adhesions. This is particularly important in the golfing population. Corticosteroid injections may be beneficial and should be performed using Ultrasound guidance. Needle aponeurotomy is typically reserved for mild contractures. Collagenase injection which is a relatively new, minimally invasive treatment derived from Clostridium histolyticum has shown good initial results. The treatment is not available in all jurisdictions and should only be performed by a hand surgeon who can deal with any potential side effects of this treatment. Surgical fasciectomy is reserved for those cases who have failed conservative therapy and have a persisting disability.
A significant proportion of older golfers suffer from this disability that causes pain, discomfort and impairs the player’s ability to consistently grip a golf club, and regularly interferes with the enjoyment of the game. Golf due to trauma may provoke the injury and once present exacerbates the condition. Early identification, finger stretching, as well as the use of topical anti-inflammatory medication assist in reducing symptoms in golfers with mild or non- progressive disease.
Golfers frequently continue to play with this condition. In these instances, the Dupuytren’s sufferer should undergo a careful assessment of equipment. Golf shaft weight and grips should be reviewed by a PGA golf professional. In particular, correct or augmented golf grips can facilitate safe and enjoyable golf for the Celtic Hand golfer. Thickening grips can help mitigate overactive hands through the hitting zone thus reducing stress on the palmar aponeurosis. Golf grips come in 4 basic diameters and can be refined by a golf professional by the addition of wraps under the grip, further customising the all-important handle of the golf club. Larger grips also improve shock absorption and reduce transition of force to an already compromised palmar fascia. Small grips result in an increase in grip pressure and a propensity to grip the club in the palm. Holding the club too high across the palm increases the risk of hand injury or the exacerbation of an existing condition. The golfer should ensure his grip is biomechanically correct and the club is held in the fingers rather than the palm of the hand. This can be achieved by regripping the club in the last three fingers of the leading hand at address, prior to swinging. This helps to stabilises the club at impact and limits the stress on the palm of the hand. These small manageable changes will contribute to lessening the affect that this condition has on recreational and elite golfers.
24. Unusual causes of leading medial wrist injuries in golfers
Rare causes of leading wrist injury in golfers include damage to the Flexor Carpi Ulnaris tendon and proximal entrapment of the ulnar and median nerves, these are rare in golf but are commonly encountered in the general sporting population and among gym users (Figure 21).
Figure 21.
Proximal entrapment of the median nerve by the pronator Teres muscle.
The Flexor Carpi Ulnaris (FCU) muscle has its origin at the medial epicondyle and it is inserted on the medial side of the wrist into the pisiform, hamate and the base of the 5th metacarpal bone. 5th carpal by a tendinous attachment. The FCU acts as a flexor and ulnar deviator of the wrist. Injury therefore can occur at impact with the ball during the golf swing as the wrist converts into a flexed and ulnar deviated position at impact. In cases of acute trauma, the injury is usually located distally at the level of the pisiform bone insertion. In cases of overuse injuries, the injury is usually proximal to the wrist at the level of the musculotendinous junction. Diagnosis is confirmed by careful palpation of the full length of the tendon. Pain is exacerbated by resisted wrist flexion and ulnar deviation. Ultrasound of the full length of the nerve confirms the diagnosis. The FCU tendon can be also compromised in injuries to the hook pf the hamate bone.
The ulnar nerve can be compromised at the elbow in cases of medial epicondylitis or “golfers elbow”. The ulnar nerve travels through the cubital tunnel prior to entering the ulnar groove as it travels caudally. The cubital tunnel is formed by bone, ligament and muscle.
The tunnel’s ceiling is formed by the cubital retinaculum, a ligament spanning from the medial epicondyle to the olecranon process that is continuous with the fascia connecting the humeral and ulnar heads of the flexor carpi ulnaris (FCU). Injury to these structures or to the flexor tendon insertion at the medial epicondyle can compromise the ulnar nerve resulting in a local irritation or compression of the ulnar nerve, known as Cubital Tunnel Syndrome. Golfers elbow is associated with golf and racket sports. Repetitive activity and holding the elbow in flexion at impact can be aetiological elements in the development of the tendon injury which may be a prequel to the local ulnar nerve irritation. The increased in elbow flexion causes the arcuate ligament to tighten, the FCU to tighten and the ulnar collateral ligament to buckle and encroach into the tunnel compromising the ulnar nerve [59, 60].
This can cause numbness and tingling in the hand and/or ring and little finger, especially when the elbow is bent. Occasionally a player will describe hand pain in the hypothermal eminence when swinging a golf club and weakness when gripping a club and a lack of consistency in golf grip due to muscle weakness in the intrinsic muscles of the hand which receive their innervation from the ulnar nerve.
Diagnosis is made by identifying the clinical signs of an ulnar neuropathy. Electrodiagnostic evaluation with Nerve Conduction Studies and needle EMG. Conservative treatment includes rest and Ultrasound guided injection therapy at the cubital tunnel. In chronic cases surgical release may be required.
Distal median neuropathies can also occur in the golfing population. It is well recognised in racket players [61]. This is referred to as pronator syndrome. The nerve can be compromised at 4 sites in the flexor aspect of the forearm.
The Ligament of Struthers is present in up to 2.7% of the population [62, 63]. Entrapment of the nerve at this site is exacerbated by elbow flexion and extension [63] which is a common manoeuvre in the leading arm of a golfer.
The median nerve travels through the 2 heads of the Pronator muscle just below the elbow joint, and can be compromised at this site. The nerve can also be entrapped by thickening of the bicipital aponeurosis, and finally by the flexor digitorum superficialis. These flexor and pronator muscles are frequently hypertrophied from overuse activities such as repeated golf swinging and practice, particularly in golfers with strong grips (pronated flexed wrists). With this grip the pronator testes muscle has to fire quickly at impact in an effort to square up the club face. The median nerve becoming entrapped at this proximal site. Symptoms are often vague and can suggest a mixed pattern of median and ulnar nerve symptoms. Diagnosis involves electrodiagnostic assessment. Treatment requires rest and alteration in technique and practice protocols. In resistant cases surgery is indicated.
25. Conclusion
Golf is a centuries old game whose popularity as a sport and entertainment grows exponentially internationally year on year. Increased golf facilities and accessibility have resulted in a world-wide explosion of golf participation. With this, golf related injuries have increased dramatically [64] as experienced and novice golfers alike attempt to imitate the extraordinary feats of distance power and accuracy exhibited by elite golfers who are beamed to out TVs week on week. These players now include 9 million participating at ranges and using indoor simulators [65] who hit “buckets “of balls in a finite period of time without the natural break between shots which occurs in a conventional game of golf. Golf teaching has mirrored these changes as golf is no longer considered a game but a sport, where improvement in performance is an essential component rather than the simple pleasures of walking in the countryside while hitting a ball towards a target in the fresh air. These natural changes in society to become better at this activity have spawned a multitude of teaching facilities in the real world and the cyber world where golfers strive for greater distance and accuracy through strength and conditioning and biomechanics. Humans are not machines and stress placed on human tissue frequently results in trauma and injury. In the case of the golf swing, sports science and biomechanical advances have improved the performance of golf with the side effect of increased injury, the leading wrist being particularly vulnerable to injury and pathology. The ECU tendon is the most commonly injured leading wrist structure particularly among elite golfers [36, 64]. The sports medicine physician should be aware of this potential and address swing mechanics and the risk reward nature of un-natural motions to the leading wrist in a golfing population to avoid chronic injury, time away from the game [66] and long-term disability.
\n',keywords:"golf injury, leading wrist/swing biomechanics, Tenosynovitis, Carpal Tunnel Syndrome, ECU Tendon, Tendinitis, Tendinosis, hook of Hamate, Guyon’s Canal Syndrome, Dupuytren’s contracture, Flexor Carpi Ulnaris tendon, Nerve Entrapment",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/75940.pdf",chapterXML:"https://mts.intechopen.com/source/xml/75940.xml",downloadPdfUrl:"/chapter/pdf-download/75940",previewPdfUrl:"/chapter/pdf-preview/75940",totalDownloads:405,totalViews:0,totalCrossrefCites:0,totalDimensionsCites:0,totalAltmetricsMentions:1,impactScore:0,impactScorePercentile:34,impactScoreQuartile:2,hasAltmetrics:1,dateSubmitted:"February 23rd 2021",dateReviewed:"March 2nd 2021",datePrePublished:"March 25th 2021",datePublished:"November 24th 2021",dateFinished:"March 25th 2021",readingETA:"0",abstract:"Golf participation has increased significantly over the past 50 years. Injury rates have mirrored this increase with amateur and elite golfers suffering a similar injury incidence to rugby players. The upper limb is the second most common anatomical site of injury in this population. Wrist injury and specifically the ulnar side of the leading wrist is the most prevalent. Leading wrist injuries affect the tendons, fibrocartilage, bones and neural structures that are located on the ulnar side of the wrist and hand as well as the soft tissue aponeurosis and bony and ligamentous canals that traverse the wrist joint. The most commonly injured lateral wrist structure is the Extensor Carpi Ulnaris tendon. This is particularly liable to injury due to the forces placed on it during the golf swing. Other structures on the medial side of the leading wrist associated with golf related injury and pathology include Triangular Fibro-cartilage, the hamate bone, the bony canals through which the nerves travel, as well as the flexor aponeurosis and Flexor Carpi Ulnaris tendon. Risk injury to the medial aspect of the leading wrist is increased by the newer golfing theories and techniques which endeavour to create increase golf club head speeds by storing greater energy by a phenomenon called “lag”. Lag results in greater speed as the club head releases at impact but results in injury to the medial wrist anatomical structures. Swing biomechanics, and their alteration and augmentation are a major factor in medial wrist injury. Diagnosis of these pathologies requires careful history and examination, as well as the use of radiology and electrodiagnostic medicine to confirm the pathology and degree. Treatment is targeted to the specific disability. Classical treatments are mostly employed and usually involve rest and anti-inflammatory treatments. Newer therapies such as Platelet Rich Plasma injection and Deep Oscillation therapy have proven beneficial. Splinting is often employed on return to play. Early diagnosis and cessation of the offending activity often allays the need for surgery. The rhyme that “minutes to diagnosis means weeks to recovery” is particularly apt for medial wrist golf injuries. Surgery will be required in long standing or chronic cases. Return to play, unlike many sports injuries, will require careful golf biomechanical assessment and alteration in swing dynamics. The objective of this chapter is to identify how the new biomechanical manipulation of the wrist and specifically the leading wrist has resulted in increased injuries to this anatomical structure. The type of injury, diagnosis and treatment is discussed in detail. Club head speed is generated through a combination of improved golf club equipment, golf payer fitness and manipulation of the golf club by the left wrist resulting in increased golf club lag and torque which all contribute to wrist injuries.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/75940",risUrl:"/chapter/ris/75940",book:{id:"10615",slug:"contemporary-advances-in-sports-science"},signatures:"Conor P. O’Brien",authors:[{id:"345562",title:"Dr.",name:"Conor",middleName:null,surname:"P. O'Brien",fullName:"Conor P. O'Brien",slug:"conor-p.-o'brien",email:"drcob50@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Golf injury incidence",level:"1"},{id:"sec_3",title:"3. Types of golf injury",level:"1"},{id:"sec_4",title:"4. Overuse injuries",level:"1"},{id:"sec_4_2",title:"4.1 Physics of a Golf swings",level:"2"},{id:"sec_4_3",title:"4.1.1 Newton’s 3rd law of motion",level:"3"},{id:"sec_5_3",title:"4.1.2 Energy transfer",level:"3"},{id:"sec_6_3",title:"4.1.3 Circular motion of a golf swing",level:"3"},{id:"sec_6_4",title:"4.1.3.1 The double pendulum effect",level:"4"},{id:"sec_7_4",title:"4.1.3.2 Centripetal force",level:"4"},{id:"sec_8_4",title:"4.1.3.3 Torque",level:"4"},{id:"sec_12",title:"5. Biomechanics of the modern golf swing",level:"1"},{id:"sec_13",title:"6. Biomechanics of the leading wrist",level:"1"},{id:"sec_14",title:"7. Leading wrist ulnar/radial deviation in the golf swing",level:"1"},{id:"sec_15",title:"8. Leading wrist flexion/extension in the golf swing",level:"1"},{id:"sec_16",title:"9. Figure leading wrist flexion on down swing and impact",level:"1"},{id:"sec_17",title:"10. Leading wrist pronation/supination in the golf swing",level:"1"},{id:"sec_18",title:"11. Elite golfers at the top of the back swing",level:"1"},{id:"sec_18_2",title:"11.1 Flex and maintain",level:"2"},{id:"sec_19_2",title:"11.2 Flex, flex and rotate",level:"2"},{id:"sec_20_2",title:"11.3 Extend and flex",level:"2"},{id:"sec_21_2",title:"11.4 Flexion/extension",level:"2"},{id:"sec_22_2",title:"11.5 Ulnar/radial deviation",level:"2"},{id:"sec_24",title:"12. The effect of wrist manipulation on the medial aspect of the leading wrist",level:"1"},{id:"sec_25",title:"13. Anatomical site of injuries in elite and professional golfers",level:"1"},{id:"sec_26",title:"14. Anatomical site of injuries for amateur golfers",level:"1"},{id:"sec_27",title:"15. Cause and pattern of injury in elite and amateur golfer",level:"1"},{id:"sec_28",title:"16. Upper limb injuries in a golfer",level:"1"},{id:"sec_29",title:"17. Shoulder injuries",level:"1"},{id:"sec_30",title:"18. Functional anatomy of the wrist joint",level:"1"},{id:"sec_31",title:"19. Wrist injuries in golf",level:"1"},{id:"sec_32",title:"20. Common leading wrist pathologies in a golfing population",level:"1"},{id:"sec_32_2",title:"20.1 Extensor carpi ulnaris tendon Injuries in golfers",level:"2"},{id:"sec_32_3",title:"20.1.1 Types of ECU tendon injury",level:"3"},{id:"sec_32_4",title:"20.1.1.1 ECU tendinopathy",level:"4"},{id:"sec_33_4",title:"20.1.1.2 ECU tendinitis",level:"4"},{id:"sec_34_4",title:"20.1.1.3 ECU tendon subluxation",level:"4"},{id:"sec_38",title:"21. Differential diagnosis of ECU tendon injury in a golfing population",level:"1"},{id:"sec_38_2",title:"21.1 Diagnosis",level:"2"},{id:"sec_39_2",title:"21.2 Treatment",level:"2"},{id:"sec_40_2",title:"21.3 Conclusion",level:"2"},{id:"sec_42",title:"22. Other common leading wrist pathologies in a golfing population",level:"1"},{id:"sec_42_2",title:"22.1 The triangular fibrocartilage injury of the wrist",level:"2"},{id:"sec_43_2",title:"22.2 Hook of the hamate",level:"2"},{id:"sec_44_2",title:"22.3 Carpal tunnel syndrome [CTS]",level:"2"},{id:"sec_45_2",title:"22.4 Guyon’s canal syndrome",level:"2"},{id:"sec_47",title:"23. Less common wrist related pathologies in a golfing population",level:"1"},{id:"sec_47_2",title:"23.1 Dupuytren’s contracture",level:"2"},{id:"sec_49",title:"24. Unusual causes of leading medial wrist injuries in golfers",level:"1"},{id:"sec_50",title:"25. Conclusion",level:"1"}],chapterReferences:[{id:"B1",body:'Royal & Ancient of St Andrews, Golf around the World ,20019, Edition 3. 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In DeLee JC ,Drez D(eds) Orthopaedic sports medicine Philadelphia:Saunders 1994 844-859'},{id:"B62",body:'Hrdlicka A.Incidence of the supracondylar process in whites and other races.Am J of Anthropology 6: 405-406 ; 1923'},{id:"B63",body:'Bilge T , Yalman O, Bilge S et al Entrapment neuropathies of the median nerve at the level of the ligament of Struthers Neurosurg, 27 (5):787-789 1990'},{id:"B64",body:'O’Brien C. ECU tendon Injury in an Elite Golfer. J Sports Med Orthop Adv. 2021;1(1):1-4.'},{id:"B65",body:'National Golf Foundation https://www.ngf.org 2019 Golf Industry report'},{id:"B66",body:'O’Brien C Golf Injuries Irish Medical News November 1993'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Conor P. O’Brien",address:"drcob50@gmail.com",affiliation:'
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1. External root morphology
The mandibular central and lateral incisors have a single conical root. The root dimensions of both incisors vary corresponding to the crown. They are narrow in mesiodistal dimension and wide in labiolingual dimension and taper uniformly on both proximal sides from the CEJ to the apex. The apical end may curve slightly to the distal. Longitudinal root depressions can be seen in both incisors from the mesial and distal views. Multiple comparisons revealed that, among all permanent teeth, mandibular central incisor has the shortest root. Furthermore, in contrary to maxillary incisors, the root of mandibular lateral incisor is longer than that of mandibular central incisor [1]. It has been reported that the average lengths of mandibular central incisor and lateral incisor roots are 12.6 mm (7.7–17.9) and 13.5 (9.4–18.1), respectively [2]. Kim et al. [3] measured the mandibular incisor root lengths using CBCT in Korean population and found that no significant differences in crown and root lengths were noted between the CBCT-based and direct measurements. The R/C ratios were higher for the mandibular lateral incisors (1.4 ± 0.1) than mandibular central incisors (1.3 ± 0.1) [4]. Therefore, crown lengthening may not be possible in the case of traumatic fracture or iatrogenic orthodontic extrusion due to the short root length in these teeth. Variations in root length between males and females have been reported. According to Zorba et al. [5], it was observed that root length was greater in males than in females. Haghanifar et al. [6] found similar results when comparing crown and root lengths between males and females. He found that females had longer crowns while males had longer roots.
Many authors reported that the external crown and root morphology of mandibular central and lateral incisors are similar [2, 7, 8]. Mandibular incisors usually have a single root, which is wider buccolingually than mesiodistally and tapers toward the apex. The lateral incisor root is larger than that of the central incisor in mesiodistal and labiolingual directions [8, 9]. Variation in number of roots has not been reported in literature. However, Loushine et al. [10] have found two rooted mandibular lateral incisors. However, the shape may vary from conical to round in different populations. Sexual variation in the number and shape of roots has not been reported [9]. Mandibular incisor roots are commonly reported to be straight and in rare occasions curved in the apical region. Curvature can be in the mesial, distal, labial, or lingual direction [9].
2. Internal anatomy
2.1 Introduction
Orban stated that the shape of the root canal “to a large degree, conforms to the shape of the root. A few canals are round and tapering, but many are elliptical, broad and thin” [11].
The internal anatomy of permanent mandibular incisors does not usually reproduce the simplicity of external anatomy. Its internal anatomy is complicated by the presence of lingual canals, lateral canals, isthmus, and apical deltas [12]. The pulp cavity is the central cavity within a tooth and is entirely enclosed by dentin except at apical foramen. It is divided into coronal portion (pulp chamber) and radicular portion. The pulp chamber is wide and ovoid labiolingually and it tapers incisally. The size of the pulp chamber is not constant throughout life. It decreases in size with aging as a result of secondary dentin deposition [13]. The pulp horn is well developed in this tooth. The root canal systems of these single-rooted teeth often have a single root with a single root canal. However, studies have shown that the root canal anatomy of these teeth is not simple. It may not be single and straight as it appears on the periapical radiograph. Indeed, these teeth have a high prevalence of bifurcation, second canals, lateral canals, and apical deltas which would complicate surgical and nonsurgical endodontic treatment. Mandibular incisor’s anatomy presents a challenge when an endodontic access is made, because of its small size and high prevalence of two canals. The main reason for failure in endodontic treatment of mandibular incisors is the inability to detect the presence of a second canal which can then not be prepared and filled during treatment [14]. In literature, the incidence of mandibular incisor teeth with more than one canal has been reported to range from 11 to 68% [15, 16, 17, 18, 19]. The differences between these morphology studies may be related to variations of examination methods, classification systems, sample sizes, and ethnic background of tooth sources. Many researchers have studied the prevalence of a second canal in mandibular permanent incisors on different populations and showed that the root canal morphology varies with race, sex, and age [20, 21, 22, 23, 24].
2.2 Shape and size of pulp cavity in permanent mandibular incisors
Routine clinical radiographs may mislead clinicians to be under an impression that all root canals are round in shape. A high prevalence of oval root canals in human teeth was reported [25, 26].
The pulp canal of the permanent mandibular central incisor is wider buccolingually than mesiodistally [9]. These dimensions are not constant along the root from the orifice till the apex. Oval canals and long oval canals are the most common canal shape seen in the coronal and middle third [27]. As we approach the apex, the canal shape becomes more rounded [28]. This canal shape morphology corresponds to the shape of the root.
2.3 Number of canals in permanent mandibular incisors
The root canal morphology of mandibular central and lateral incisors is very similar. Although they have only one root and a high prevalence of Type 1 root canal morphology, surgical and nonsurgical root canal treatment may fail in these teeth if there is a lack of awareness in their internal anatomy which is complicated by the presence of the lingual canal, bifurcation, lateral anatomy, and isthmus [17, 29]. The morphological characteristics of the root canal system were studied using a number of techniques [18, 27, 30]. The prevalence of a second canal in mandibular permanent incisors is different between populations. Vertucci [18] reported that the incidence of the presence of a second canal was 25.7% among American population, whereas the incidence in Chinese population for the mandibular central and lateral incisors was 5.71 and 27.36%, respectively [31], 30% in Saudi population [32], 26.2% in north Jordanian population [33], and 36.25% in North-East Indian population [34]. In Iranian population, the incidence of mandibular central and lateral incisors having two canals was 27.3 and 29.4%, respectively [35]. The highest incidence (63%) of a second canal in mandibular incisors has been reported in a study in Turkish population [19].
Rankine-Wilson and Henry [36] filled the root canals of mandibular anterior teeth with radio-opaque material, sectioned them in a horizontal plane, and exposed radiographs. They reported two canals in 40.5% of mandibular incisors. Later, Vertucci [18] studied the root canal morphology of 300 extracted mandibular anterior teeth using the clearing technique. In 30% of mandibular central incisors and in 25% of mandibular lateral incisors, there was a second canal. On the other hand, higher prevalence of a second canal in Chinese population was reported in lateral mandibular incisors 25.5% compared with 10.9% in central mandibular incisors [37].
Many researches have shown that root canal systems also vary according to gender. In Turkish population, Sert and Bayirli [19] reported the incidence of second canal in central incisors in females (70%) was higher than in males (65%). Also in Turkish population, Arslan et al. [38] found the frequency of mandibular incisors with a second root canal in males (63%) was higher than in females (35%). The differences among both studies may be due to the fact that Sert and Bayirli examined the root canal morphology in vitro, whereas Arslan et al. studied the root canal anatomy in vivo. In Chinese population, Zhengyan et al. [30] found a significant difference between sex. The result of his study showed that 9.4% of the mandibular lateral incisors in males had a second canal, whereas this value was 11.9% in females. Among Iranian population, Haji et al. [39] reported that there was no significant difference between males and females in the incidence of a second canal in mandibular incisors.
2.4 Canal configurations in permanent mandibular incisors
It has become clear that teeth have complicated root canal systems rather than simplified canals [40]. Most investigators have shown that the root canal systems for most, if not all, permanent teeth are complex and canals may branch, divide, and rejoin. In addition to the complexity of root canal anatomy, root canal morphology varies from tooth to tooth. Concerning root canal treatment, these variations in root canal morphology of permanent teeth may result in missing root canals, nonsurgical endodontic treatment failure, and a need for surgical procedures. Weine et al. [41] classified root canal systems into four basic types, but Vertucci [18] subsequently classified them into eight configurations. The Vertucci classification may give consideration to the complex reality of canal systems in a way that the Weine et al. system did not.
Weine [42] described each of the canal types as below:
Type I: Single canal from pulp chamber to apex.
Type II: Two canals leaving the chamber and merging to form a single canal short of the apex.
Type III: Two separate and distinct canals from chamber to apex.
Type IV: One canal leaving the chamber and dividing into two separate and distinct canals.
Vertucci [24] classified canal configurations into eight types as described below:
Type 1: A single canal from the pulp chamber to apex [1].
Type II: Two separate canals leaving the pulp chamber before joining short of the apex to form one canal [2-1].
Type III: One canal leaving the pulp chamber before dividing into two in the root and then merging to exit as one canal [1-2].
Type IV: Two distinct canals that extended from the pulp chamber to the apex [2].
Type V: One canal leaving the pulp chamber and dividing short of the apex into two separate distinct canals with different apical foramina [1-2].
Type VI: Two separate canals leaving the pulp chamber, merging in the body of the root, and re-dividing short of the apex to exit as two distinct canals [2-1-2].
Type VII: One canal leaving the pulp chamber, dividing and then rejoining in the body of the root, and finally re-dividing into two distinct canals short of the apex [1-2-1-2].
Type VIII: Three separate, distinct canals that extended from pulp chamber to apex [3].
Although mandibular incisors are usually single-rooted teeth, their root canal system cannot be predicted not only between different populations but also between the same population, with respect to the Vertucci’s configuration. Studies reported that Vertucci’s Type I configuration has the highest prevalence among the other Vertucci configurations [43, 44, 45]. When a second canal is present, Vertucci’s Type III configuration is the most common for central and lateral incisors. Scarlatescu [46] found Type III has higher incidence than Type II, of 25 and 6.3% respectively in a Romanian population. de Almeida [47] reported that Vertucci’s Type I and III configurations represented 92% of the sample. Leoni investigated the root canal anatomy of mandibular central (n = 100) and lateral (n = 100) incisors and founded that Vertucci’s Type I (50 and 62%, respectively) and Type III (28%) were the most prevalent canal configurations in incisors [48]. However, researchers found high prevalence of Vertucci’s Type II than Vertucci’s Type III when a second canal is present. For example, Al-Qudah and Awawdeh [33] reported that the most common root canal configurations were Vertucci’s Type I, II, III, IV, and V with a prevalence of 73.8, 10.9, 6.7, 5.1, and 3.6% of mandibular central and lateral incisors respectively in a Jordanian population. Another study done in an Iranian population conducted by Yazdi and Jafari [49] using in vitro radiography, staining, and sectioning technique reported 88, 3.5, 0.5, and 8% prevalence of canal types I, II, IV, and V respectively in mandibular incisors. A similar study done by Miyashita et al. [17] among Japanese population founded central and lateral incisors with prevalence of Vertucci’s Type I, II, III and IV as 87.6, 9.3, 1.4, and 1.7% respectively. These configurations may have an implication in endodontic treatment outcome. A properly executed root canal treatment will lead to success in Type I, II, IV, and VIII canal configurations while the same treatment might lead to unfavorable treatment outcome in Type III canal configuration. Apically dividing systems like Type V, VI, and VII are the most difficult systems to prepare and obturate and may have an influence on the outcome of root canal treatment. Miyashita et al. [17] studied the relationship between canal configuration and external dimension, and found that Type II and III root canal configurations of mandibular incisors were larger in tooth length, and crown width labiolingually and mesiodistally. In cases of nonsurgical root canal procedure, disinfection and obturation of Type I and IV canal systems are relatively simple owing to that each of these configurations having definite canals with separate orifice and apex. Contrarily, Type II, III, and V systems are different because there are areas in the root where the two canals share space and others where the canals are separate. This requires an individualized procedure for preparation and filling in each of these conditions to obtain the most desirable results. Although the incidence of two separate canals is low, ribbon-like canals are detected in cases that were classified as Type I (simple root canal) based on their canal configuration, and this results in enabling the file to touch a large area of the canal walls.
2.5 Lateral canals in permanent mandibular incisors
Lateral canals are accessory canals located in the coronal or middle third of the root, extending horizontally from the main canal to the external surface of the root. Their formation is due to the entrapment of periodontal vessels in Hertwig’s epithelial root sheath or when blood vessels running from the dental sac through the dental papilla persist during calcification [50]. Lateral canals communicate with the periodontal ligament space and this increases risk of spread of periodontal disease into the pulp canal. According to their location, Vertucci classified lateral canals into coronal, middle, apical, or furcation. He observed lower occurrence of canal ramifications in the middle 11.4% and coronal 6.3% thirds compared to the apical 73.5% third [18, 24]. Recent micro-CT studies on root canal morphology of mandibular anterior teeth reported that lateral canals are rare [48, 51]. Miyashita et al. [17] reported that out of mandibular incisors with lateral branches, single lateral branch had the highest prevalence (82.2%) and multiple branches were extremely narrow. Al-Qudah and Awawdeh [33] found that there was an increasing prevalence of lateral canals toward the apical third of the root with approximately 64% occurring in the apical part of the roots. On the other hand, other studies reported that lateral canals were frequently found in the middle of the canal [34, 46]. Clinically, lateral canals are not usually visible in preoperative radiographs, but its presence can be suspected when there is a localized thickening of the periodontal ligament or a lesion on the lateral surface of the root [50]. It is also important to note that lateral canals cannot be instrumented. Its contents can only be neutralized by the action of effective irrigation with appropriate tissue dissolvent properties and antimicrobial activity solution or with the addition of use of intracanal medications.
2.6 Apical deltas in permanent mandibular incisors
Apical deltas are defined as an intricate system of spaces within the root canal that allows free passage of blood vessels and nerves from the periapical compartment to the pulp tissue [52, 53]. The apical delta is different from the accessory canal in which the main pulp canal is still distinguishable. The prevalence of apical deltas in human permanent teeth varies among populations, and the type and locations of tooth and methods of study. High prevalence of apical deltas is found in maxillary second premolars, mandibular lateral incisors, and mandibular second premolars [22]. Among American population, Vertucci [18] reported that the incidence of apical deltas was 5, 6, and 8% in the mandibular central incisors, lateral incisors, and canines, respectively. However, Çalişkan et al. [22] reported that the prevalence of apical deltas in those teeth was 9.8, 23.5 and 7.8% in a Turkish population. Apical deltas have been reported to be of great importance in endodontics because they are difficult to be instrumented during chemical-mechanical preparation. Furthermore, their long vertical extension may cause failure of the apical surgery if not involved during apical resection [54]. Gao et al. [55] reported that the median vertical distance of the apical delta was 1.87 mm with 13% of them more than 3 mm. Therefore, resection of the apical 3 mm of a root may include the whole apical delta and residual microorganisms from 87% of roots with apical delta.
2.7 Intercanal anastomosis in permanent mandibular incisors
A thin communication can occur between two or more canals in the same root or between vascular elements in tissues [56]. Green [23] described this corridor as a “ribbon shaped passage.” He found this corridor in 22% of mandibular incisors. An isthmus is formed when an individual root projection is unable to close itself off. Any root that contains two root canals has the potential to contain an isthmus [57]. It may contain tissue remnants and necrotic debris, which participate in microorganisms’ growth resulting in root canal treatment failure [58]. Therefore, knowledge of the root canal anatomy is essential for complete cleaning of the root canal and successful endodontic treatment [11]. Isthmus classification was described by Hsu and Kim et al. [59]. They classified isthmus into five types: Type I—two canals with no notable communication; Type II—a hair-thin connection between the two main canals; Type III—differs from Type II because of the presence of three canals instead of two; Type IV—an isthmus with extended canals into the connection; and Type V—there is a true connection or wide corridor of tissue between two main canals. Mauger reported that isthmus was present in 20% of the teeth at the 1-mm level, 30% at 2 mm, and 55% at 3 mm [27]. Estrela et al. [60] demonstrated high prevalence of both partial and complete isthmii in mandibular lateral incisors (47.6%) compared with mandibular central incisors (33.3%). On the other hand, Arslan et al. [38] found a low incidence (3.7%) of intracanal communication among Turkish population. A similar study done by Haghanifar [61] found the prevalence of complete isthmus in the mandibular anterior teeth ranged from 3 to 5%.
2.8 Anatomy, number, and position of apical foramina in permanent mandibular incisors
As a result of large width of the root canal buccolingually than mesiodistally, mandibular incisors have oval and flattened canals [25]. The overall prevalence of long oval root canals in the apical region in mandibular incisors is >50% [25]. When using rotary files, these oval-shaped canals are a challenge for proper shaping of the canal. This is because rotary instrumentation cannot touch all the canal walls, leaving behind untouched area. To improve mechanical apical debridement, the use of instruments up to an ISO size 100 is required to avoid leaving untouched area on the buccal and/or lingual walls of the canal [62]. However, using files with large taper or tip may cause lateral or apical perforation of the root as the root has a narrower diameter in the mesiodistal direction. Therefore, it stresses the use of good chemical disinfection protocol on these teeth. Canals are considered as oval, long oval, and flattened when the ratio between the maximum and the minimum cross-sectional diameter is <2:1, 2–4:1, and >4:1, respectively. Apical foramina are the main apical opening of the root canal. It is the main exit of the root canal onto the external root surface. Variation in the number and position of apical foramina is especially seen in mandibular incisors with two canals. The apical foramen coincides with the anatomical apex in 17–52.2% of the cases [19, 22, 33, 57, 63].
A number of studies (17.33%) reported that the position and the number of the apical foramen vary according to the race. Al-Qudah and Awawdeh [33] reported that more than half of the roots (52.2%) had centrally located foramina and 47.8% had laterally located foramina. Apical deltas were observed in only eight teeth (1.8%), and among mandibular incisors with two canals, single foramen was more prevalent than two apical foramina. Miyashita et al. [17] reported that only 3% of the mandibular incisors containing two canals had two foramina. He also found that 67.9% of mandibular incisors with curved root had eccentrically located foramina toward the labial direction and none of the canals were curved lingually.
According to Walker [63], the distance between the apical foramen and the most apical end of the root ranges between 0.2 and 2.0 mm. The diameter of the apical foramen of mandibular incisors has been reported to be as 262.5 μm.
2.9 Anomalies in permanent mandibular incisors
Anomaly (Gk, anomalos; irregular) is a deviation from what is regarded as normal [64]. These abnormalities may occur, in terms of size or shape, to either crown or root. WHO listed the following dental anomalies: concrescence, fusion, gemination, dens evaginatus, dens in dente, dens invaginatus, enamel pearls, macrodontia, microdontia, peg-shaped teeth, taurodontism, and tuberculum paramolare [65]. Anomalies of permanent mandibular incisors regarding the crown and root shape are extremely rare. However, few case reports have registered anomalies associated with mandibular incisors. As an example, dens invaginatus, a deep surface invagination of the crown or root, which is lined by enamel and resulting from the invagination of the enamel organ into the dental papilla during odontogenesis, can be seen in these teeth [66]. Dens invaginatus has been classified into three categories according to the depth of invagination and communication with the periapical tissue or periodontal ligament [67].
Type 1: The invagination ends as a blind sac confined to the crown.
Type 2: The invagination extends apically beyond the external CEJ, ending as a blind sac and never reaching the periapical tissues.
Type 3: The invagination extends beyond the CEJ and a second “apical foramen” is found in either the periapical tissues or the periodontal ligament.
The prevalence of this anomaly has been found to range from 0.25 to 5.1% of the population [66]. More commonly, dens invaginatus occurs in the maxillary permanent lateral incisors. Also, it may occur in maxillary central incisors, premolars, canines, and molars. It usually occurs unilaterally, but bilateral cases have also been reported [68]. Occurrence of dens invaginatus in mandibular teeth is very rare. When it occurs in mandibular incisors, the central incisor has a higher incidence compared with lateral incisor [69, 70].
Talon cusp is also a rare developmental anomaly defined as an additional cusp that projects predominantly from the labial or lingual surface of primary or permanent anterior teeth [71]. Mellor and Ripa [72] named this anomaly “talon cusp” as it resembles the shape of an eagle’s talon. Talon cusp was classified by Hattab [73] as follows:
Type 1: True talon cusp—this is a morphologically well-delineated additional cusp that prominently projects from the palatal surface of a primary or permanent anterior tooth and extends at least half the distance from the CEJ to the incisal edge.
Type 2: Semi talon cusp—this is an additional cusp of size a millimeter or more but extending less than half the distance from the CEJ to the incisal edge.
Type 3: Trace talon—this is enlarged or prominent cingula and their variations (i.e., conical, bifid, or tubercle-like).
Radiographically, the talon cusp may appear typically as a V-shaped radiopacity, starting from the cervical third of the crown. Most of the talon cusps occur in the maxillary lateral incisors (55%), followed by maxillary central incisors (32%) and maxillary canines (9%) [71]. Although it is rarely seen in mandibular teeth [74], Gündüz and Celenk [43] studied the site distribution of talon cusp among Turkish population and found only 3% of talon cusp was seen in the mandibular right central incisors.
Another rare developmental anomaly that has been reported to occur in mandibular central incisor is “Gemination” [75]. It is a rare anomaly that arises when the tooth bud of a single tooth attempts to divide. The structure most often presents as two crowns, either totally or partially separated, with a single root and one root canal [76]. In the anterior region, gemination can cause poor esthetic appearance due to irregular morphology. In addition, these teeth are more susceptible to periodontal disease and caries, if deep groove is present [77, 78].
Fusion is another developmental anomaly which can occur in these teeth. Contrary to gemination, fusion is defined as the union of two or more separately developing tooth germs during odontogenesis, when the crown is not yet mineralized at the dentinal level, yielding a single large tooth [79]. Depending on the stage of development at the time of union, the pulp might be merged or separated [80]. Fusion is more frequently seen in primary dentition, but it may occur in both dentitions. If it occurs in permanent dentition, the vast majority of permanent teeth fusion cases are seen in maxillary teeth. Although, the incidence of fusion of mandibular incisors is rare, mandibular central incisors have been reported to fuse with a supernumerary tooth [81] and bilaterally with the adjacent lateral incisor [82].
It should be emphasized that special attention is required during root canal treatment owing to the abnormal morphology of the crown and the complexity of the root canal system in fused teeth.
3. Clinical recommendation relevant to the mandibular incisors’ anatomy
Mandibular incisors are prone to endodontic treatment as a result of several reasons. Due to their location in the jaw, they are prone to traumas that result in tooth fracture which may necessitate root canal therapy. Moreover, their proximity to the opening of the sublingual and submandibular ducts increases the incidence of dental caries as a result of lingual deposition of calculus. Therefore, an accurate knowledge of the external and internal anatomy of these teeth is an essential prerequisite to carry out root canal treatment. They often have two canals that are buccolingually located and the lingual canal usually is missed. Therefore, the dentist should extend the access preparation in lingual direction to locate the lingual canal which is usually below the cingulum. In case of two canals, Type II canal is the most prevalent configuration where the buccal canal is the most straight and easiest to be located. Consequently, it is recommended to instrument and fill these canals till the apex whereas the lingual canal merges with the labial canal. Presence of an isthmus may complicate the root canal disinfection as it may contain tissue remnants and necrotic debris, hence irrigation and activation are very essential to overcome these anatomical difficulties.
\n',keywords:"morphology, mandibular incisors, variation, root canal",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/65806.pdf",chapterXML:"https://mts.intechopen.com/source/xml/65806.xml",downloadPdfUrl:"/chapter/pdf-download/65806",previewPdfUrl:"/chapter/pdf-preview/65806",totalDownloads:1182,totalViews:0,totalCrossrefCites:0,dateSubmitted:"November 2nd 2018",dateReviewed:"January 22nd 2019",datePrePublished:"September 11th 2019",datePublished:"January 22nd 2020",dateFinished:"February 22nd 2019",readingETA:"0",abstract:"A clear understanding of dental root anatomy, external and internal, is an essential prerequisite to all dental procedures. In periodontology, the external root morphology has been proven to have a clinical significance in the predisposing factors of periodontal diseases. Orthodontic literature shows the importance of radicular anatomy in orthodontic mechanics through the concept of anchorage. The significance of internal root anatomy has been emphasized by studies demonstrating that variations in canal geometry before cleaning, shaping, and obturation procedures had a greater effect on the outcome than the techniques themselves. The mandibular central incisor is the smallest tooth in the mouth, but the buccolingual dimension of its root is very large. This tooth is usually single-rooted; however, the root canal system of this group is unpredictable. The incidence of two canals has been reported as low as 0.3% and as high as 45.3%. The wide range of variation reported in literature regarding the prevalence of a second canal has been related to methodological and racial differences. This chapter will summarize the morphological aspects of the root canal anatomy published in the literature of the anterior mandibular teeth. This will provide precious knowledge regarding root canal morphology and its variation among populations.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/65806",risUrl:"/chapter/ris/65806",signatures:"Mohammed A. Aldawla, Abdulbaset A. Mufadhal and Ahmed A. Madfa",book:{id:"8837",type:"book",title:"Human Teeth",subtitle:"Key Skills and Clinical Illustrations",fullTitle:"Human Teeth - Key Skills and Clinical Illustrations",slug:"human-teeth-key-skills-and-clinical-illustrations",publishedDate:"January 22nd 2020",bookSignature:"Zühre Akarslan and Farid Bourzgui",coverURL:"https://cdn.intechopen.com/books/images_new/8837.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-78923-840-2",printIsbn:"978-1-78923-839-6",pdfIsbn:"978-1-78984-522-8",isAvailableForWebshopOrdering:!0,editors:[{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"204110",title:"Dr.",name:"Ahmed A.",middleName:null,surname:"Madfa",fullName:"Ahmed A. Madfa",slug:"ahmed-a.-madfa",email:"ahmed_um_2011@yahoo.com",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204110/images/system/204110.jpg",institution:null},{id:"281125",title:"Dr.",name:"Mohammed A.",middleName:null,surname:"Aldawla",fullName:"Mohammed A. Aldawla",slug:"mohammed-a.-aldawla",email:"mohdaldawla@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"281126",title:"Dr.",name:"Abdulbaset A.",middleName:null,surname:"Mufadhal",fullName:"Abdulbaset A. Mufadhal",slug:"abdulbaset-a.-mufadhal",email:"dr.obad99@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. External root morphology",level:"1"},{id:"sec_2",title:"2. Internal anatomy",level:"1"},{id:"sec_2_2",title:"2.1 Introduction",level:"2"},{id:"sec_3_2",title:"2.2 Shape and size of pulp cavity in permanent mandibular incisors",level:"2"},{id:"sec_4_2",title:"2.3 Number of canals in permanent mandibular incisors",level:"2"},{id:"sec_5_2",title:"2.4 Canal configurations in permanent mandibular incisors",level:"2"},{id:"sec_6_2",title:"2.5 Lateral canals in permanent mandibular incisors",level:"2"},{id:"sec_7_2",title:"2.6 Apical deltas in permanent mandibular incisors",level:"2"},{id:"sec_8_2",title:"2.7 Intercanal anastomosis in permanent mandibular incisors",level:"2"},{id:"sec_9_2",title:"2.8 Anatomy, number, and position of apical foramina in permanent mandibular incisors",level:"2"},{id:"sec_10_2",title:"2.9 Anomalies in permanent mandibular incisors",level:"2"},{id:"sec_10_3",title:"3. Clinical recommendation relevant to the mandibular incisors’ anatomy",level:"3"}],chapterReferences:[{id:"B1",body:'Ozaki T, Satake T, Kanazama E. 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European Journal of Dentistry. 2007;1(3):188'},{id:"B79",body:'Velasco LFL, FBd A, Ferreira ES, LEL V. Esthetic and functional treatment of a fused permanent tooth: A case report. Quintessence International. 1997;28(10):677-680'},{id:"B80",body:'Brook A, Winter G. Double teeth. A retrospective study of ‘geminated’ and ‘fused’ teeth in children. British Dental Journal. 1970;129(3):123'},{id:"B81",body:'Sachdeva G, Malhotra D, Sachdeva L, Sharma N, Negi A. Endodontic management of mandibular central incisor fused to a supernumerary tooth associated with a talon cusp: A case report. International Endodontic Journal. 2012;45(6):590-596'},{id:"B82",body:'Prabhakar AR, Kaur T, Nadig B. Bilateral fusion of permanent mandibular incisors with Talon’s cusp: A rare case report. Journal of Oral and Maxillofacial Pathology. 2009;13(2):93'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Mohammed A. Aldawla",address:"mohdaldawla@gmail.com",affiliation:'
Department of Conservative Dentistry, Faculty of Dentistry, Sana’a University, Yemen
'},{corresp:null,contributorFullName:"Abdulbaset A. Mufadhal",address:null,affiliation:'
Department of Conservative Dentistry, Faculty of Dentistry, Sana’a University, Yemen
'},{corresp:null,contributorFullName:"Ahmed A. Madfa",address:null,affiliation:'
Department of Conservative Dentistry, Faculty of Dentistry, Sana’a University, Yemen
Department of Conservative Dentistry, Faculty of Dentistry, Thamar University, Yemen
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All published Book Chapters are licensed under a Creative Commons Attribution 3.0 Unported License. Monographs are licensed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) license granted to all others. Our Copyright Policy aims to guarantee that original material is published while at the same time giving significant freedom to our Authors. IntechOpen upholds a flexible Copyright Policy meaning that there is no copyright transfer to the publisher and Authors hold exclusive copyright to their work.
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IntechOpen's Authorship Policy is based on ICMJE criteria for authorship. In order to be identified as an Author, the following requirements must be met:
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A substantial contribution to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work
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Approval of the manuscript version to be published
All scientific works are subject to Peer Review prior to publishing. IntechOpen is a member of the Committee on Publication Ethics (COPE) and all participating referees and Academic Editors are expected to review submitted scientific works in line with the COPE Ethical Guidelines for Peer Reviewers where applicable.
The Internet has changed the dynamics of scholarly communication and publishing which is why we find it necessary to clearly indicate our stance on what we consider to be a published scientific work. A significant number of working papers, early drafts, and similar works in progress are shared openly online between members of the scientific community. It has become common practice for researchers to announce their work on a personal website or a blog in order to gather comments and suggestions from other researchers. Such works and online postings are ‘published’ in the sense that they are made publicly available, but this does not mean that if submitted for publication by IntechOpen they are not original works. We differentiate between reviewed and non-reviewed works when determining whether a work is original and has been published in a scholarly sense or not.
To identify instances of fraud and misconduct during the publishing process, IntechOpen implements a robust policy governing such occurrences. In line with our general commitment to openness, and in order to maintain the highest scientific standards, we are committed to transparency about our editorial policy regarding retractions and corrections.
When faced with potential misconduct, IntechOpen accepts its responsibility to maintain the integrity of the academic record. For particularly complex cases, IntechOpen might ask for the assistance of formal industry bodies or seek advice from an appropriate team of advisors.
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IntechOpen's advisors are professionals and scholars with broad knowledge and understanding of different aspects of the scientific publishing process: editorial, authorship, and reviewing roles; publication ethics, copyright, and general legal issues; as well as bibliographic and technical standards.
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In order to provide us with unbiased insights, without compromising the privacy of third parties, IntechOpen presents problematic cases to its advisors in an anonymized format.
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All chapters will be published via IntechOpen's 'Online First' service meaning chapters will be published individually, immediately after review and before the entire book is ready for publication, allowing content to be shared, searched and cited straightaway, thereby generating early stage interest and momentum for your research
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You are invited to download, use, reproduce, make derivative works of, display, distribute and cite the Online First works. You can find "How to Cite and Reference" by following the link at the end of each online book chapter. Please be aware that it is possible that further editing and changes might be made before the final release of the book.
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If there are supplemental materials to the chapter, these will be published at the time the final book is published online.
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Access policy
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IntechOpen books are available online by accessing all published content on a chapter level.
All published Book Chapters are licensed under a Creative Commons Attribution 3.0 Unported License. Monographs are licensed under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) license granted to all others. Our Copyright Policy aims to guarantee that original material is published while at the same time giving significant freedom to our Authors. IntechOpen upholds a flexible Copyright Policy meaning that there is no copyright transfer to the publisher and Authors hold exclusive copyright to their work.
With the purpose of protecting our Authors' copyright and the transparent reuse of Open Access content, IntechOpen has developed an Attribution Policy for works published under Creative Commons licenses.
IntechOpen is committed to disseminating high-quality scientific research in a manner that exemplifies the best practice in scholarly publishing. IntechOpen is an official member of the Committee on Publication Ethics (COPE), which advocates the maintenance of the highest ethical standards for all parties involved in the act of publishing, including Authors, Academic Editors of the book, Peer Reviewers, the publisher and Societies, where applicable.
\n\n
Conflicts of Interest Policy
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In line with publication ethics practices recommended by COPE, ICMJE, and other similar organizations, IntechOpen's contributing Authors, Academic Editors, and Peer Reviewers are required to declare fully all possible conflicts of interest.
IntechOpen's Authorship Policy is based on ICMJE criteria for authorship. In order to be identified as an Author, the following requirements must be met:
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A substantial contribution to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work
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Participation in drafting or revising the work
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Approval of the manuscript version to be published
All scientific works are subject to Peer Review prior to publishing. IntechOpen is a member of the Committee on Publication Ethics (COPE) and all participating referees and Academic Editors are expected to review submitted scientific works in line with the COPE Ethical Guidelines for Peer Reviewers where applicable.
The Internet has changed the dynamics of scholarly communication and publishing which is why we find it necessary to clearly indicate our stance on what we consider to be a published scientific work. A significant number of working papers, early drafts, and similar works in progress are shared openly online between members of the scientific community. It has become common practice for researchers to announce their work on a personal website or a blog in order to gather comments and suggestions from other researchers. Such works and online postings are ‘published’ in the sense that they are made publicly available, but this does not mean that if submitted for publication by IntechOpen they are not original works. We differentiate between reviewed and non-reviewed works when determining whether a work is original and has been published in a scholarly sense or not.
To identify instances of fraud and misconduct during the publishing process, IntechOpen implements a robust policy governing such occurrences. In line with our general commitment to openness, and in order to maintain the highest scientific standards, we are committed to transparency about our editorial policy regarding retractions and corrections.
When faced with potential misconduct, IntechOpen accepts its responsibility to maintain the integrity of the academic record. For particularly complex cases, IntechOpen might ask for the assistance of formal industry bodies or seek advice from an appropriate team of advisors.
\n\n
IntechOpen's advisors are professionals and scholars with broad knowledge and understanding of different aspects of the scientific publishing process: editorial, authorship, and reviewing roles; publication ethics, copyright, and general legal issues; as well as bibliographic and technical standards.
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In order to provide us with unbiased insights, without compromising the privacy of third parties, IntechOpen presents problematic cases to its advisors in an anonymized format.
\n\n
Translation Policy
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IntechOpen publishes books in the English language. If you are interested in the translation of Book Chapters, please check IntechOpen's Translation Policy.
In line with the Principles of Transparency and Best Practice in Scholarly Publishing, you can access a more detailed description of IntechOpen's Advertising Policy.
At IntechOpen we realize that exceptional circumstances can occur, resulting in a request for a refund. We will honor all justified requests in the specific instances outlined in our Refund Policy.
All chapters will be published via IntechOpen's 'Online First' service meaning chapters will be published individually, immediately after review and before the entire book is ready for publication, allowing content to be shared, searched and cited straightaway, thereby generating early stage interest and momentum for your research
\n\n
Online First Chapters are considered published on the day they are posted and are citable from that date.
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Chapters will remain listed as Online First until the final versions of the books are published online. Following publication of the full monograph, Chapters will be redirected from the Online First version and will be available only through the final link of the official published page.
\n\n
You are invited to download, use, reproduce, make derivative works of, display, distribute and cite the Online First works. You can find "How to Cite and Reference" by following the link at the end of each online book chapter. Please be aware that it is possible that further editing and changes might be made before the final release of the book.
\n\n
If there are supplemental materials to the chapter, these will be published at the time the final book is published online.
\n\n
Readers and Authors can notify us if they find any errors in the works published under Online First. All major errors will be accompanied by a separate correction notice, erratum or corrigendum (Retraction and Correction Policy.)
\n\n
Access policy
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IntechOpen books are available online by accessing all published content on a chapter level.
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Singh",profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",institutionURL:null,country:{name:"India"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"8018",title:"Extracellular Matrix",subtitle:"Developments and Therapeutics",coverURL:"https://cdn.intechopen.com/books/images_new/8018.jpg",slug:"extracellular-matrix-developments-and-therapeutics",publishedDate:"October 27th 2021",editedByType:"Edited by",bookSignature:"Rama Sashank Madhurapantula, Joseph Orgel P.R.O. and Zvi Loewy",hash:"c85e82851e80b40282ff9be99ddf2046",volumeInSeries:23,fullTitle:"Extracellular Matrix - Developments and Therapeutics",editors:[{id:"212416",title:"Dr.",name:"Rama Sashank",middleName:null,surname:"Madhurapantula",slug:"rama-sashank-madhurapantula",fullName:"Rama Sashank Madhurapantula",profilePictureURL:"https://mts.intechopen.com/storage/users/212416/images/system/212416.jpg",institutionString:"Illinois Institute of Technology",institution:{name:"Illinois Institute of Technology",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null},{type:"book",id:"9759",title:"Vitamin E in Health and Disease",subtitle:"Interactions, Diseases and Health Aspects",coverURL:"https://cdn.intechopen.com/books/images_new/9759.jpg",slug:"vitamin-e-in-health-and-disease-interactions-diseases-and-health-aspects",publishedDate:"October 6th 2021",editedByType:"Edited by",bookSignature:"Pınar Erkekoglu and Júlia Scherer Santos",hash:"6c3ddcc13626110de289b57f2516ac8f",volumeInSeries:22,fullTitle:"Vitamin E in Health and Disease - Interactions, Diseases and Health Aspects",editors:[{id:"109978",title:"Prof.",name:"Pınar",middleName:null,surname:"Erkekoğlu",slug:"pinar-erkekoglu",fullName:"Pınar Erkekoğlu",profilePictureURL:"https://mts.intechopen.com/storage/users/109978/images/system/109978.jpg",institutionString:"Hacettepe University",institution:{name:"Hacettepe University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}]},subseriesFiltersForPublishedBooks:[{group:"subseries",caption:"Proteomics",value:18,count:4},{group:"subseries",caption:"Metabolism",value:17,count:6},{group:"subseries",caption:"Cell and Molecular Biology",value:14,count:9},{group:"subseries",caption:"Chemical Biology",value:15,count:13}],publicationYearFilters:[{group:"publicationYear",caption:"2022",value:2022,count:8},{group:"publicationYear",caption:"2021",value:2021,count:7},{group:"publicationYear",caption:"2020",value:2020,count:12},{group:"publicationYear",caption:"2019",value:2019,count:3},{group:"publicationYear",caption:"2018",value:2018,count:2}],authors:{paginationCount:148,paginationItems:[{id:"165328",title:"Dr.",name:"Vahid",middleName:null,surname:"Asadpour",slug:"vahid-asadpour",fullName:"Vahid Asadpour",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/165328/images/system/165328.jpg",biography:"Vahid Asadpour, MS, Ph.D., is currently with the Department of Research and Evaluation, Kaiser Permanente Southern California. He has both an MS and Ph.D. in Biomedical Engineering. He was previously a research scientist at the University of California Los Angeles (UCLA) and visiting professor and researcher at the University of North Dakota. He is currently working in artificial intelligence and its applications in medical signal processing. In addition, he is using digital signal processing in medical imaging and speech processing. Dr. Asadpour has developed brain-computer interfacing algorithms and has published books, book chapters, and several journal and conference papers in this field and other areas of intelligent signal processing. He has also designed medical devices, including a laser Doppler monitoring system.",institutionString:"Kaiser Permanente Southern California",institution:null},{id:"169608",title:"Prof.",name:"Marian",middleName:null,surname:"Găiceanu",slug:"marian-gaiceanu",fullName:"Marian Găiceanu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/169608/images/system/169608.png",biography:"Prof. Dr. Marian Gaiceanu graduated from the Naval and Electrical Engineering Faculty, Dunarea de Jos University of Galati, Romania, in 1997. He received a Ph.D. (Magna Cum Laude) in Electrical Engineering in 2002. Since 2017, Dr. Gaiceanu has been a Ph.D. supervisor for students in Electrical Engineering. He has been employed at Dunarea de Jos University of Galati since 1996, where he is currently a professor. Dr. Gaiceanu is a member of the National Council for Attesting Titles, Diplomas and Certificates, an expert of the Executive Agency for Higher Education, Research Funding, and a member of the Senate of the Dunarea de Jos University of Galati. He has been the head of the Integrated Energy Conversion Systems and Advanced Control of Complex Processes Research Center, Romania, since 2016. He has conducted several projects in power converter systems for electrical drives, power quality, PEM and SOFC fuel cell power converters for utilities, electric vehicles, and marine applications with the Department of Regulation and Control, SIEI S.pA. (2002–2004) and the Polytechnic University of Turin, Italy (2002–2004, 2006–2007). He is a member of the Institute of Electrical and Electronics Engineers (IEEE) and cofounder-member of the IEEE Power Electronics Romanian Chapter. He is a guest editor at Energies and an academic book editor for IntechOpen. He is also a member of the editorial boards of the Journal of Electrical Engineering, Electronics, Control and Computer Science and Sustainability. Dr. Gaiceanu has been General Chairman of the IEEE International Symposium on Electrical and Electronics Engineering in the last six editions.",institutionString:'"Dunarea de Jos" University of Galati',institution:{name:'"Dunarea de Jos" University of Galati',country:{name:"Romania"}}},{id:"4519",title:"Prof.",name:"Jaydip",middleName:null,surname:"Sen",slug:"jaydip-sen",fullName:"Jaydip Sen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/4519/images/system/4519.jpeg",biography:"Jaydip Sen is associated with Praxis Business School, Kolkata, India, as a professor in the Department of Data Science. His research areas include security and privacy issues in computing and communication, intrusion detection systems, machine learning, deep learning, and artificial intelligence in the financial domain. He has more than 200 publications in reputed international journals, refereed conference proceedings, and 20 book chapters in books published by internationally renowned publishing houses, such as Springer, CRC press, IGI Global, etc. Currently, he is serving on the editorial board of the prestigious journal Frontiers in Communications and Networks and in the technical program committees of a number of high-ranked international conferences organized by the IEEE, USA, and the ACM, USA. He has been listed among the top 2% of scientists in the world for the last three consecutive years, 2019 to 2021 as per studies conducted by the Stanford University, USA.",institutionString:"Praxis Business School",institution:null},{id:"320071",title:"Dr.",name:"Sidra",middleName:null,surname:"Mehtab",slug:"sidra-mehtab",fullName:"Sidra Mehtab",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00002v6KHoQAM/Profile_Picture_1584512086360",biography:"Sidra Mehtab has completed her BS with honors in Physics from Calcutta University, India in 2018. She has done MS in Data Science and Analytics from Maulana Abul Kalam Azad University of Technology (MAKAUT), Kolkata, India in 2020. Her research areas include Econometrics, Time Series Analysis, Machine Learning, Deep Learning, Artificial Intelligence, and Computer and Network Security with a particular focus on Cyber Security Analytics. Ms. Mehtab has published seven papers in international conferences and one of her papers has been accepted for publication in a reputable international journal. She has won the best paper awards in two prestigious international conferences – BAICONF 2019, and ICADCML 2021, organized in the Indian Institute of Management, Bangalore, India in December 2019, and SOA University, Bhubaneswar, India in January 2021. Besides, Ms. Mehtab has also published two book chapters in two books. Seven of her book chapters will be published in a volume shortly in 2021 by Cambridge Scholars’ Press, UK. Currently, she is working as the joint editor of two edited volumes on Time Series Analysis and Forecasting to be published in the first half of 2021 by an international house. Currently, she is working as a Data Scientist with an MNC in Delhi, India.",institutionString:"NSHM College of Management and Technology",institution:null},{id:"226240",title:"Dr.",name:"Andri Irfan",middleName:null,surname:"Rifai",slug:"andri-irfan-rifai",fullName:"Andri Irfan Rifai",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226240/images/7412_n.jpg",biography:"Andri IRFAN is a Senior Lecturer of Civil Engineering and Planning. He completed the PhD at the Universitas Indonesia & Universidade do Minho with Sandwich Program Scholarship from the Directorate General of Higher Education and LPDP scholarship. He has been teaching for more than 19 years and much active to applied his knowledge in the project construction in Indonesia. His research interest ranges from pavement management system to advanced data mining techniques for transportation engineering. He has published more than 50 papers in journals and 2 books.",institutionString:null,institution:{name:"Universitas Internasional Batam",country:{name:"Indonesia"}}},{id:"314576",title:"Dr.",name:"Ibai",middleName:null,surname:"Laña",slug:"ibai-lana",fullName:"Ibai Laña",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314576/images/system/314576.jpg",biography:"Dr. Ibai Laña works at TECNALIA as a data analyst. He received his Ph.D. in Artificial Intelligence from the University of the Basque Country (UPV/EHU), Spain, in 2018. He is currently a senior researcher at TECNALIA. His research interests fall within the intersection of intelligent transportation systems, machine learning, traffic data analysis, and data science. He has dealt with urban traffic forecasting problems, applying machine learning models and evolutionary algorithms. He has experience in origin-destination matrix estimation or point of interest and trajectory detection. Working with large volumes of data has given him a good command of big data processing tools and NoSQL databases. He has also been a visiting scholar at the Knowledge Engineering and Discovery Research Institute, Auckland University of Technology.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"314575",title:"Dr.",name:"Jesus",middleName:null,surname:"L. Lobo",slug:"jesus-l.-lobo",fullName:"Jesus L. Lobo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314575/images/system/314575.png",biography:"Dr. Jesús López is currently based in Bilbao (Spain) working at TECNALIA as Artificial Intelligence Research Scientist. In most cases, a project idea or a new research line needs to be investigated to see if it is good enough to take into production or to focus on it. That is exactly what he does, diving into Machine Learning algorithms and technologies to help TECNALIA to decide whether something is great in theory or will actually impact on the product or processes of its projects. So, he is expert at framing experiments, developing hypotheses, and proving whether they’re true or not, in order to investigate fundamental problems with a longer time horizon. He is also able to design and develop PoCs and system prototypes in simulation. He has participated in several national and internacional R&D projects.\n\nAs another relevant part of his everyday research work, he usually publishes his findings in reputed scientific refereed journals and international conferences, occasionally acting as reviewer and Programme Commitee member. Concretely, since 2018 he has published 9 JCR (8 Q1) journal papers, 9 conference papers (e.g. ECML PKDD 2021), and he has co-edited a book. He is also active in popular science writing data science stories for reputed blogs (KDNuggets, TowardsDataScience, Naukas). Besides, he has recently embarked on mentoring programmes as mentor, and has also worked as data science trainer.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"103779",title:"Prof.",name:"Yalcin",middleName:null,surname:"Isler",slug:"yalcin-isler",fullName:"Yalcin Isler",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQ8QAK/Profile_Picture_1628834958734",biography:"Yalcin Isler (1971 - Burdur / Turkey) received the B.Sc. degree in the Department of Electrical and Electronics Engineering from Anadolu University, Eskisehir, Turkey, in 1993, the M.Sc. degree from the Department of Electronics and Communication Engineering, Suleyman Demirel University, Isparta, Turkey, in 1996, the Ph.D. degree from the Department of Electrical and Electronics Engineering, Dokuz Eylul University, Izmir, Turkey, in 2009, and the Competence of Associate Professorship from the Turkish Interuniversity Council in 2019.\n\nHe was Lecturer at Burdur Vocational School in Suleyman Demirel University (1993-2000, Burdur / Turkey), Software Engineer (2000-2002, Izmir / Turkey), Research Assistant in Bulent Ecevit University (2002-2003, Zonguldak / Turkey), Research Assistant in Dokuz Eylul University (2003-2010, Izmir / Turkey), Assistant Professor at the Department of Electrical and Electronics Engineering in Bulent Ecevit University (2010-2012, Zonguldak / Turkey), Assistant Professor at the Department of Biomedical Engineering in Izmir Katip Celebi University (2012-2019, Izmir / Turkey). He is an Associate Professor at the Department of Biomedical Engineering at Izmir Katip Celebi University, Izmir / Turkey, since 2019. In addition to academics, he has also founded Islerya Medical and Information Technologies Company, Izmir / Turkey, since 2017.\n\nHis main research interests cover biomedical signal processing, pattern recognition, medical device design, programming, and embedded systems. He has many scientific papers and participated in several projects in these study fields. He was an IEEE Student Member (2009-2011) and IEEE Member (2011-2014) and has been IEEE Senior Member since 2014.",institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"339677",title:"Dr.",name:"Mrinmoy",middleName:null,surname:"Roy",slug:"mrinmoy-roy",fullName:"Mrinmoy Roy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/339677/images/16768_n.jpg",biography:"An accomplished Sales & Marketing professional with 12 years of cross-functional experience in well-known organisations such as CIPLA, LUPIN, GLENMARK, ASTRAZENECA across different segment of Sales & Marketing, International Business, Institutional Business, Product Management, Strategic Marketing of HIV, Oncology, Derma, Respiratory, Anti-Diabetic, Nutraceutical & Stomatological Product Portfolio and Generic as well as Chronic Critical Care Portfolio. A First Class MBA in International Business & Strategic Marketing, B.Pharm, D.Pharm, Google Certified Digital Marketing Professional. Qualified PhD Candidate in Operations and Management with special focus on Artificial Intelligence and Machine Learning adoption, analysis and use in Healthcare, Hospital & Pharma Domain. Seasoned with diverse therapy area of Pharmaceutical Sales & Marketing ranging from generating revenue through generating prescriptions, launching new products, and making them big brands with continuous strategy execution at the Physician and Patients level. Moved from Sales to Marketing and Business Development for 3.5 years in South East Asian Market operating from Manila, Philippines. Came back to India and handled and developed Brands such as Gluconorm, Lupisulin, Supracal, Absolut Woman, Hemozink, Fabiflu (For COVID 19), and many more. In my previous assignment I used to develop and execute strategies on Sales & Marketing, Commercialization & Business Development for Institution and Corporate Hospital Business portfolio of Oncology Therapy Area for AstraZeneca Pharma India Ltd. Being a Research Scholar and Student of ‘Operations Research & Management: Artificial Intelligence’ I published several pioneer research papers and book chapters on the same in Internationally reputed journals and Books indexed in Scopus, Springer and Ei Compendex, Google Scholar etc. Currently, I am launching PGDM Pharmaceutical Management Program in IIHMR Bangalore and spearheading the course curriculum and structure of the same. I am interested in Collaboration for Healthcare Innovation, Pharma AI Innovation, Future trend in Marketing and Management with incubation on Healthcare, Healthcare IT startups, AI-ML Modelling and Healthcare Algorithm based training module development. I am also an affiliated member of the Institute of Management Consultant of India, looking forward to Healthcare, Healthcare IT and Innovation, Pharma and Hospital Management Consulting works.",institutionString:null,institution:{name:"Lovely Professional University",country:{name:"India"}}},{id:"310576",title:"Prof.",name:"Erick Giovani",middleName:null,surname:"Sperandio Nascimento",slug:"erick-giovani-sperandio-nascimento",fullName:"Erick Giovani Sperandio Nascimento",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y00002pDKxDQAW/ProfilePicture%202022-06-20%2019%3A57%3A24.788",biography:"Prof. Erick Sperandio is the Lead Researcher and professor of Artificial Intelligence (AI) at SENAI CIMATEC, Bahia, Brazil, also working with Computational Modeling (CM) and HPC. He holds a PhD in Environmental Engineering in the area of Atmospheric Computational Modeling, a Master in Informatics in the field of Computational Intelligence and Graduated in Computer Science from UFES. He currently coordinates, leads and participates in R&D projects in the areas of AI, computational modeling and supercomputing applied to different areas such as Oil and Gas, Health, Advanced Manufacturing, Renewable Energies and Atmospheric Sciences, advising undergraduate, master's and doctoral students. He is the Lead Researcher at SENAI CIMATEC's Reference Center on Artificial Intelligence. In addition, he is a Certified Instructor and University Ambassador of the NVIDIA Deep Learning Institute (DLI) in the areas of Deep Learning, Computer Vision, Natural Language Processing and Recommender Systems, and Principal Investigator of the NVIDIA/CIMATEC AI Joint Lab, the first in Latin America within the NVIDIA AI Technology Center (NVAITC) worldwide program. He also works as a researcher at the Supercomputing Center for Industrial Innovation (CS2i) and at the SENAI Institute of Innovation for Automation (ISI Automação), both from SENAI CIMATEC. He is a member and vice-coordinator of the Basic Board of Scientific-Technological Advice and Evaluation, in the area of Innovation, of the Foundation for Research Support of the State of Bahia (FAPESB). He serves as Technology Transfer Coordinator and one of the Principal Investigators at the National Applied Research Center in Artificial Intelligence (CPA-IA) of SENAI CIMATEC, focusing on Industry, being one of the six CPA-IA in Brazil approved by MCTI / FAPESP / CGI.br. He also participates as one of the representatives of Brazil in the BRICS Innovation Collaboration Working Group on HPC, ICT and AI. He is the coordinator of the Work Group of the Axis 5 - Workforce and Training - of the Brazilian Strategy for Artificial Intelligence (EBIA), and member of the MCTI/EMBRAPII AI Innovation Network Training Committee. He is the coordinator, by SENAI CIMATEC, of the Artificial Intelligence Reference Network of the State of Bahia (REDE BAH.IA). He leads the working group of experts representing Brazil in the Global Partnership on Artificial Intelligence (GPAI), on the theme \"AI and the Pandemic Response\".",institutionString:"Manufacturing and Technology Integrated Campus – SENAI CIMATEC",institution:null},{id:"1063",title:"Prof.",name:"Constantin",middleName:null,surname:"Volosencu",slug:"constantin-volosencu",fullName:"Constantin Volosencu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/1063/images/system/1063.png",biography:"Prof. Dr. Constantin Voloşencu graduated as an engineer from\nPolitehnica University of Timișoara, Romania, where he also\nobtained a doctorate degree. He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. He has developed automation equipment for machine tools, spooling\nmachines, high-power ultrasound processes, and more.",institutionString:"Polytechnic University of Timişoara",institution:{name:"Polytechnic University of Timişoara",country:{name:"Romania"}}},{id:"221364",title:"Dr.",name:"Eneko",middleName:null,surname:"Osaba",slug:"eneko-osaba",fullName:"Eneko Osaba",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/221364/images/system/221364.jpg",biography:"Dr. Eneko Osaba works at TECNALIA as a senior researcher. He obtained his Ph.D. in Artificial Intelligence in 2015. He has participated in more than twenty-five local and European research projects, and in the publication of more than 130 papers. He has performed several stays at universities in the United Kingdom, Italy, and Malta. Dr. Osaba has served as a program committee member in more than forty international conferences and participated in organizing activities in more than ten international conferences. He is a member of the editorial board of the International Journal of Artificial Intelligence, Data in Brief, and Journal of Advanced Transportation. He is also a guest editor for the Journal of Computational Science, Neurocomputing, Swarm, and Evolutionary Computation and IEEE ITS Magazine.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"275829",title:"Dr.",name:"Esther",middleName:null,surname:"Villar-Rodriguez",slug:"esther-villar-rodriguez",fullName:"Esther Villar-Rodriguez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/275829/images/system/275829.jpg",biography:"Dr. Esther Villar obtained a Ph.D. in Information and Communication Technologies from the University of Alcalá, Spain, in 2015. She obtained a degree in Computer Science from the University of Deusto, Spain, in 2010, and an MSc in Computer Languages and Systems from the National University of Distance Education, Spain, in 2012. Her areas of interest and knowledge include natural language processing (NLP), detection of impersonation in social networks, semantic web, and machine learning. Dr. Esther Villar made several contributions at conferences and publishing in various journals in those fields. Currently, she is working within the OPTIMA (Optimization Modeling & Analytics) business of TECNALIA’s ICT Division as a data scientist in projects related to the prediction and optimization of management and industrial processes (resource planning, energy efficiency, etc).",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",biography:"Prof. Dr. Javier Del Ser received his first PhD in Telecommunication Engineering (Cum Laude) from the University of Navarra, Spain, in 2006, and a second PhD in Computational Intelligence (Summa Cum Laude) from the University of Alcala, Spain, in 2013. He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. He is a Senior Member of the IEEE, and a recipient of the Biscay Talent prize for his academic career.",institutionString:"Tecnalia Research & Innovation",institution:null},{id:"278948",title:"Dr.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRcmyQAC/Profile_Picture_1564224512145",biography:'Carlos Pedro Gonçalves (PhD) is an Associate Professor at Lusophone University of Humanities and Technologies and a researcher on Complexity Sciences, Quantum Technologies, Artificial Intelligence, Strategic Studies, Studies in Intelligence and Security, FinTech and Financial Risk Modeling. He is also a progammer with programming experience in:\n\nA) Quantum Computing using Qiskit Python module and IBM Quantum Experience Platform, with software developed on the simulation of Quantum Artificial Neural Networks and Quantum Cybersecurity;\n\nB) Artificial Intelligence and Machine learning programming in Python;\n\nC) Artificial Intelligence, Multiagent Systems Modeling and System Dynamics Modeling in Netlogo, with models developed in the areas of Chaos Theory, Econophysics, Artificial Intelligence, Classical and Quantum Complex Systems Science, with the Econophysics models having been cited worldwide and incorporated in PhD programs by different Universities.\n\nReceived an Arctic Code Vault Contributor status by GitHub, due to having developed open source software preserved in the \\"Arctic Code Vault\\" for future generations (https://archiveprogram.github.com/arctic-vault/), with the Strategy Analyzer A.I. module for decision making support (based on his PhD thesis, used in his Classes on Decision Making and in Strategic Intelligence Consulting Activities) and QNeural Python Quantum Neural Network simulator also preserved in the \\"Arctic Code Vault\\", for access to these software modules see: https://github.com/cpgoncalves. He is also a peer reviewer with outsanding review status from Elsevier journals, including Physica A, Neurocomputing and Engineering Applications of Artificial Intelligence. Science CV available at: https://www.cienciavitae.pt//pt/8E1C-A8B3-78C5 and ORCID: https://orcid.org/0000-0002-0298-3974',institutionString:"University of Lisbon",institution:{name:"Universidade Lusófona",country:{name:"Portugal"}}},{id:"241400",title:"Prof.",name:"Mohammed",middleName:null,surname:"Bsiss",slug:"mohammed-bsiss",fullName:"Mohammed Bsiss",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241400/images/8062_n.jpg",biography:null,institutionString:null,institution:null},{id:"276128",title:"Dr.",name:"Hira",middleName:null,surname:"Fatima",slug:"hira-fatima",fullName:"Hira Fatima",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/276128/images/14420_n.jpg",biography:"Dr. Hira Fatima\nAssistant Professor\nDepartment of Mathematics\nInstitute of Applied Science\nMangalayatan University, Aligarh\nMobile: no : 8532041179\nhirafatima2014@gmal.com\n\nDr. Hira Fatima has received his Ph.D. degree in pure Mathematics from Aligarh Muslim University, Aligarh India. Currently working as an Assistant Professor in the Department of Mathematics, Institute of Applied Science, Mangalayatan University, Aligarh. She taught so many courses of Mathematics of UG and PG level. Her research Area of Expertise is Functional Analysis & Sequence Spaces. She has been working on Ideal Convergence of double sequence. She has published 17 research papers in National and International Journals including Cogent Mathematics, Filomat, Journal of Intelligent and Fuzzy Systems, Advances in Difference Equations, Journal of Mathematical Analysis, Journal of Mathematical & Computer Science etc. She has also reviewed few research papers for the and international journals. 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Fungal infectious illness prevalence and prognosis are determined by the exposure between fungi and host, host immunological state, fungal virulence, and early and accurate diagnosis and treatment. \r\nPatients with both congenital and acquired immunodeficiency are more likely to be infected with opportunistic mycosis. Fungal infectious disease outbreaks are common during the post- disaster rebuilding era, which is characterised by high population density, migration, and poor health and medical conditions.\r\nSystemic or local fungal infection is mainly associated with the fungi directly inhaled or inoculated in the environment during the disaster. The most common fungal infection pathways are human to human (anthropophilic), animal to human (zoophilic), and environment to human (soilophile). Diseases are common as a result of widespread exposure to pathogenic fungus dispersed into the environment. \r\nFungi that are both common and emerging are intertwined. In Southeast Asia, for example, Talaromyces marneffei is an important pathogenic thermally dimorphic fungus that causes systemic mycosis. Widespread fungal infections with complicated and variable clinical manifestations, such as Candida auris infection resistant to several antifungal medicines, Covid-19 associated with Trichoderma, and terbinafine resistant dermatophytosis in India, are among the most serious disorders. \r\nInappropriate local or systemic use of glucocorticoids, as well as their immunosuppressive effects, may lead to changes in fungal infection spectrum and clinical characteristics. Hematogenous candidiasis is a worrisome issue that affects people all over the world, particularly ICU patients. CARD9 deficiency and fungal infection have been major issues in recent years. Invasive aspergillosis is associated with a significant death rate. Special attention should be given to endemic fungal infections, identification of important clinical fungal infections advanced in yeasts, filamentous fungal infections, skin mycobiome and fungal genomes, and immunity to fungal infections.\r\nIn addition, endemic fungal diseases or uncommon fungal infections caused by Mucor irregularis, dermatophytosis, Malassezia, cryptococcosis, chromoblastomycosis, coccidiosis, blastomycosis, histoplasmosis, sporotrichosis, and other fungi, should be monitored. \r\nThis topic includes the research progress on the etiology and pathogenesis of fungal infections, new methods of isolation and identification, rapid detection, drug sensitivity testing, new antifungal drugs, schemes and case series reports. It will provide significant opportunities and support for scientists, clinical doctors, mycologists, antifungal drug researchers, public health practitioners, and epidemiologists from all over the world to share new research, ideas and solutions to promote the development and progress of medical mycology.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/4.jpg",keywords:"Emerging Fungal Pathogens, Invasive Infections, Epidemiology, Cell Membrane, Fungal Virulence, Diagnosis, Treatment"},{id:"5",title:"Parasitic Infectious Diseases",scope:"Parasitic diseases have evolved alongside their human hosts. In many cases, these diseases have adapted so well that they have developed efficient resilience methods in the human host and can live in the host for years. Others, particularly some blood parasites, can cause very acute diseases and are responsible for millions of deaths yearly. Many parasitic diseases are classified as neglected tropical diseases because they have received minimal funding over recent years and, in many cases, are under-reported despite the critical role they play in morbidity and mortality among human and animal hosts. The current topic, Parasitic Infectious Diseases, in the Infectious Diseases Series aims to publish studies on the systematics, epidemiology, molecular biology, genomics, pathogenesis, genetics, and clinical significance of parasitic diseases from blood borne to intestinal parasites as well as zoonotic parasites. We hope to cover all aspects of parasitic diseases to provide current and relevant research data on these very important diseases. In the current atmosphere of the Coronavirus pandemic, communities around the world, particularly those in different underdeveloped areas, are faced with the growing challenges of the high burden of parasitic diseases. At the same time, they are faced with the Covid-19 pandemic leading to what some authors have called potential syndemics that might worsen the outcome of such infections. Therefore, it is important to conduct studies that examine parasitic infections in the context of the coronavirus pandemic for the benefit of all communities to help foster more informed decisions for the betterment of human and animal health.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/5.jpg",keywords:"Blood Borne Parasites, Intestinal Parasites, Protozoa, Helminths, Arthropods, Water Born Parasites, Epidemiology, Molecular Biology, Systematics, Genomics, Proteomics, Ecology"},{id:"6",title:"Viral Infectious Diseases",scope:"The Viral Infectious Diseases Book Series aims to provide a comprehensive overview of recent research trends and discoveries in various viral infectious diseases emerging around the globe. The emergence of any viral disease is hard to anticipate, which often contributes to death. A viral disease can be defined as an infectious disease that has recently appeared within a population or exists in nature with the rapid expansion of incident or geographic range. This series will focus on various crucial factors related to emerging viral infectious diseases, including epidemiology, pathogenesis, host immune response, clinical manifestations, diagnosis, treatment, and clinical recommendations for managing viral infectious diseases, highlighting the recent issues with future directions for effective therapeutic strategies.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/6.jpg",keywords:"Novel Viruses, Virus Transmission, Virus Evolution, Molecular Virology, Control and Prevention, Virus-host Interaction"}],annualVolumeBook:{},thematicCollection:[{type:"book",id:"11672",title:"Chemokines Updates",subtitle:null,isOpenForSubmission:!0,hash:"c00855833476a514d37abf7c846e16e9",slug:null,bookSignature:"Prof. Murat Şentürk",coverURL:"https://cdn.intechopen.com/books/images_new/11672.jpg",editedByType:null,submissionDeadline:"May 6th 2022",editors:[{id:"14794",title:"Prof.",name:"Murat",middleName:null,surname:"Şentürk",slug:"murat-senturk",fullName:"Murat Şentürk",profilePictureURL:"https://mts.intechopen.com/storage/users/14794/images/system/14794.jpeg",biography:"Dr. Murat Şentürk obtained a baccalaureate degree in Chemistry in 2002, a master’s degree in Biochemistry in 2006, and a doctorate degree in Biochemistry in 2009 from Atatürk University, Turkey. Dr. Şentürk currently works as an professor of Biochemistry in the Department of Basic Pharmacy Sciences, Faculty of Pharmacy, Ağri Ibrahim Cecen University, Turkey. \nDr. Şentürk published over 120 scientific papers, reviews, and book chapters and presented several conferences to scientists. \nHis research interests span enzyme inhibitor or activator, protein expression, purification and characterization, drug design and synthesis, toxicology, and pharmacology. \nHis research work has focused on neurodegenerative diseases and cancer treatment. Dr. Şentürk serves as the editorial board member of several international journals.",institutionString:"Ağrı İbrahim Çeçen University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Ağrı İbrahim Çeçen University",institutionURL:null,country:{name:"Turkey"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}],selectedSeries:null,selectedSubseries:null},seriesLanding:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"July 5th, 2022",hasOnlineFirst:!0,numberOfOpenTopics:4,numberOfPublishedChapters:320,numberOfPublishedBooks:32,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},subseries:[{id:"14",title:"Cell and Molecular Biology",keywords:"Omics (Transcriptomics; Proteomics; Metabolomics), Molecular Biology, Cell Biology, Signal Transduction and Regulation, Cell Growth and Differentiation, Apoptosis, Necroptosis, Ferroptosis, Autophagy, Cell Cycle, Macromolecules and Complexes, Gene Expression",scope:"The Cell and Molecular Biology topic within the IntechOpen Biochemistry Series aims to rapidly publish contributions on all aspects of cell and molecular biology, including aspects related to biochemical and genetic research (not only in humans but all living beings). We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics include, but are not limited to: Advanced techniques of cellular and molecular biology (Molecular methodologies, imaging techniques, and bioinformatics); Biological activities at the molecular level; Biological processes of cell functions, cell division, senescence, maintenance, and cell death; Biomolecules interactions; Cancer; Cell biology; Chemical biology; Computational biology; Cytochemistry; Developmental biology; Disease mechanisms and therapeutics; DNA, and RNA metabolism; Gene functions, genetics, and genomics; Genetics; Immunology; Medical microbiology; Molecular biology; Molecular genetics; Molecular processes of cell and organelle dynamics; Neuroscience; Protein biosynthesis, degradation, and functions; Regulation of molecular interactions in a cell; Signalling networks and system biology; Structural biology; Virology and microbiology.",annualVolume:11410,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"79367",title:"Dr.",name:"Ana Isabel",middleName:null,surname:"Flores",fullName:"Ana Isabel Flores",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRpIOQA0/Profile_Picture_1632418099564",institutionString:null,institution:{name:"Hospital Universitario 12 De Octubre",institutionURL:null,country:{name:"Spain"}}},{id:"328234",title:"Ph.D.",name:"Christian",middleName:null,surname:"Palavecino",fullName:"Christian Palavecino",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000030DhEhQAK/Profile_Picture_1628835318625",institutionString:null,institution:{name:"Central University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"186585",title:"Dr.",name:"Francisco Javier",middleName:null,surname:"Martin-Romero",fullName:"Francisco Javier Martin-Romero",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSB3HQAW/Profile_Picture_1631258137641",institutionString:null,institution:{name:"University of Extremadura",institutionURL:null,country:{name:"Spain"}}}]},{id:"15",title:"Chemical Biology",keywords:"Phenolic Compounds, Essential Oils, Modification of Biomolecules, Glycobiology, Combinatorial Chemistry, Therapeutic peptides, Enzyme Inhibitors",scope:"Chemical biology spans the fields of chemistry and biology involving the application of biological and chemical molecules and techniques. In recent years, the application of chemistry to biological molecules has gained significant interest in medicinal and pharmacological studies. This topic will be devoted to understanding the interplay between biomolecules and chemical compounds, their structure and function, and their potential applications in related fields. Being a part of the biochemistry discipline, the ideas and concepts that have emerged from Chemical Biology have affected other related areas. This topic will closely deal with all emerging trends in this discipline.",annualVolume:11411,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null,editorialBoard:[{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",fullName:"Abdulsamed Kükürt",profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",institutionString:null,institution:{name:"Kafkas University",institutionURL:null,country:{name:"Turkey"}}},{id:"241413",title:"Dr.",name:"Azhar",middleName:null,surname:"Rasul",fullName:"Azhar Rasul",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRT1oQAG/Profile_Picture_1635251978933",institutionString:null,institution:{name:"Government College University, Faisalabad",institutionURL:null,country:{name:"Pakistan"}}},{id:"178316",title:"Ph.D.",name:"Sergey",middleName:null,surname:"Sedykh",fullName:"Sergey Sedykh",profilePictureURL:"https://mts.intechopen.com/storage/users/178316/images/system/178316.jfif",institutionString:null,institution:{name:"Novosibirsk State University",institutionURL:null,country:{name:"Russia"}}}]},{id:"17",title:"Metabolism",keywords:"Biomolecules Metabolism, Energy Metabolism, Metabolic Pathways, Key Metabolic Enzymes, Metabolic Adaptation",scope:"Metabolism is frequently defined in biochemistry textbooks as the overall process that allows living systems to acquire and use the free energy they need for their vital functions or the chemical processes that occur within a living organism to maintain life. Behind these definitions are hidden all the aspects of normal and pathological functioning of all processes that the topic ‘Metabolism’ will cover within the Biochemistry Series. Thus all studies on metabolism will be considered for publication.",annualVolume:11413,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"243049",title:"Dr.",name:"Anca",middleName:null,surname:"Pantea Stoian",fullName:"Anca Pantea Stoian",profilePictureURL:"https://mts.intechopen.com/storage/users/243049/images/system/243049.jpg",institutionString:null,institution:{name:"Carol Davila University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"203824",title:"Dr.",name:"Attilio",middleName:null,surname:"Rigotti",fullName:"Attilio Rigotti",profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institutionString:null,institution:{name:"Pontifical Catholic University of Chile",institutionURL:null,country:{name:"Chile"}}},{id:"300470",title:"Dr.",name:"Yanfei (Jacob)",middleName:null,surname:"Qi",fullName:"Yanfei (Jacob) Qi",profilePictureURL:"https://mts.intechopen.com/storage/users/300470/images/system/300470.jpg",institutionString:null,institution:{name:"Centenary Institute of Cancer Medicine and Cell Biology",institutionURL:null,country:{name:"Australia"}}}]},{id:"18",title:"Proteomics",keywords:"Mono- and Two-Dimensional Gel Electrophoresis (1-and 2-DE), Liquid Chromatography (LC), Mass Spectrometry/Tandem Mass Spectrometry (MS; MS/MS), Proteins",scope:"With the recognition that the human genome cannot provide answers to the etiology of a disorder, changes in the proteins expressed by a genome became a focus in research. Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. The Proteomics topic aims to attract contributions on all aspects of MS-based proteomics that, by pushing the boundaries of MS capabilities, may address biological problems that have not been resolved yet.",annualVolume:11414,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null,editorialBoard:[{id:"72288",title:"Dr.",name:"Arli Aditya",middleName:null,surname:"Parikesit",fullName:"Arli Aditya Parikesit",profilePictureURL:"https://mts.intechopen.com/storage/users/72288/images/system/72288.jpg",institutionString:null,institution:{name:"Indonesia International Institute for Life Sciences",institutionURL:null,country:{name:"Indonesia"}}},{id:"40928",title:"Dr.",name:"Cesar",middleName:null,surname:"Lopez-Camarillo",fullName:"Cesar Lopez-Camarillo",profilePictureURL:"https://mts.intechopen.com/storage/users/40928/images/3884_n.png",institutionString:null,institution:{name:"Universidad Autónoma de la Ciudad de México",institutionURL:null,country:{name:"Mexico"}}},{id:"81926",title:"Dr.",name:"Shymaa",middleName:null,surname:"Enany",fullName:"Shymaa Enany",profilePictureURL:"https://mts.intechopen.com/storage/users/81926/images/system/81926.png",institutionString:"Suez Canal University",institution:{name:"Suez Canal University",institutionURL:null,country:{name:"Egypt"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"bookSubject",path:"/subjects/1158",hash:"",query:{},params:{id:"1158"},fullPath:"/subjects/1158",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()