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Objective: To analyze the patterns and causes of tennis-related injuries using, for the first time, a nationally representative dataset. Design: A retrospective cohort analysis was performed using the National Electronic Injury Surveillance System database. Setting: All tennis-related injuries treated in U.S. emergency departments (EDs) from 1990 to 2011 were analyzed. Patients: During the study period, an estimated 492,002 (95% CI=364668-619336) individuals, ages 5 to 94 years, presented to U.S. EDs for tennis-related injuries. Assessment of Risk Factors: Independent variables include patient age and gender, mechanism of injury, and location of injury event. Main Outcome Measures: Outcome variables include injury diagnosis, body region injured, disposition from ED, and involvement of the net. Results: Most injuries were sustained by a nonspecific mechanism during play (37.9%) and occurred at a sport or recreation facility (83.4%). Children ages 5-18 years had a higher mean injury rate than adults older than 19 years. The most commonly injured body regions were the lower extremities (42.2%) and upper extremities (26.7%). Sprains or strains (44.1%) were the most common type of injury. The number of tennis-related injuries decreased by 41.4% from 1990 to 2011, and the rate of these injuries decreased by 45.2% - 53.4% during a 12-18 year period. Among the 3.4% of patients who were admitted to the hospital, two-thirds (65.6%) involved patients 56 years of age or older. Conclusions: Despite the decrease in tennis-related injuries, the growing popularity of this sport warrants increased efforts to prevent injuries, especially among child and older adult participants.