Shoulder Injuries in Golfers

Thanks in no small part to Tiger Woods, the popularity of golf is growing throughout the world. Children as well as adults are taking up the sport in record numbers. With the increase in players, physicians specializing in the musculoskeletal system will be seeing more and more golf-related injuries. The shoulder is the fourth most commonly injured site in golfers (after the elbow, wrist, and low back). Imagine swinging a club with a painful shoulder. It's easy to see how important the shoulder is to the golf swing.

Shoulder problems in golf are commonly overuse injuries, but traumatic injuries do occur. Injuries to muscles and tendons (tissues that attach muscles to bones) range from minor strains to complete tears. Strains occur when the muscle or tendon is pulled but does not completely tear. The rotator cuff muscles of the shoulder and their tendons are very active throughout the golf swing. Inflammation of the rotator cuff tendons, or tendinitis, and even tears of the rotator cuff can occur with overuse or poor swing mechanics. Studies have shown that compared with amateurs, professional golfers do not rely as heavily on their rotator cuff muscles during the swing. Proper technique is a first step in preventing injury, and a lesson from a golf instructor can get you started down the right path.

When one thinks about shoulder problems in golfers, it is important to consider the age and individual mechanics of each golfer. Injuries usually occur in the lead arm but can occur in the trailing arm as well. Younger golfers (less than 35 years old) are more likely to have problems with inflammation and strains, while older golfers may experience complete tears of the rotator cuff and degenerative changes in the joint, such as bone spur formation.

Initially, injured golfers should be treated with a decrease in their playing time, ice, physical therapy, and nonsteroidal anti-inflammatory medications. If they continue to have pain, further examination or treatment is warranted. This may include injections into the shoulder, x-rays or an MRI (magnetic resonance imaging) scan (test that shows the bones, muscles, tendons, and ligaments). If patients continue to have pain and dysfunction after a thorough treatment program, surgery may be necessary.

Subacromial bursitis which is persistent inflammation above the rotator cuff tendons, can be treated arthroscopically (examination or treatment of a joint through small incisions) by removing the inflamed tissue. Similarly, bone spurs that dig into the rotator cuff can be removed, or if a tendon is significantly torn, it can be repaired arthroscopically.

Shoulder problems in golfers can usually be avoided with proper lessons and warm-up exercises. However, if you do experience pain that does not improve within 7 to 10 days, you should see your physician for an evaluation. A delay in diagnosis and treatment can lead to further damage and the need for more involved treatment such as surgery. A delay could keep you off the links for a while, and that's something we all want to avoid.

David D. Nedeff, M.D.
Columbus, Georgia

Further reading:
Theriault G, Lachance P. Golf injuries: an overview. Sports Med. 1998;26(1):43-57. Jobe FW, Pink MM. Shoulder pain in golf. Clin Sports Med. 1996;15(1):55-63.