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Fore . . . a Better Golf Swing

Doctors are reporting a new shoulder problem in elite golfers. These are competitive golfers at the amateur, collegiate, or professional level. These golfers swing 2,000 times or more each week, and they golf with a handicap of five or less.

In technical terms, the problem involves shoulder impingement and posterior instability. Impingement is a pinching of tendons or soft tissue between two bones of the shoulder. This occurs during movement. Overuse can lead to a loss of soft tissue form and strength around the joint. This results in an unstable joint.

The golfer may begin to notice problems in the "lead" arm during the back swing. This occurs either at the beginning of a swing or at the top of the back swing. The lead arm is the one that first crosses the body during the forward swing. For a right-handed golfer, this is the left arm.

Pain and a "pop" or "clunk" are the most common symptoms of these two problems. The pain is caused by stress on the lead shoulder as it moves into a position that loads the shoulder joint. Over time and with overuse, the fibrous tissue around the joint (called the joint capsule) can get stretched out or torn. The back of the shoulder (posterior) becomes unstable at the top of the back swing.

This can cause the head of the humerus (the top of the long upper arm bone) to slip out of the shoulder socket. The golfer then hears and feels a pop or clunk when the head slips back into the socket.

Treatment is most successful when both problems are identified and treated. Now that doctors are aware of these conditions, studies will be done to find out what treatment is best. For now, a rehab program of strengthening the muscles is advised before surgery. Surgery is done to take pressure off the pinched tissues. If the capsule is torn, it can be repaired and tightened up.

References: W. David Hovis, MD, et al. Posterior Instability of the Shoulder with Secondary Impingement in Elite Golfers. In American Journal of Sports Medicine. November/December 2002. Vol. 30. No. 6. Pp. 886-890.

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