The shoulder joint is one of the most mobile and flexible joints in the body, which also makes it unstable and more prone to injury. Shoulder pain is a fairly common occurrence in golfers, accounting for roughly 10-20% of all golf injuries. Shoulder injuries involve the lead shoulder in the vast majority of instances, in other words the left shoulder for a right-handed swing or the right shoulder for a left-handed swing. In one survey of professional golfers, lead shoulder injury was about 3 times more common than trail shoulder injury, and in another study capturing more of the golfing population over 90% of shoulder injuries affected the leading shoulder.

Pain can come from injury or dysfunction at a number of structures in the shoulder region. One type of condition is rotator cuff disease. The rotator cuff is a group of 4 muscles and tendons that help hold the humerus in place as well as produce various motions of the upper arm. A tear or strain of a rotator cuff muscle or tendon can cause pain.

Another source of potential pain is glenohumeral arthritis. The glenohumeral joint is the joint between the humerus and scapula and is the actual shoulder joint itself. It’s often referred to as a “ball-in-socket” joint, the ball being the humerus and the socket being the scapula. Arthritis is typically a chronic wear and tear related issue and more likely to be seen in the older population.

Arthritis can also affect the acromioclavicular joint-- where the clavicle meets the acromion-- and can often result in pain on top of the shoulder.

Shoulder instability is another source of pain. Shoulder instability is a problem resulting from the surrounding structures failing to keep the shoulder joint firmly in place, or in other words failing to keep the ball inside the socket. The support structures of/around the shoulder joint include the boney joint surface, the labrum, multiple ligaments, the shoulder capsule, and numerous muscles and tendons. Repetitive microtrauma, repetitive stress from over-stretching, a history of shoulder dislocation, activity in overhead sports, or being born that way with extra-lax ligaments can contribute to shoulder instability. The sliding of the ball out of the socket is often painful.

What to do if you are having shoulder pain? See a doctor of course. I’m partial toward Physical Medicine and Rehabilitation doctors-- physiatrists-- in particular. Often, you may need to take a break from golfing to allow your body to heal while undergoing a physical therapy program. Chipping and putting practice should be okay but if you continue to take full swings before addressing the underlying musculoskeletal problem, the problem is likely to continue if not get worse. Physical therapy may include strengthening and stretching exercises geared around the shoulder especially scapular stabilizers and rotator cuff muscles. Core work is also an indispensable part of physical therapy programs.

In addition, it could be worth getting evaluated by a golf teaching professional. Swing modifications or club modifications could be essential to reduce your risk of recurrent shoulder problems. Simple changes such as shortening the backswing or the follow through can lessen straining forces placed on the shoulder in these positions. Additionally, keeping the arms and hands positioned in front of the chest as much as possible during the swing may also reduce stress on the shoulder. Leg, hip, and trunk flexibility can help achieve upper torso rotation during the backswing and reduce forces on the shoulder.

In sum, the shoulder is a complex part of the body with many moving parts and potential sources of injury. Shoulder injury in the golfer is most likely to affect the leading shoulder. A multidisciplinary approach involving a physiatrist, physical therapist, and teaching professional has been shown to be highly effective in returning golfers to their prior level of play as well as preventing re-injury.

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Sources:

- Escamilla RF, Andrews JR. Shoulder muscle recruitment patterns and related biomechanics during upper extremity sports. Sports Med. 2009;39(7):569-90.

- Liem D, Gosheger G, Schmidt C. [Shoulder injuries in golf]. Orthopade. 2014;43(3):244-8.

- Mchardy A, Pollard H, Luo K. Golf injuries: a review of the literature. Sports Med. 2006;36(2):171-87.

- Zouzias IC, Hendra J, Stodelle J, Limpisvasti O. Golf Injuries: Epidemiology, Pathophysiology, and Treatment. J Am Acad Orthop Surg. 2018;26(4):116-123.