Upper Extremity Golf Injuries (P1)
Golf is a global sport enjoyed by an estimated 60 million people around the world. Despite the common misconception that the risk of injury during the play of golf is minimal, golfers are subject to a myriad of potential pathologies. While the majority of injuries in golf are attributable to overuse, acute traumatic injuries can also occur. As the body’s direct link to the golf club, the upper extremities are especially prone to injury. A thorough appreciation of the risk factors and patterns of injury will afford accurate diagnosis, treatment, and prevention of further injury.
The game of golf originated on the eastern links of Scotland. The earliest recorded mention of golf in Scotland was in a 1457 Act of the Scottish Parliament issued by King James II outlawing the game as he felt it was a distraction from archery practice for military purposes. The oldest golf course in the world is Musselburgh Links, which has documentation of play since 1672. There is even some evidence that Mary Queen of Scots played there as early as 1567.
In recent decades, golf has seen a boom in popularity in part from television coverage, worldwide growth in golf course development, and the emergence of superstars such as Arnold Palmer, Jack Nicklaus, and Tiger Woods. Golf is an activity regularly enjoyed by many millions of people across the world. In 2008, the National Golf Foundation estimated there were 28.6 million golfers in the United States alone. There are an estimated 60 million golfers worldwide playing on 32,000 golf courses. The purpose of this paper is to review the epidemiology of golf injuries, the kinematics of the golf swing, and injury diagnosis and prevention in golfers.
Golf has mistakenly been considered a sport without much physical demand. However, golfers do experience significant injuries. A recent study found that over a 2 year period, 60% of professionals and 40% of amateurs experienced a traumatic or overuse golf injury. Shoulder, elbow, wrist, and hand injuries rank amongst the most common in golfers.
McCarroll surveyed a cohort of professional and amateur golfers (Table 1). Too much play or practice was the most commonly reported mechanism of injury in both groups. Amateurs also blamed poor swing mechanics and hitting the ground for a large portion of their injuries. Batt surveyed 193 amateur golfers from a single English golf club about their golfing injuries. Thirty two percent of those surveyed reported sustaining injuries on the golf course. Poor swing mechanics and overuse were the two most commonly cited causes. In a group of amateur golfers, Thériault and coworkers observed a slightly more frequent pattern of overuse injury [67/123 (54.5%)] compared with a single traumatic event [56/123 (45.5%)]. In a study of 412 amateur golfers, Jobe and Yocum noted the most common factor for injury was overpractice. They reported the most common sites of injury in descending order were the back, shoulder, elbow, and knee. McCarroll and associates, in a survey with 1,144 amateur respondents, reported the back as the most common site of injury, followed by the elbow, hand and wrist, and shoulder. In a study of professional golfers, McCarroll and colleagues found that wrist injuries were most common, followed by injuries to the back, left hand, left shoulder, left knee, and left thumb (in reference to a right-handed golfer).
The frequency of injuries increases with improved skill level, which is correlated to a golfer’s handicap. A golf handicap roughly estimates how many shots above par the golfer averages over an 18-hole round of play. More skilled golfers carry lower handicaps. In a 1990 survey of 1,144 amateur golfers, those with handicaps greater than 18 had a 59% rate of injury, while those with handicaps from 10 to17 had a 61.8% rate of injury, and golfers with a handicap under 10 had a 67.5% injury rate. This can be attributed to the fact that highly-skilled golfers must practice the game many hours a week to maintain or improve their level of play, which lends itself to more overuse injuries.
There are serveral identifiable risk factors for golf injuries. Excessive play or practice leads to a spectrum of overuse injuries. Golfers also sustain hand, wrist, and elbow injuries when striking an unintended object at impact such as a tree root or rock. Additionally, risk factors for amateurs include injuries as a result of poor conditioning, inadequate warm-up, and faulty swing mechanics.