What to do if rotator-cuff injuries keep you from enjoying golf

Published 02/08/2012 19:55:00

Mention "rotator-cuff injury,'' and most often you think of hard-throwing pitchers and quarterbacks. Immediately, the dreaded phrase "career threatening" comes to mind.

Golfers, too, suffer shoulder injuries and fear their effects on their games. A number of Senior PGA Tour players have had rotator-cuff problems during their careers, among them Gil Morgan and Calvin Peete. Morgan solved his by undergoing surgery. Tom Watson and Bernhard Langer have also been sidelined by shoulder woes.

The good news: When properly diagnosed and treated, most golf-related shoulder injuries can be overcome. In fact, the players named above have returned to competitive golf. You, too, can get your "A" game back after a shoulder injury by learning a more shoulder-friendly swing and, even more important, following the strength and flexibility exercises detailed later in this article.

The shoulder's rotator cuff is a series of four muscles surrounding the bone of the upper arm (the humerus) just like a "cuff." The muscles help to rotate the arm.

Most golfers with rotator-cuff problems get them in the lead arm (the left arm for right-handed players). The most common affliction is tendinitis. Here one or more of the tendons that form the rotator cuff becomes inflamed and painful. Raising the arm above shoulder height is especially hurtful, although often a person will have pain only through a short arc of elevation (sometimes termed a "painful arc" syndrome).

Another common shoulder problem is bursitis. A bursa is a fluid-filled sac that overlies the tendons of the rotator cuff. Its purpose is lubrication. It can also become inflamed and filled with fluid, causing pain. The tendons and the bursa are so close together that many times the two problems coexist.

A more problematic injury is when the rotator cuff tears completely apart. Although sportswriters often talk about this happening to athletes, a torn rotator cuff is not a common scenario, especially among golfers. Primarily a degenerative disease, in which the rotator cuff tears from years of attrition, it is usually, but not always, preceded by warning signs of painful tendinitis or bursitis.

Another less frequent and more subtle problem is that the shoulder may be unstable, attempting to dislocate or slip out of joint. When there's a potential for dislocation, continued instability and pressure on the tendons may cause them to stretch, resulting in painful tendinitis. Simply treating the tendinitis will often be unsuccessful, because the underlying cause has not been addressed.

What are some rotator-cuff symptoms? If you have pain in your shoulder during muscular activity-if it hurts to raise an arm above shoulder level, or you have a "painful arc" of elevation, or your shoulder hurts worse at night when you're lying down and, especially, if you're over 40, you should suspect you have a rotator-cuff problem.

Could it be anything else? Yes-and if you're not certain, have the problem evaluated by a doctor. One very important point to remember is that heart problems can cause shoulder pain, most commonly in the left shoulder. The key differential here is muscular activity versus aerobic activity: If you experience pain in your left shoulder only while walking, especially upstairs or uphill, or during any vigorous activity that does not involve your arms, I would strongly suggest you get to a cardiologist to be checked out.Is there any way to tell if you simply have tendinitis or if the rotator cuff is torn?

That specific diagnosis is best left to a physician, who will look for some subtle changes on X-rays and test for weakness in certain movements around the shoulder. In many cases, orthopedists prefer to perform magnetic resonance imaging (MRI) or an ultra-sound to be certain.

Most rotator-cuff problems are simply "overuse" injuries that respond to standard sports-medical protocols of rest, ice, compression and elevation (RICE). Avoiding painful activities for a few weeks to rest your shoulder is often all the treatment that's needed. Applying ice when it hurts will also help decrease inflammation.

Compression and elevation are difficult in the shoulder, but elevation can be achieved, if necessary, by sleeping sitting up, or in a recliner, or with several pillows.

The next, most common treatment for rotator-cuff problems involves exercise and, often, an anti-inflammatory medication. Most orthopedists will start patients with such injuries on a rehabilitation regimen based on strengthening certain muscles around the shoulder (see page 160). Many rotator-cuff problems respond well to this treatment.

Anti-inflammatory medication can be as simple as aspirin or other over-the-counter medications now avail-able. In more severe cases, prescription anti-inflammatory medicines can be tried. One caution: All of these medications can cause stomach upset and even an ulcer if used excessively. If you have an ulcer, or have had one, you should not use these medicines without being under a doctor's care. A history of kidney problems is another reason to avoid their use, unless prescribed by your doctor and used with care.

Use a shoulder-friendly swing

If you want to keep playing despite shoulder problems, try these simple swing adjustments (see previous page). Remember, elevation of the arm usually causes the rotator cuff to hurt. That position should be avoided.

The two best ways then are to (1) shorten your backswing and (2) keep it slightly flatter. (A long backswing, and an upright one, will cause your hands to become more elevated, potentially hurting your rotator cuff.) Because the right arm is relatively protected, few adjustments are usually needed in the downswing or follow-through. Turning your hips more will take some stress off the shoulder area.

More important, be certain to warm up carefully before going out to play. You should do some gentle stretching exercises to loosen up your shoulders. Make sure you hit a few balls on the practice tee, starting out with short clubs and easy swings. Deep-heating salves and creams may also help your shoulders stay warm while playing.

The last resort: surgery

If your rotator cuff is not torn and tendinitis is the cause of your discomfort, your orthopedist may recommend an acromioplasty. In this operation, a portion of the bone overlying the rotator cuff is removed to take pressure off the cuff and decrease any mechanical impingement that may be causing the tendinitis. This operation usually keeps you off the golf course six to 12 weeks.

Recovery will be slower if you have a complete rotator-cuff tear, and you elect to have it surgically re-paired. The operation is virtually al-ways done with an open incision and involves pulling the tendon back down into the bone and holding it there with sutures. You should not expect to play golf any earlier than three months after this operation, and more likely, six months.

Except in cases of very large rotator-cuff tears, most golfers will eventually be able to return to the course. It will take time, rehabilitation and practice, but take heart-you can get there from here.



1.  This is a mainstream arthroscopic procedure,NOT open incision.

comment by David Knight - 13/02/2013 07:44

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