How common it is, and which sideEmerging evidence
No study counts the causes of shoulder pain across all golfers. In 910 amateurs followed for a season, the shoulder caused 0.33 injuries a golfer a year and the second-largest loss of golf after the lower back (3.47 days a player a year). It was 11.8% of injuries in 588 Australian amateurs and 4% to 19% of amateur injuries across studies, and in 363 Korean women professionals over 2 seasons the shoulder and collarbone were the commonest injury site (15.6%).
In competitive golfers, the lead shoulder dominates: 34 of 35 competitive golfers with shoulder pain had it in the lead shoulder, and reviews say it was hurt about 3 times as often as the trail shoulder in a survey of professionals. In club golfers it's less clear: in 1,170 male golfers, 10.5% had right shoulder pain and 8.7% left shoulder pain in the past week, so the trail shoulder (the right, for most) hurt slightly more often. Reviews think higher-handicap golfers are hurt mostly through swing mechanics, and low-handicap and professional golfers mostly through overuse.
Sources 1, 2, 3, 4, 5, 6, 7, 8
What the swing asks of the shoulderEmerging evidence
At the top of the backswing, the lead arm is raised, turned inward and pulled across the chest: the position that squeezes the AC joint and the cuff tendons and stretches the back of the joint. The trail arm is raised and turned out, like the start of a throw, and older golfers turned it out about 38 degrees less than college golfers. The finish turns the lead arm out and brings the trail arm across the chest, which is why pain at the end of the follow-through also fits the cuff (our reading).
Muscle studies with fine wire electrodes in small numbers of professionals found the subscapularis (at the front of the shoulder blade) the most active cuff muscle throughout, the deltoid largely quiet, and the big chest and back muscles powering the downswing on both sides; the serratus anterior, which holds the shoulder blade to the ribs, worked through every phase on the lead side. Peak rotator cuff effort in golf, at about 28% to 68% of maximum, is well below baseball pitching (up to 99%).
Sources 7, 9, 10, 11, 12, 13, 14, 15
The causes, and what's commonEmerging evidence
In a series of 35 competitive golfers with shoulder pain, 53% of those with lead shoulder pain had AC joint problems. Reviews name rotator cuff pain (impingement), cuff tears, AC joint and shoulder arthritis and, less often, a loose shoulder as golfers' common problems; in 8 elite golfers with lead shoulder pain at the top of the backswing, all had a loose shoulder at the back. The NHS links pain on top of the shoulder, where the collarbone and shoulder joint meet, with the AC joint, and the AAOS says people over 40 are at greater risk of a rotator cuff tear because tears mostly come with normal wear as we age.
The NHS says shoulder impingement usually gets better in a few weeks or months, and frozen shoulder can take months or years. A joint infection (septic arthritis) is rare but urgent: sudden severe pain in a joint, which is hot, swollen or red, often with a high temperature, although not everyone has one.
Sources 6, 16, 9, 8, 17, 18, 19, 20, 21
When a scan or test mattersEmerging evidence
Most golfers' shoulder pain is recognised from the story and an examination, and the NHS says a health professional might send you for tests such as an X-ray. An X-ray shows AC joint and shoulder arthritis; an ultrasound or magnetic resonance imaging (MRI) scan looks at the rotator cuff when surgery is being considered, or after a fall with sudden weakness, when a tear needs urgent referral. Scans mislead on their own: as our rotator cuff tear guide says, many cuff tears cause no symptoms at all.
Sources 17, 18
How it usually goesEmerging evidence
The NHS says you usually need to look after a sore shoulder for 2 weeks before it starts to ease, and it can take 6 months or longer to recover from shoulder pain; the AAOS says complete relief from rotator cuff pain typically takes 2 to 4 months but may take up to a year. In golfers, 17 of 18 competitive golfers with AC joint problems returned to competitive golf, and all 8 elite golfers with a loose shoulder were back at their previous level, 2 after rehab alone.
After a rotator cuff repair, 73.6% of 197 Korean golfers returned, mostly between 6 months and a year, and 76.3% of 47 Edinburgh golfers returned; handicaps were 1.2 shots worse at a year and back to their old level by two in another study. No one can promise a date.
Sources 17, 22, 6, 16, 23, 24, 25
