Posterior instability of the shoulder with secondary impingement in elite golfers.

BACKGROUND Shoulder injuries in golf are related to the biomechanics of the golf swing and typically occur in the lead arm at the top of the back swing. PURPOSE We report a newly recognized entity in a series of elite golfers: posterior glenohumeral instability associated with subacromial impingement. STUDY DESIGN Retrospective review. METHODS Eight elite golfers were treated between March 1991 and July 1998 for pain occurring in the nondominant, lead shoulder at the top of the back swing. Posterior instability was diagnosed in all eight patients; six of the eight also demonstrated signs of subacromial impingement. Initial treatment consisted of rehabilitation. For patients in whom rehabilitation failed, surgery was performed. RESULTS Two patients improved with nonoperative treatment and returned to play immediately. Six patients underwent shoulder arthroscopy with posterior thermal capsulorrhaphy. Four of the six also underwent arthroscopic subacromial decompression. The six surgically treated patients returned to play at an average 4 months after surgery. At an average 4.5 years of follow-up, all eight patients were playing at their previous level of competitive play. One patient had complications that led to the need for subsequent arthroscopic subacromial decompression; she eventually returned to competitive play. CONCLUSION Clinicians should be aware of posterior shoulder instability and the associated secondary diagnosis of rotator cuff impingement as a possible cause of shoulder pain in elite golfers.