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Golf injuries of the upper extremity.

Golf has demonstrated increasing popularity and with this heightened enthusiasm has come an increased awareness of the significant number of injuries associated with playing golf. While back injuries represent the most commonly injured specific body part, upper extremity injuries are most frequent overall and the most likely to result in loss of play. Patterns of injury differ based on level of play and time spent playing or practicing golf. Among golf professionals, the hand/wrist is the most commonly injured upper extremity structure. Among amateurs, the elbow is most commonly injured. The vast majority of upper extremity injuries are due to overuse. Age, ability, equipment, and swing mechanics also play contributing roles. Most upper extremity golf injuries can be successfully treated with appropriate cessation or modification of play, anti-inflammatory modalities, and rehabilitation. Surgical treatment is rarely required, but if needed can prove successful in a high percentage of patients.

Carpal Bones↗

Ocular trauma resulting from the explosive rupture of a liquid center golf ball.

The likelihood of a patient seeking consultation with an ocular injury due to puncturing and subsequent explosive rupture of a golf ball seems remote. This very set of circumstances occurred at our V.A. Medical Center Optometry clinic. Golf ball manufacturers receive inquiries each year concerning the makeup of these liquid centers. Lack of current available information from ophthalmic journals or poison control centers prompted an inquiry into the exact nature of these golf balls. Further concern was for the measured alkalinity and extreme pressure exhibited by the liquid center golf ball brought in by the patient just after injury occurred. A case report is presented. Retrospective evaluation of previous literature is reviewed as well as information from golf ball manufacturers.

Adult↗

How the use of chlorothalonil on golf courses impacts Paenibacillus sp., a pathogen of Ataenius spretulus (Coleoptera: Scarabaeidae).

One of the most frequently used fungicides on golf courses, chlorothalonil, was applied to field plots at four different golf courses to determine how Ataenius spretulus Haldeman, Aphodius granarius L., carabids, staphylinids, formicids and Paenibacillus sp. were affected. Chlorothalonil had no influence on the incidence of Paenibacillus sp. infection of A. spretulus larvae in golf course fairways. The incidence of Paenibacillus sp. infection of A. spretulus larvae was much greater in the rough (47.4%) compared with the fairway (26.4%) at Cattails Golf Club despite a more dense population (fourfold) of larvae in the fairway. Chlorothalonil treatment of turf plots had no influence on the number of staphylinids, carabids, formicids, or A. spretulus adults caught in pitfall traps. It also did not affect the density of A. spretulus larvae. Data from this study suggest that the widespread use of chlorothalonil on fairways is not likely to cause outbreaks of A. spretulus on golf courses.

Animals↗

Biochemical characterization of three stimulatory GTP-binding proteins. The large and small forms of Gs and the olfactory-specific G-protein, Golf.

The biochemical properties of three stimulatory guanine nucleotide-binding protein (G-protein) alpha subunits, the large and small forms of Gs, Gs-l (52 kDa) and Gs-s (45 kDa), and the olfactory specific G-protein, Golf, have been compared. Complementary DNAs (cDNAs) encoding each alpha subunit were independently expressed in a mammalian cell line deficient in endogenous stimulatory G-proteins (S49 cyc-kin-). Gs-l and Gs-s respond similarly to activation by the beta-adrenergic agonist isoproterenol (EC50 = 80 and 60 nM, respectively) and the receptor-independent G-protein activators guanosine 5-O-3-(thio)triphosphate) (GTP gamma S) and AlF-4. The ability of Golf to interact with the beta-adrenergic receptor was also examined. Surprisingly, Golf interacts with beta-adrenergic receptors and is activated by isoproterenol (EC50 = 120 nM). All three G-proteins respond similarly to treatment with different alpha, beta, and gamma thiophosphoryl analogs of GTP. Specifically, (R)-GTP alpha S and GTP gamma S activate each G-protein, whereas (S)-GTP alpha S and (R)- or (S)-GTP beta S are inactive. In addition, similar to Gs alpha, Golf alpha is covalently modified and constitutively activated by cholera toxin. These studies demonstrate that all three stimulatory G-proteins are functionally and structurally similar, however, subtle differences between Golf and the two forms of Gs appear to modulate their interactions with receptors.

Adenylyl Cyclases↗

Golf course development in a major tourist destination: implications for planning and management.

The planning and design of golf course developments is influenced by many factors. This paper focuses on the environmental ramifications of insufficient or lack of compliance with standard environmental and economic planning practices. Specifically, it looks at a tourist destination location that was under the influence of extensive land development and investment speculation. The Gold Coast in Australia was the focal point for large overseas investment due to changes in government legislation regarding foreign investment. Due to the economic climate in the second half of the 1980s many golf course resort developments were built, approved, or planned. Many of these circumvented normal business and environment planning processes. The result has been a dangerous concentration of golf facilities in environmentally sensitive areas and an oversupply of golf facilities. Both of these matters are discussed in terms of the general planning process and the potential economic and environmental impacts to the Gold Coast and similar destinations in other parts of the world.

Commerce↗

Pediatric golf-related head injuries.

OBJECTIVES: Golf-related head injuries constitute an increasingly common mechanism of head trauma in children. We present our experience with 33 pediatric cases of golf-associated head injury, with special emphasis in the type of injury, management strategy, and outcome. MATERIALS AND METHODS: A thorough review of all children admitted to our hospital with golf-related head injury during a period of 10 years (1 January 1994 to 31 December 2003) was undertaken. The patients' charts, operative reports, imaging studies, and follow-up data were analyzed. A comparison of our findings with those described in the pertinent literature was subsequently performed. CONCLUSIONS: Pediatric golf-related head trauma is a significant cause of sport-associated head injury, sometimes harboring a very dismal prognosis. The significance of establishing a task force for the prevention of these injuries cannot be overemphasized.

Adolescent↗

Use of comet and micronucleus assays to measure genotoxicity in meadow voles (Microtus pennsylvanicus) living in golf course ecosystems exposed to pesticides.

The purpose of this study was to conduct a biomonitoring study to measure the effects of pesticide exposure in meadow voles (Microtus pennsylvanicus) living in golf courses of the Ottawa/Gatineau region of Canada. In this article we present the results from the comet and micronucleus assay. Voles were captured in 2001 and 2002 at five golf courses and two reference sites. Blood was collected from sedated voles. Three animals from each course were euthanized to determine body burdens of historically used organochlorine (OC) and metal-based pesticides. Exposure to in-use pesticides was determined from detailed golf course pesticide use records. Comet tail length and tail moment were not related to body burdens of OC pesticides and metals historically used on these golf courses. In generally, tail length and moment significantly decreased in relation to days since last application of a pesticide, and to days since the last application of a specific fungicide (Daconil) containing a potentially genotoxic active ingredient (chlorothalonil). The slopes of these curves in 2002 were not significantly different than the half-life decay curve of chlorothalonil on vegetation. Both comet assay parameters appeared to increase in a dose-dependent manner with the amount of the last application Daconil. The number of micronucleated polychromatic erythrocytes was not related to any pesticide application parameter.

Animals↗

A controlled trial of the health benefits of regular walking on a golf course.

PURPOSE: To study the effects of regular walking during a golf game on various health and fitness indicators in middle-aged men. METHODS: Study subjects were 55 healthy male golfers aged 48 to 64 years who had been sedentary during the 7 months before the study, and 55 age-matched, similarly sedentary controls. During the 20-week study, those in the intervention group were encouraged to play golf two to three times a week; the controls were not. Measurements of body composition, cardiorespiratory performance, motor and musculoskeletal fitness, blood pressure, and serum lipid, glucose, and insulin levels were obtained at baseline and after the 20-week study. RESULTS: Walking during a golf game was a practical and safe form of physical activity with high adherence. It significantly increased aerobic performance and trunk muscle endurance, with a net difference (pretraining to posttraining change between the golfers and controls) of 36 seconds (95% confidence interval [CI]: 19 to 53 seconds, P < 0.001) for treadmill walking time and 13 seconds (95% CI: 2 to 24 seconds, P = 0.02) for static back extension. In addition, regular walking favorably affected body composition, including reductions in weight of 1.4 kg (95% CI: 0.6 to 2.1 kg, P < 0.001), in waist circumference of 2.2 cm (95% CI: 1.0 to 3.3 cm, P < 0.001), and in abdominal skin fold thickness of 2.2 cm (95% CI: 0.9 to 3.4 cm, P = 0.001). Golfers also had significantly greater increases in serum high-density lipoprotein (HDL) cholesterol levels and in the ratio of HDL cholesterol to total cholesterol. CONCLUSIONS: Regular walking had many positive effects on the health and fitness of sedentary middle-aged men. Walking during a golf game is characterized by high adherence and low risk of injury and is therefore a good form of health-enhancing physical activity.

Aged↗

Arsenic transport and transformation associated with MSMA application on a golf course green.

The impact of extensively used arsenic-containing herbicides on groundwater beneath golf courses has become a topic of interest. Although currently used organoarsenicals are less toxic, their application into the environment may produce the more toxic inorganic arsenicals. The objective of this work was to understand the behavior of arsenic species in percolate water from monosodium methanearsonate (MSMA) applied golf course greens, as well as to determine the influences of root-zone media for United State Golf Association (USGA) putting green construction on arsenic retention and species conversion. The field test was established at the Fort Lauderdale Research and Education Center (FLREC), University of Florida. Percolate water was collected after MSMA application for speciation and total arsenic analyses. The results showed that the substrate composition significantly influenced arsenic mobility and arsenic species transformation in the percolate water. In comparison to uncoated sands (S) and uncoated sands and peat (S + P), naturally coated sands and peat (NS + P) showed a higher capacity of preventing arsenic from leaching into percolate water, implying that the coatings of sands with clay reduce arsenic leaching. Arsenic species transformation occurred in soil, resulting in co-occurrence of four arsenic species, arsenite (As(III)), arsenate (As(V)), monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) in percolate water. The results indicated that substrate composition can significantly affect both arsenic retention in soil and arsenic speciation in percolate water. The clay coatings on the soil particles and the addition of peat in the soil changed the arsenic bioavailability, which in turn controlled the microorganism-mediated arsenic transformation. To better explain and understand arsenic transformation and transport after applying MSMA in golf green, a conceptual model was proposed.

Arsenic↗

Traumatic intracerebral venous thrombosis associated with an abnormal golf swing.

OBJECTIVES: To describe the occurrence of cerebral venous thrombosis in a 40-year-old man whose cerebral event was induced by a poor golf swing, to review the literature on possible mechanisms producing venous thrombosis, and to compare this case with the literature. BACKGROUND: Headache is the most frequent symptom in patients with cerebral venous thrombosis. However, patients presenting with a headache due to cerebral venous thrombosis are uncommon. The known risk factors for thrombosis include both acquired and genetic factors. When the interaction of these two groups occurs, the magnitude of this interaction is thought to produce a dynamic state that can favor thrombosis. Our case report illustrates that moderate levels of anticardiolipin antibodies together with the mild trauma of a golf swing can induce a cerebral venous thrombosis. This case also suggests that although headache is rarely due to cerebral venous thrombosis, it should be excluded by good medical acumen and testing. RESULTS: Minor trauma induced by a poor golf swing was chronologically related to the development of a progressive cerebral venous thrombosis. The patient had none of the risk factors associated with a predisposition to venous thrombosis: hypercoagulable state, concurrent infection, pregnancy/puerperium, collagen vascular disorder, malignancy, migraine, false-positive VDRL, previous deep vein thrombosis, renal disease, factor V Leiden, or a hematological disorder. There was no anatomical abnormality that would predispose the patient to a cerebral venous thrombosis. The only laboratory abnormality was a moderate anticardiolipin antibody level (25 GPL). The patient was placed on warfarin sodium therapy and is currently without clinical sequela from the venous thrombotic event. CONCLUSIONS: Under certain circumstances, minor trauma can induce cerebral venous thrombosis. A review of the literature indicates that cerebral venous thrombosis in the presence of anticardiolipin antibodies and in the absence of systemic lupus erythematosus is a rare event. Previously, only major traumatic events have been reported to be associated with cerebral venous thromboses. The chronological development of cerebral venous thrombosis after a faulty golf swing strongly indicates that given a background of moderate levels of anticardiolipin antibodies, even minor trauma can induce a venous thrombotic event.

Adult↗

Ehrlichiosis in a golf-oriented retirement community.

BACKGROUND: Ehrlichiosis due to Ehrlichia chaffeensis usually occurs sporadically or in small clusters, with an annual incidence estimated at 3 to 5 cases per 100,000 population in areas of endemic disease. The putative principal vector is the Lone Star tick (Amblyomma americanum). We investigated an outbreak of ehrlichiosis that occurred in June 1993 among members of a golf-oriented retirement community (community A) in Tennessee. The community is densely wooded and borders a wildlife-management area where deer are numerous. METHODS: We conducted a case-control study, using medical-history reviews, serologic testing, and testing with the polymerase chain reaction for E. chaffeensis infection. We also surveyed a sample of 10 percent of the households in community A and in another golf-oriented community (community B) more than 20 miles (32 km) from the wildlife-management area. Survey participants completed a questionnaire and provided specimens for serologic testing. In both communities, searches for ticks were undertaken. RESULTS: Eleven cases of symptomatic ehrlichiosis were identified in the case-control study, 10 of which were in community A (attack rate, 330 per 100,000). Of 311 surveyed residents of community A, 12.5 percent had serologic evidence of past E. chaffeensis infection, as compared with 3.3 percent of 92 in community B (relative risk in community A as compared with community B, 3.9; 95 percent confidence interval, 1.2 to 12.2). The risk of infection was associated with tick bites, exposure to wildlife, golfing, and among golfers, retrieving lost golf balls from the rough. Persons who never used insect repellent were more likely to have had infection than persons who did. In community A, thousands of Lone Star ticks were found; in community B, only three ticks were found. CONCLUSIONS: The high rate of E. chaffeensis infection in community A resulted from its proximity to a wildlife reserve. When outdoor recreational activities are common and concentrations of ticks are high, outbreaks of arthropod-borne zoonoses can be anticipated.

Adolescent↗

A new device for evaluating distance and directional performance of golf putters.

The purpose of this study was to construct and evaluate the reliability of an apparatus for testing golf putters with respect to distance and direction deviation at different impact points on the clubface. An apparatus was constructed based on the pendulum principle that allowed putter golf clubs to swing at different speeds. The mean speed of the club head before ball impact, and of the ball after impact, was calculated from time measurements with photocells. A pin profile rig was used to determine the directional deviation of the golf ball. Three different putters were used in the study, two that are commercially available (toe-heel weighted and mallet types) and one specially made (wing-type) putter. The points of impact were the sweet spot (as indicated by the manufacturer's aim line), and 1, 2 and 3 cm to the left and right of the sweet spot. Calculation of club head speed before impact, and of ball speed after impact (proportional to distance), showed errors < or = 0.5% of interval duration. The variability in ball impacts was tested by measuring time and direction deviations during 50 impacts on the same ball. The mean duration (+/- s) after ball impact in the test interval (1.16 m long) was 206 (0.8) ms and the standard deviation in the perpendicular spreading of the balls in relation to the direction of the test interval was 0.005 m. A test-retest of one putter on two consecutive days after remounting of the putter on the test apparatus showed less than 1% difference in distance deviation. We conclude that the test apparatus enables a precise recording of distance and direction deviation in golf putters as well as comparisons between different putters. The apparatus and set-up can be used in the laboratory as well as outdoors on the putting green.

Equipment Design↗

Expert golf instructors' student-teacher interaction patterns.

The purpose of this study was to identify the dominant instructional interaction patterns of expert golf instructors. Instructors (N = 22) were selected by the Ladies Professional Golf Association (LPGA) Teaching based on the following criteria: (a) 10 or more years of golf teaching experience, (b) LPGA certification, (c) awards received for the quality of their instruction, and (d) peer and student recognition for outstanding teaching. The instructors were videotaped teaching a 60-min lesson to a novice college-age woman with no previous golf experience. The tapes were then analyzed using both the Cheffers Adaptation of Flanders' Interaction Analysis System (CAFIAS) and a qualitative analysis. Based on the findings from descriptive statistics and correlation analyses of the CAFIAS data and qualitative data analysis, several trends were identified. First, the dominant instructional behavior of these teachers was providing information to the students using both explanations and demonstrations. Second, the prevailing instructional interaction pattern of the expert teachers included extensive explanations and demonstrations followed by directions. The student followed the directions by practicing skills and received praise for their achievements. Third, high rates of directions and praise from teachers prompted student practice. Fourth, engaging students in subject-related discussion was positively correlated with teachers' questions but negatively correlated with teachers' criticisms. Finally, teacher acceptance was positively correlated with student analytic behavior, while teachers' talk negatively correlated with students initiating discussions.

Golf↗

Visual outcome and ocular survival after sports related ocular trauma in playing golf.

PURPOSE: To study eye injuries. More specifically, to study the visual performance and ocular findings in people generating the eye trauma while golfing and to define the main mechanisms of injury. METHODS: We retrospectively reviewed a case series of seven patients with golf-related eye injuries treated at Austrian hospitals over the last seven years in a multicenter setting. RESULTS: Five men and two women received treatment. The mean age was 46 (range, 29-63), and three of the patients had blunt close globe trrauma and four suffered from a ruptured globe. Following the injuries, the patients' initial visual acuity ranged from no light perception to 20/40. All of the patients recquired surgery, with the resulting visual acuily ranging from moving hands to 20/20. It should be noted that three eyes required enucleation. CONCLUSION: Visual outcome from surgery is frequently very poor in golf related injuries. This is further complicated by these traumas frequently being accompanied by a high enucleation rate. Among the patients reviewed, it was observed that ruptured globe trauma has a worse prognosis than close blunt trauma. Due to the severe resulting complications of golf-related ocular injuries, we believe eye protection should be considered and emphasized.

Adult↗

Organismal effects of pesticide exposure on meadow voles (Microtus pennsylvanicus) living in golf course ecosystems: developmental instability, clinical hematology, body condition, and blood parasitology.

This is the second of two articles reporting the results of a nonlethal biomonitoring study that quantified the effects of pesticide exposure on meadow voles (Microtus pennsylvanicus) living in golf course ecosystems of the Ottawa/Gatineau region (ON and PQ, Canada, respectively). In the present article, we describe results of measurements regarding developmental instability (e.g., fluctuating asymmetry), congenital birth defects (e.g., skeletal terata), clinical hematology (e.g., differential counts), general body condition (e.g., body mass-length relationships), and blood parasite load (Trypanosoma sp. and Bartonella spp.). Voles were captured during the year 2001 to 2003 at six golf courses and two reference sites. Once voles were fully sedated using isoflurane, blood was collected, radiographs taken, and morphometric measurements recorded. Three animals from each course were euthanized to determine body burdens of historically used organochlorine (OC) and metal-based pesticides. Exposure to in-use pesticides was determined from detailed golf course pesticide-use records. None of the endpoints measured was significantly related to body burdens of OC pesticides and metals historically used, nor did any endpoint significantly vary among capture sites in relation to total pesticide application to the capture site or to the number of days since the last application of pesticide. Based on these findings, it appears that voles from golf courses were no less healthy than their conspecifics from reference sites.

Animals↗

A multidisciplinary study of the 'yips' phenomenon in golf: An exploratory analysis.

BACKGROUND: The 'yips' is a psychoneuromuscular impediment affecting execution of the putting stroke in golf. Yips symptoms of jerks, tremors and freezing often occur during tournament golf and may cause performance problems. Yips-affected golfers add approximately 4.7 strokes to their scores for 18 holes of golf, and have more forearm electromyogram activity and higher competitive anxiety than nonaffected golfers in both high and low anxiety putting conditions. The aetiology of the yips is not clear. OBJECTIVE: To determine whether the yips is a neurological problem exacerbated by anxiety, or whether the behaviour is initiated by anxiety and results in a permanent neuromuscular impediment. METHODS: In phase I, golf professionals assisted investigators in developing a yips questionnaire that was sent to tournament players (<12 handicap) to establish the prevalence and characteristics of the yips. Phase II measured putting behaviour in scenarios that contribute to the yips response. Four self-reported yips and 3 nonaffected golfers putted 3 scenarios using an uncorrected grip and a standard length putter. Heart rate was superimposed on the videotape and the putter grip was instrumented with strain gauges to measure grip force. Electromyograms and relative putting performance were also measured. RESULTS: The questionnaire was sent to 2,630 tournament players, of whom 1,031 (39%) responded (986 men and 45 women). Of these, 541 (52%) perceived they experienced the yips compared with 490 (48%) who did not. Yips-affected golfers reported that the most troublesome putts were 3, 4 and 2 feet (0.9, 1.2 and 0.6 metres) from the hole. Fast, downhill, left-to-right breaking putts and tournament play also elicited the yips response. Golfers affected by the yips had a faster mean heart rate, increased electromyogram activity patterns and exerted more grip force than nonrffected golfers and had a poorer putting performance. CONCLUSIONS: For <10 handicap male golfers and <12 handicap female golfers, the prevalence of the yips is between 32.5% and 47.7%, a high proportion of serious golfers. This high prevalence suggests that medical practitioners need to understand the aetiology of the yips phenomenon so that interventions can be identified and tested for effectiveness in alleviating symptoms. Although previous investigators concluded that the yips is a neuromuscular impediment aggravated but not caused by anxiety, we believe the yips represents a continuum on which 'choking' (anxiety-related) and dystonia symptoms anchor the extremes. The aetiology may well be an interaction of psychoneuromuscular influences. Future research to test the effect of medications such as beta-blockers should assist in better identifying the contributions these factors make to the yips phenomenon.

Adaptation, Physiological↗

Buffer zones promoting oligotrophication in golf course runoffs: fiddler crabs as estuarine health indicators.

Nitrogen pollution above a threshold level induces a eutrophication process in coastal creek ecosystems and consequently impacts on the water quality. The remedy for this scenario is the introduction of methods to enhance oligotrophication by means of constructed wetlands and buffer zones. This paper discusses new data on nitrogen flux and population changes in the primary consumers in the Bradley Creek ecosystem, adjacent to the Duck Haven Golf Course in southeastern North Carolina. In 1998-99, over different seasons, density distribution of the field populations of the fiddler crab Uca minax, was monitored as an indicator of environmental health. A control site at Whiskey Creek, adjacent to the University Center for Marine Sciences, was monitored in the same period since this site is not influenced by any golf course nutrient flux. The results pointed out that threshold level for optimum population density in Spartina grandiflora salt marsh is 0.1 mg/L of nitrates. A dense crab population, adjacent to the golf course with a buffer zone, was indicative of restoration of the estuarine ecosystem. A model, involving the use of constructed wetlands for oligotrophication, is being prepared on the basis of studies conducted by the University of South Alabama for a stormwater wetland constructed adjacent to the university's golf course.

Animals↗

Evaluating best management practices at an urban golf course.

This three-year study evaluated the effects of best management practices (BMPs) in reducing surface water contamination at an urban golf course. Water samples were collected before BMP implementation from two ponds on Braeburn Golf Course (Wichita, KS, USA). The pesticides 2,4-dicholorodiphenoxyacetic acid (2,4-D) and simazine were periodically found at concentrations above recommended water quality criteria. Excessive nutrients in the form of nitrates and total phosphorus were also measured. In addition, an assessment of macroinvertebrate populations revealed only a few tolerant species. Beginning in year 2, recommendations to alter chemical applications on the course were implemented as part of the BMPs. Surface water sampling during year 2 showed significant declines in nitrate and total phosphorus levels; however, seasonal contamination from pesticides continued to occur. Beginning in year 3, structural changes to the golf course were made as part of the BMPs. Subsequent water sampling indicated further reductions of nitrates (80%) and total phosphorus (40 and 60% in the two ponds, respectively), and elimination of contamination from spring applications of 2,4-D and simazine. Finally, an assessment of macroinvertebrate populations indicated an improvement in taxa richness, as well as repopulation by less tolerant organisms. Results of this study can be used to develop and refine golf course management procedures to protect aquatic environments.

2,4-Dichlorophenoxyacetic Acid↗