Imaging the elite golfer.

Imaging in professional golf is, as in many sports, becomingincreasingly important. The value of magnetic resonance(MR) first came to the attention of golfers in 1974 withthe MR diagnosis of a hook of hamate stress fracture. Thiscame after a 7-year struggle with this injury for John Cook,one of the US tours top professionals. The events are de-tailed graphically in John Feinstein’s “A good walkspoiled”, which highlights the difficulties professional golf-ers found in gaining consistent reliable medical opinions.This results from the unusual injury patterns in golf, thenomadic nature of the professional golfer’s life, the increas-ing length of the tours, and the huge geographic spread ofthe venues.Fortunately, the structure of the Professional Golfers’Association Tour in the USA and the European Tour lendsitself to the development of coordinated player medicalservices. The players are essentially the shareholders in thetours and have a great influence on how the tour uses itsfunds to support the game. Obviously, prize money remainsthe top priority, but consistent high-quality medical servicesare now viewed by the players as vital.The last 10–15 years have seen professional golfers be-coming busier both on and off the course with less timespent in any one place. As a result, medical care is difficultto access and varied. Tournament medical services are usu-ally satisfactory, but provide little continuity and aim merelyto provide in-play support rather than provide a more com-plete management plan.Consequently, in Europe, a more comprehensive sportsmedicine service is supported by the tour. This is providedby four sports medics who complement the existing tourna-ment physiotherapist services. Medical cover is provided onthe 2 days before events when players are practising and isseparate from the tournament doctor service. The service ismobile, using a purposely built extendable medical andtraining unit that moves between tournaments and includesphysiotherapy, gym, consultation rooms, an imaging reviewworkstation, and diagnostic and interventional ultrasound.As in other areas of sports medicine, radiology is vital tothe delivery of these services for diagnosis and intervention.By using electronictransfer,the sportsmedicine team is ableto send magnetic resonance imaging (MRI) studies per-formed locally to anywhere in the world, to a support-ing radiologist who reports on them almost immediatelyand liaises with the referrer. Regular visits to events bythe radiologists are clinically invaluable, offering a casereview, and diagnostic and interventional services. It alsoimproves team working, and provides an opportunity forteaching and research. The incorporation of all these servicesprovides a comprehensive central base for the players’medical data combining clinical assessment, physiotherapy,and imaging in a truly multidisciplinary setting. This con-centration of medical data and skills has led to a muchgreater understanding of the patterns of injury seen in pro-fessional golf.Injury patterns differ between professional and amateurgolfers, mainly as a result of swing mechanics and theincreased number of repetitions [1]. The professional golfswing is much more consistent, channeling forces throughthe same areas of the musculoskeletal system on a repeatedbasis. This and the increased levels of activity result in ahigh incidence of stress injury to the kinetic chain and spine.