Shoulder impingement syndrome in water polo players: muscle shortening manoeuvre controls pain intensity, recovers function and normalizes sonographic parameters

Swimmer's Shoulder: Ultrasound Anatomical Description of Shoulder Tendons in Elite Swimmers and Water Polo Players

Objectives: This study aimed to examine the differences in shoulder ultrasonographic parameters between overhead aquatic athletes and their relationship with shoulder pain. Methods: Sixty-four healthy junior subjects (n = 128 shoulders) participated in the study, including 17 healthy controls, 25 elite junior swimmers, and 22 elite junior water polo players. An ultrasonographic study of the shoulder was carried out to measure the thickness of the rotator cuff structures in sex- and age-paired groups. Results: Compared to controls, female and male swimmers and water polo players had thicker values in the rotator cuff tendons, including the subscapularis (SSB) (p < 0.001), supraspinatus (p < 0.001), infraspinatus (p < 0.001) and teres minor (Tm) (p < 0.025). The female swimmers had thicker values than the water polo players in the SSB (p < 0.001) and Tm (p < 0.011). In the comparison by sexes, the female controls had a thinner LHBB, SSB and Tm (p < 0.019), the female swimmers had a thinner ISP (p = 0.001), and the female water polo players had a thinner LHBB, SSB, ISP and acromiohumeral distance than their group-paired counterparts (p < 0.018). Finally, the females had a lower incidence of positive Jobe test results compared to the males (p = 0.018), which was associated with lower pain scores at rest (p < 0.034) and during training (p < 0.036). Conclusions: The rotator cuff tendon structures were larger in the healthy overhead aquatic athletes compared to the age- and sex-paired controls. The females had smaller values in the shoulder ultrasonographic tendon parameters compared to the age- and sport-paired males, except for the supraspinatus tendon.

The Muscle Shortening Maneuver: a noninvasive approach to the treatment of peroneal nerve injury. A case report

BACKGROUND

The treatment of peripheral nerve injuries is a debated topic. The Muscle Shortening Maneuver (MSM), a physiotherapy approach, is noninvasive and free of side effects; it consists of a muscle shortening and a solicitation in traction applied simultaneously.

OBJECTIVE

The focus of this report is to describe the effects of the MSM combined with walking retraining in a patient with incomplete injury of the peroneal nerve.

DESCRIPTION

The patient was a 17-year-old man, who underwent osteotomy surgery of the proximal two-thirds of the fibula, due to an Ewing sarcoma that caused a partial injury of the left peroneal nerve. Our assessment plan of the left ankle movement ability comprised range of movement, muscle strength, and surface electromyography (EMG); and a gait analysis was conducted by using an iPhone application. MSM and walking retraining were administered twice and once a week, respectively, for 4 weeks.

OUTCOMES

The active range of movement substantially improved in dorsiflexion (≥15°), whereas slightly decreased in plantar flexion (-5°). Aside from the tibialis anterior, an increase in muscle strength was detected. Surface EMG showed an increased activation, particularly in the peroneus longus. A decrease in gait speed and step length was recorded from the gait analysis, with a better bilateral symmetry.

CONCLUSIONS

Positive outcomes were reported without evidence of risk or adverse events for the participant.