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Holt K, Delbridge A, Josey L, Dhupelia S, Livingston G, Waddington G, Boettcher C. Subscapularis tendinopathy is highly prevalent in elite swimmer's shoulders: an MRI study. J Sci Med Sport 2022; 25:720-725. [PMID: 35906124 DOI: 10.1016/j.jsams.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 06/09/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The aim of this study is to determine the prevalence of abnormal anatomical change present on MRI in elite swimmers' shoulders compared to age-matched controls. DESIGN Descriptive epidemiological study. METHODS Sixty (aged 16-36 years) elite Australian swimmers and 22 healthy active, age and gender matched controls (aged 16-34 years). All participants completed a demographic, and training load and shoulder pain questionnaire and underwent shoulder MRI. Tests for differences in the population proportion was used for comparison between swimmers dominant and non-dominant shoulders and those of the controls. RESULTS Subscapularis and supraspinatus tendinopathy was the most common tendon abnormality identified in swimming participants, being reported in at least one shoulder in 48/60 (73 %) and 46/60 (70 %) swimmers, respectively. There was no significant difference between dominant and non-dominant shoulders for either tendinopathy, however, grade 3 tendinopathy was significantly more prevalent in subscapularis than in supraspinatus (P < 0.01). Compared with controls, significantly more abnormalities were reported in swimmers' shoulders in both subscapularis and supraspinatus tendons along with the labrum and acromioclavicular joint. Pathology was not a predictor of current pain. CONCLUSIONS This data confirms that tendon abnormality is the most common finding in elite swimmers' shoulders. Furthermore, that subscapularis tendinopathy is not only as common as supraspinatus but has a greater prevalence of grade 3 tendinopathy. With significant varied abnormalities including tendinopathy being so common in both symptomatic and asymptomatic shoulders of swimming athletes', clinicians should consider imaging findings alongside patient history, symptom presentation and clinical examination in determining their relevance in the presenting condition.
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Affiliation(s)
- Kylie Holt
- University of Canberra Research Institute for Sport and Exercise, Australia.
| | | | | | | | - Glen Livingston
- Centre for Computer-Assisted Research Mathematics and its Applications, School of Information and Physical Sciences, University of Newcastle, Australia
| | - Gordon Waddington
- University of Canberra Research Institute for Sport and Exercise, Australia
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Kreulen RT, Spiker AM, Heinlein SA, Cosgarea AJ. Evidence-Based Musculoskeletal Care for Swimmers: A Critical Analysis Review. JBJS Rev 2022; 10:01874474-202204000-00002. [PMID: 35385413 DOI: 10.2106/jbjs.rvw.21.00200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Swimming is a popular activity with numerous health benefits. » Swimming involves complex biomechanical movements that, especially if performed incorrectly, can lead to musculoskeletal injuries. » The shoulder is the most commonly affected joint, although lower-extremity and spine injuries have also been reported.
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Affiliation(s)
- R Timothy Kreulen
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Andrea M Spiker
- Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Andrew J Cosgarea
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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Du T, Yanai T. Critical scapula motions for preventing subacromial impingement in fully-tethered front-crawl swimming. Sports Biomech 2019; 21:121-141. [PMID: 31355716 DOI: 10.1080/14763141.2019.1640277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aims were to quantitatively describe the coordinated motions of the scapula and humerus during fully tethered front-crawl strokes and to test the hypothesis that scapular motion functions to reduce the risk of subacromial compression. An electromagnetic tracking device was used to record the kinematics of the thorax, humerus, and scapula on the dominant side in 17 collegiate swimmers. Because evidence suggests that compressive force develops under the coracoacromial arch when the arm elevated above 90º of arm elevation is maximally internally rotated, such shoulder configurations were measured for each participant. A series of scapulohumeral angles measured with this procedure were compared with the corresponding angles exhibited during fully tethered front-crawl swimming to identify the scapulohumeral angles indicative of subacromial compression. Additional comparison was performed without taking the scapular motion into account. Scapulohumeral angles indicative of subacromial compression were observed in 15 participants, accounting for 7.7 ± 7.1% of stroke cycle time. This duration was significantly less than the corresponding duration identified without having taken the scapular motion into account (22.6 ± 13.8% of stroke cycle time). The difference was due primarily to the unique movements of the scapular to accommodate demands imposed by stroke motions, and this supported the hypothesis.
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Affiliation(s)
- Tanghuizi Du
- a Faculty of Sport Sciences, Waseda University , Tokorozawa , Japan
| | - Toshimasa Yanai
- a Faculty of Sport Sciences, Waseda University , Tokorozawa , Japan
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Abstract
Swimmer's shoulder is a broad term often used to diagnose shoulder injury in swimmers. However, research has elucidated several specific shoulder injuries that often are incurred by the competitive swimmer. Hyperlaxity, scapular dyskinesis, subacromial impingement, labral damage, os acromiale, suprascapular nerve entrapment, and glenohumeral rotational imbalances all may be included within a differential diagnosis for shoulder pain in the competitive swimmer. An understanding of the mechanics of the swim stroke, in combination with the complex static and dynamic properties of the shoulder, is essential to the comprehension and identification of the painful swimmer's shoulder. It is important for the athlete, coach, and clinician to be aware of the discerning characteristics among these different injuries to ensure a proper diagnosis and treatment plan to aid the swimmer in his or her return to competition.
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Wymore L, Fronek J. Shoulder functional performance status of National Collegiate Athletic Association swimmers: baseline Kerlan-Jobe Orthopedic Clinic scores. Am J Sports Med 2015; 43:1513-7. [PMID: 25790836 DOI: 10.1177/0363546515574058] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shoulder trouble, described in the literature as "swimmer's shoulder," has been associated with competitive swimmers. The Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Score is a validated survey used to define functional and performance measures of the upper extremity in overhead athletes. To date, no study has investigated the baseline functional scores for swimmers actively competing in the sport. PURPOSE To establish a baseline score for National Collegiate Athletic Association (NCAA) swimmers actively competing in the sport. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS After institutional review board approval, the KJOC Shoulder and Elbow Score was administered to 5 NCAA swim teams (N = 99 participants; 46 men, 53 women). The results on 10 specific individual questions and on the total score were calculated according to the survey's original description. The mean scores were calculated for all participants. The Mann-Whitney U test was used to determine differences between sexes, years swimming, and self-reported injury status. RESULTS The mean ± SD baseline KJOC score (out of a possible 100) for all participants was 79.0 ± 18.7; the mean score for men was 81.9 ± 15.6 and for women 76.6 ± 20.8. The score for athletes identifying themselves as injured at baseline was 53.9 ± 18.8, compared with 84.4 ± 13.6 for those not reporting as injured (P < .001). Athletes competing ≥11 years had a mean score of 72.0 ± 22.1; those competing ≤10 years scored 86.4 ± 11.4 (P = .007). CONCLUSION Baseline scores for swimmers, which were lower than expected, were lower than baseline scores seen in studies of other overhead sports athletes. The data corroborate previous studies identifying swimmers as having a high level of shoulder trouble. Further research is indicated for improving shoulder symptoms and performance in competitive swimmers.
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Affiliation(s)
- Lucas Wymore
- Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
| | - Jan Fronek
- Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA
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Bencardino JT, Gyftopoulos S, Palmer WE. Imaging in Anterior Glenohumeral Instability. Radiology 2013; 269:323-37. [DOI: 10.1148/radiol.13121926] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Arriaza R, Ballesteros J, López-Vidriero E. Suprascapular neuropathy as a cause of swimmer's shoulder: results after arthroscopic treatment in 4 patients. Am J Sports Med 2013; 41:887-93. [PMID: 23449835 DOI: 10.1177/0363546513477383] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Rafael Arriaza
- Arriaza and Associates Medical Institute, La Coruña, Spain
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Bedi A, Rodeo SA. Os acromiale as a cause for shoulder pain in a competitive swimmer: a case report. Sports Health 2012; 1:121-4. [PMID: 23015862 PMCID: PMC3445069 DOI: 10.1177/1941738108326705] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Montgomery SR, Chen NC, Rodeo SA. Arthroscopic capsular plication in the treatment of shoulder pain in competitive swimmers. HSS J 2010; 6:145-9. [PMID: 21886527 PMCID: PMC2926370 DOI: 10.1007/s11420-009-9153-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 12/10/2009] [Indexed: 02/07/2023]
Abstract
UNLABELLED Shoulder pain is a common and difficult problem in competitive swimmers due to cumulative loads from repetitive overhead motion. Capsular laxity has been implicated as a potential etiology for shoulder pain in competitive swimmers. No study has examined the role of capsular plication in addressing recurrent shoulder pain in competitive swimmers. The purpose of this study is to retrospectively describe our series of competitive swimmers treated with arthroscopic capsular plication with a primary outcome of return to competitive swimming. Eighteen shoulders in 15 patients underwent arthroscopic capsular plication from 2003 to 2007. Patients were contacted at an average follow-up of 29 months (range, 8-42) and a swimming history, American Shoulder and Elbow (ASES) scores, and L'Insalata scores were obtained. At time of surgery, all patients demonstrated laxity under examination under anesthesia. All patients had a positive drive-through sign. Eighty percent (12/15) of patients returned to competitive swimming although only 20% (3/15) were able to return to their pre-injury training regimen volume. All patients subjectively reported improved pain after surgery. The average ASES score was 78 ± 16 (average, standard deviation). The average L'Insalata score was 82 ± 11. Although our results demonstrate that arthroscopic capsular plication has utility in the treatment of shoulder pain in swimmers who have failed non-operative treatment, the inability of some athletes to return to pre-injury training volume illustrates the difficult nature of shoulder pain in swimmers. LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Affiliation(s)
- Scott R. Montgomery
- Department of Orthopaedic Surgery, UCLA Center for Health Sciences, 10833 Le Conte Avenue, 76-143 CHS, Los Angeles, CA 90095-6902 USA
| | - Neal C. Chen
- Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, MI USA
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Abstract
Shoulder pain is the most common musculoskeletal complaint in competitive swimmers. Problems with the shoulders of swimmers resemble that of the disabled thrower's shoulder, but the clinical findings and associated dysfunctions are not quite the same. Therefore, swimmers with shoulder pain should be evaluated and treated as a separate clinical entity, aimed toward underlying pathology and dysfunction. Balanced strength training of the rotator cuff, improvement of core stability, and correction of scapular dysfunction is central in treatment and prevention. Technical and training mistakes are still a major cause of shoulder pain, and intervention studies that focus on this are desirable. Imaging modalities rarely help clarify the diagnosis, their main role being exclusion of other pathology. If nonoperative treatment fails, an arthroscopy with debridement, repair, or reduction of capsular hyperlaxity is indicated. The return rate and performance after surgery is low, except in cases where minor glenohumeral instability is predominant. Overall, the evidence for clinical presentation and management of swimmer's shoulder pain is sparse. Preliminary results of an intervention study show that scapular dyskinesis can be prevented in some swimmers. This may lead to a reduction of swimmer's shoulder problems in the future.
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Affiliation(s)
- Klaus Bak
- Parken's Private Hospital, Copenhagen, Denmark.
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Suder PA, Hougaard K, Frich LH, Rasmussan OS, Lundorf E. Diagnostic evaluation of athletes with posttraumatic chronic shoulder pain. Scand J Med Sci Sports 2007. [DOI: 10.1111/j.1600-0838.1994.tb00427.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Suder PA, Hougaard K. Posterior detachment of the glenoid labrum in athletes with posttraumatic chronic shoulder pain. Scand J Med Sci Sports 2007. [DOI: 10.1111/j.1600-0838.1994.tb00437.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brushøj C, Bak K, Johannsen HV, Faunø P. Swimmers' painful shoulder arthroscopic findings and return rate to sports. Scand J Med Sci Sports 2006; 17:373-7. [PMID: 16805785 DOI: 10.1111/j.1600-0838.2006.00571.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Shoulder pain is the most common musculo-skeletal complaint in competitive swimmers. It remains one of the shoulder pain syndromes in overhead athletes where no golden standard of treatment exists. Eighteen competitive swimmers who all had undergone shoulder arthroscopy for therapy-resistant shoulder pain were retrospectively evaluated with respect to operative findings and ability to return to their sport after the operation. The most common finding at arthroscopy was labral pathology in 11 (61%) and subacromial impingement in five shoulders (28%). Operative procedures included debridement in 11 swimmers, partial release of the coraco-acromial ligament in four, and bursectomy in four. Sixteen (89%) responded to the follow-up evaluation. Nine swimmers (56%) were able to compete at preinjury level after 4 (2-9) months. Findings at arthroscopy suggest that the term "Swimmer's shoulder" covers a variety of pathologies including labral wearing and subacromial impingement. Arthroscopic debridement of labral tears or bursectomy in swimmers with shoulder pain has a low success rate with regard to return to sport. Further understanding and investigation of this syndromes complex pathophysiology is needed.
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Affiliation(s)
- C Brushøj
- Division of Sports Orthopaedics, Department of Orthopaedic Surgery, Amager Hospital, Copenhagen, Denmark.
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Borsa PA, Scibek JS, Jacobson JA, Meister K. Sonographic stress measurement of glenohumeral joint laxity in collegiate swimmers and age-matched controls. Am J Sports Med 2005; 33:1077-84. [PMID: 15983126 DOI: 10.1177/0363546504272267] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Glenohumeral laxity that is greater than normal has been implicated as a causal factor in the development of shoulder pain and dysfunction in elite swimmers; however, quantitative evidence demonstrating greater-than-normal glenohumeral joint laxity in swimmers is lacking. OBJECTIVE To quantify glenohumeral joint laxity in elite swimmers and nonswimming controls using stress sonography. STUDY DESIGN Controlled laboratory study. METHODS Force-displacement measures were performed bilaterally in 42 National Collegiate Athletic Association Division I swimmers and 44 age-matched controls. Of the 42 swimmers, 27 (64%) reported a history of unilateral or bilateral shoulder pain resulting from swimming. Ultrasound imaging was used to measure glenohumeral joint displacement under stressed and non-stressed conditions. RESULTS An analysis of variance revealed no significant difference in glenohumeral joint displacement between swimmers (anterior, 2.82 +/- 1.7 mm; posterior, 5.30 +/- 2.4 mm) and age-matched controls (anterior, 2.74 +/- 1.7 mm; posterior, 4.90 +/- 2.7 mm). No significant difference in glenohumeral joint displacement was found between swimmers with a history of shoulder pain (anterior, 2.90 +/- 1.6 mm; posterior, 5.42 +/- 2.3 mm) versus swimmers without a history of shoulder pain (anterior, 2.74 +/- 1.8 mm; posterior, 5.14 +/- 2.6 mm). Shoulders displayed significantly more glenohumeral joint displacement in the posterior direction compared to the anterior direction (P < .001). CONCLUSIONS Our instrumented technique was unable to identify significantly greater glenohumeral joint displacement in elite swimmers compared to nonswimming controls, and elite swimmers with a history of shoulder pain were not found to have significantly more glenohumeral joint displacement compared to swimmers without a history of shoulder pain. CLINICAL RELEVANCE Objective assessment of glenohumeral joint displacement in athletes participating in overhead-motion sports may be important for injury prevention and management.
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Affiliation(s)
- Paul A Borsa
- ATC, University of Florida, 149 Florida Gymnasium, PO Box 118205, Gainesville, FL 32611-8205, USA.
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Shoulder-Rotator Strength of High School Swimmers Over the Course of a Competitive Season. J Sport Rehabil 2004. [DOI: 10.1123/jsr.13.1.9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Context:Changes in strength over the course of a swim season could predispose the shoulder to strength imbalances and lead to injury.Objective:To examine isometric shoulder internal- (IR) and external-rotator (ER) strength in high school swimmers over a 12-week competitive season.Design:Three 3 × 2 × 2 ANOVAs with repeated measures were used to determine significant main effects for IR, ER, and IR:ER strength ratio.Participants:27 (14 female, 13 male) high school varsity swimmers.Main Outcome Measures:IR and ER strength during preseason, midseason, and postseason.Results:Significant increases in IR strength in both groups were revealed for all test sessions. ER strength significantly improved in both males and females from preseason to midseason and from preseason to postseason. IR:ER ratio revealed a significant increase from preseason to postseason.Conclusions:Increases in IR strength without equal gains in ER strength were revealed and could contribute to future shoulder pathologies in competitive swimmers
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O'Brien SJ, Allen AA, Coleman SH, Drakos MC. The trans-rotator cuff approach to SLAP lesions: technical aspects for repair and a clinical follow-up of 31 patients at a minimum of 2 years. Arthroscopy 2002; 18:372-7. [PMID: 11951195 DOI: 10.1053/jars.2002.30646] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To discuss a new technique for the surgical treatment of type II SLAP lesions as well as the evaluation of the technique's effectiveness with a minimum 2-year follow-up. TYPE OF STUDY Retrospective clinical follow-up study. METHODS We present a clinical follow-up of 31 patients who were treated arthroscopically for type II SLAP lesions using a trans-rotator cuff portal at an average follow-up time of 3.7 years. Patients were screened for concomitant procedures including rotator cuff repairs, shoulder stabilizations, thermal capsullographies, and previous surgeries. These patients were subsequently excluded from the study. Patients were given a standard physical examination of the upper extremity at our institution and they completed both the L'Isalata and American Shoulder and Elbow Surgeons questionnaires. RESULTS All 31 patients identified were available for follow-up at an average time of 3.7 years postoperatively (range, 2.0 to 7.4 years). The average L'Insalata score was 87.0 points (range, 46.1-100 points); the average ASES score was 87.2 points (range, 46.7-100 points). The average pain score was 1.5 (range, 0-5) and only 4 of the 31 patients complained of moderate pain with activity. Sixteen of the 31 patients returned to their preinjury level of sports; 11 of the 31 patients returned to limited activity and 2 patients were inactive at the time of follow-up. Overall satisfaction with the procedure averaged 3.79 points (range, 0-5 points): 22 patients rated overall satisfaction as good or excellent, 6 patients reported a fair outcome, and only 3 patients were unsatisfied with the results of the surgery. One patient who was unsatisfied with the procedure had reinjured his superior labrum and required a second operation. None of the 31 patients had symptoms suggestive of rotator cuff pathology. Of the 30 patients found to have a positive Active Compression test preoperatively, 26 of these patients now had a negative sign. CONCLUSIONS The trans-rotator cuff approach allows for a more optimal placement of a biodegradable fixation device and/or suture anchors into the superior labrum. Furthermore, we believe that this approach does not compromise the function of the rotator cuff. The trans-rotator cuff technique is an effective and safe modality to address superior labral pathology.
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Affiliation(s)
- Stephen J O'Brien
- Sports Medicine and Shoulder Service, The Hospital for Special Surgery, New York, New York 10021, USA
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Abstract
Shoulder injuries are common problems in all types of sports. There can be a good deal of variability in how symptoms are expressed from individual to individual, and part of the challenge in understanding the injury is being able to interpret the athlete's complaints as they relate to examination findings and the conditions that produce the symptoms. The history is particularly important because the sensitivity and specificity of many aspects of the examination are variable. A relaxed patient and a systematic evaluation is the best way to be thorough. Radiographs and even MRIs are frequently negative in soft tissue problems in the young athlete. This underscores the importance of a good examination. There may be some utility in using contrast-enhanced MRIs to look at labral pathologic conditions, cysts, or ganglions, but this information is certainly less useful than the patient's description of symptoms and the examiner's findings. With this awareness, we can manage these injuries with more confidence.
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Affiliation(s)
- S Owens
- USC Orthopaedic Surgery Associates, Los Angeles, California 90033-4608, USA
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Weldon EJ, Richardson AB. Upper extremity overuse injuries in swimming. A discussion of swimmer's shoulder. Clin Sports Med 2001; 20:423-38. [PMID: 11494832 DOI: 10.1016/s0278-5919(05)70260-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treatment of shoulder pain includes the following: 1. Avoid all painful activities. 2. A 2-week course of nonsteroidal anti-inflammatory medication and ice. 3. Decreased anterior capsule stretching and increased posterior capsule stretching. 4. Increased rotator cuff exercise with emphasis on external rotators. 5. Scapular-positioning muscle exercises and increasing body roll. Shoulder pain can be prevented by the following: 1. Avoid all painful activities, and notify coach of shoulder pain immediately. 2. Do not use nonsteroidal anti-inflammatory medications or ice on a chronic basis. 3. Spend equal time stretching the posterior and anterior capsules. 4. Perform general rotator cuff exercises. 5. Perform scapular-positioning muscle exercises, with emphasis on body roll. [figure: see text] Shoulder pain in swimmers is common and can be debilitating. Most of the pain is caused by instability, which stems from swimming-specific demands that increase performance but decrease shoulder stability. These sport-specific demands are (1) increased shoulder range of motion, (2) increased internal rotation and adduction strength, and (3) prolonged, fatiguing, shoulder-intensive training. Instability leads to [figure: see text] inflammation and pain and can become a self-perpetuating process. Treatment consists of patient education, cessation of all activities that cause pain, activity modifications to increase shoulder stability, and pharmacologic treatment of the inflammation. In patients who do not improve using this regimen, surgery can be of benefit, either to reduce capsular laxity or to remove chronic inflammation and scar tissue. The patient must be aware of the risk of decreased performance.
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Affiliation(s)
- E J Weldon
- Division of Orthopaedic Surgery, John A. Burns School of Medicine, Honolulu, Hawaii
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Abstract
Given the popularity of swimming and the high risk of injury associated with the sport, many clinicians come into contact with the swimmer's shoulder. This article describes the mechanism of injury, diagnostic tools, and subtle signs of injury for swimmer's shoulder. It focuses on conservative treatment for the injury, including methods for stretching and strengthening and eliminating acute inflammation.
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Affiliation(s)
- M M Pink
- Biomechanics Laboratory, Centinela Hospital Medical Center, Inglewood, CA, USA
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Abstract
Thoracic outlet syndrome is a well-recognized group of symptoms resulting from compression of the subclavian artery and vein, as well as the brachial plexus, within the thoracic outlet. Symptoms are related directly to the structure that is compressed. Diagnosis is difficult because there is no single objective, reliable test; therefore, diagnoses of thoracic outlet syndrome is based primarily on a set of historical and physical findings, supported and corroborated by a host of standard tests. Because aquatic athletes are primarily "overhead" athletes, one may expect a higher incidence of thoracic outlet syndrome in this population. The differential between TOS and "swimmer's shoulder" (multidirectional instability and subacromial impingement) may be difficult. Nonsurgical treatment methods can be helpful in relieving symptoms; in certain recalcitrant cases, however, surgical intervention can provide lasting relief and a return to aquatic athletics.
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Affiliation(s)
- A B Richardson
- Division of Orthopaedic Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
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Abstract
Sports medicine literature often refers to "swimmer's shoulder." Increasingly, however, it is evident that swimmer's shoulder is a spectrum of maladies whose underlying origins may be incidental to athletic activity. Those dealing with the treatment of swimmers should have a thorough understanding of the differential diagnosis of the shoulder, the age range of competitive swimmers, and the effects of the aging process, and age-related disease processes and should consider the possibilities of neoplasm, degenerative diseases, and acquired processes such as arthritis or metabolic diseases.
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Affiliation(s)
- W C McMaster
- Department of Orthopaedic Surgery, University of California, Irvine College of Medicine, USA.
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Abstract
Nine athletes (seven football offensive linemen, one defensive lineman, and one lacrosse player) were found at arthroscopy to have posterior labral detachment from the glenoid. In our series, this lesion is specific to contact athletes who engage their opponents with arms in front of the body. All patients had pain with bench pressing and while participating in their sport, diminishing their ability to play effectively. Conservative measures were ineffective in relieving their symptoms. Examination under anesthesia revealed symmetric glenohumeral translation bilaterally, without evidence of posterior instability. Treatment consisted of glenoid rim abradement and posterior labral repair with a bioabsorbable tack. All patients returned to complete at least one full season of contact sports and weightlifting without pain (minimum follow-up, > or = 2 years). Although many injuries leading to subluxation of the glenohumeral joint occur when an unanticipated force is applied, contact athletes ready their shoulder muscles in anticipation of impact with opponents. This leads to a compressive force at the glenohumeral joint. We hypothesize that, in combination with a posteriorly directed force at impact, the resultant vector is a shearing force to the posterior labrum and articular surface. Repeated exposure leads to posterior labral detachment without capsular injury. Posterior labral reattachment provides consistently good results, allowing the athlete to return to competition.
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Affiliation(s)
- S D Mair
- Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Abstract
Shoulder pain is a common problem among competitive swimmers, often limiting their ability to train and compete. Although a number of rehabilitation programs for shoulder injuries have been reported in the literature, there is a lack of objective data regarding the effectiveness of these protocols in the competitive swimming population. This case report describes the evaluation and treatment of shoulder pain in an NCAA Division I swimmer during the competitive season. Once a physical therapy diagnosis was made, a plan of care was developed to address each component impairment. This required the input of the team trainers, the team physician, and an orthopaedic surgeon. A chief component of the athlete's rehabilitation involved allowing the athlete to compete, but not practice. Excellent results were achieved, as evidenced by symptom reduction and swimming performance. This case report highlights the interactive, team approach necessary for optimal management of the injured athlete.
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Affiliation(s)
- D W Russ
- Doctoral Program in Biomechanics and Movement Science, University of Delaware, Newark 19711, USA
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McMaster WC, Roberts A, Stoddard T. A correlation between shoulder laxity and interfering pain in competitive swimmers. Am J Sports Med 1998; 26:83-6. [PMID: 9474407 DOI: 10.1177/03635465980260013201] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Shoulder pain in the swimming athlete that interferes with effective training is serious and may result in decreased performance. Based on the hypothesis that shoulder laxity is an important factor in shoulder pain, this study of 40 senior national and elite swimmers was undertaken. A questionnaire identified those athletes currently suffering from such pain. Shoulder laxity was assessed using standard clinical tests, from which a laxity score was derived. A statistically significant correlation was identified between the shoulder laxity score and the presence of interfering shoulder pain, confirming the hypothesis of the study. These results have direct implications for training the symptomatic athlete.
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Affiliation(s)
- W C McMaster
- Department of Orthopaedic Surgery, University of California, Irvine, Orange 92868, USA
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27
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Abstract
Musculoskeletal injuries constantly provide challenges to the team physician, including those to the shoulder. Shoulder injuries are common in athletes, whether as a result of direct contact from a collision or from repetitive overhead motion. This article reviews sports-related injuries to the shoulder, including similarities between sports, clinical evaluation, and rehabilitation of the athletes.
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Affiliation(s)
- M J Hulstyn
- Department of Orthopaedic Surgery, Brown University School of Medicine, Rhode Island Hospital, Providence, USA
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28
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Abstract
To evaluate differences in shoulder strength and range of motion between painful and pain-free shoulders we examined two matched groups of athletes. Fifteen competitive swimmers were allocated to two groups. Group 1 consisted of seven swimmers with unilateral shoulder pain related to swimming (Neer and Welsh phase I to II). The control group (Group 2) consisted of eight swimmers with no present or previous history of shoulder pain. Concentric and eccentric internal rotational torques were reduced in painful shoulders in between-group comparisons as well as in side-to-side comparisons. The decrease in internal rotational torque resulted in significantly greater concentric and eccentric external-to-internal rotational strength ratios of the painful shoulder in Group 1 swimmers compared with the controls. Furthermore, the functional ratio (eccentric external rotation:concentric internal rotation) was significantly greater in the painful shoulder in both between-group and side-to-side comparisons. Both groups of swimmers exhibited increased external range of motion and reduced internal range of motion compared with normalized data, but no between-group or side-to-side differences were detected. Our findings suggest that prevention or rehabilitation of swimmer's shoulder might not solely involve strengthening of the external rotators of the shoulder joint. Attention might also be drawn toward correction of a possible deficit in internal rotational strength. Changes in shoulder range of motion seem unrelated to the occurrence of shoulder pain.
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Affiliation(s)
- K Bak
- Department of Orthopaedics, Gentofte Hospital, University of Copenhagen, Denmark
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29
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Segmüller HE, Hayes MG, Saies AD. Arthroscopic repair of glenolabral injuries with an absorbable fixation device. J Shoulder Elbow Surg 1997; 6:383-92. [PMID: 9285879 DOI: 10.1016/s1058-2746(97)90007-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In view of potential problems with metallic implants around the shoulder a bioabsorbable tact has been used in arthroscopic repair of labral lesions in the shoulder joint. We report on a consecutive series of 70 patients (71 shoulders) who had arthroscopic stabilization of Bankart lesions, SLAP lesions, and other labral detachments with the Suretac device. Minimum follow-up time was 12 months (range 12 to 27 months). Clinical outcome was assessed with the Constant score. The recurrence of dislocation or subluxation in the 42 unstable shoulders was 12% (5 of 42), and in 78% (33 of 42) the Constant score was rated good or excellent. The recurrence of dislocation in true anteroinferior dislocators was 3.2% (1 of 31). A total of 82.3% (14 of 17) of patients with SLAP repairs were rated good or excellent, and 53% (9 of 17) returned to their preinjury level of sporting activities. Eight (67%) of 12 patients with labral detachments other than Bankart and SLAP lesions were rated good or excellent, and 64% (7 of 11) returned fully to sports.
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30
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Abstract
We clinically evaluated 36 competitive swimmers who had shoulder pain; the majority were women. Twenty-three swimmers had unilateral shoulder pain and 13 had bilateral pain, making a total of 49 painful shoulders. Shoulder pain had been present significantly longer in swimmers with bilateral shoulder pain (mean, 104 weeks) than in swimmers with unilateral pain (mean, 33 weeks). Twelve shoulders exhibited signs of impingement without excessive humeral head translation. In 25 shoulders, concomitant signs of impingement and increased glenohumeral translation, together with a positive apprehension sign, were found. Four swimmers, who were generally joint hypermobile, exhibited bilateral impingement signs and excessive humeral head translation, most commonly in the anteroinferior direction. Four shoulders had excessive humeral head translation and apprehension without impingement. Lack of coordination in the scapulohumeral joint was seen significantly more often in symptomatic than in asymptomatic shoulders. Hawkin's test for impingement was more sensitive than Neer's test. Swimmers with shoulder pain have variable clinical findings. The majority demonstrate signs of impingement and increased humeral head translation in the anteroinferior direction together with a positive apprehension sign. This nontraumatic instability might result from wearing of the anteroinferior capsuloligamentous complex. The different clinical findings might represent different stages of the same condition.
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Affiliation(s)
- K Bak
- Department of Orthopaedics, Gentofte Hospital, University of Copenhagen, Denmark
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31
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Liu SH, Henry MH, Nuccion SL. A prospective evaluation of a new physical examination in predicting glenoid labral tears. Am J Sports Med 1996; 24:721-5. [PMID: 8947391 DOI: 10.1177/036354659602400604] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We studied 62 patients (40 men and 22 women) with an average age of 28 years over a 28-month period who presented with shoulder pain that was refractory to 3 months of conservative management. Patients with a prior glenohumeral dislocation or a rotator cuff tear were excluded. The "crank" test was performed with the arm elevated to 160 degrees in the scapular plane of the body, loaded axially along the humerus, and with maximal internal and external rotation. Although similar tests have been described, the crank test is a new examination previously unreported. Half of the patients (31) had a positive crank test. Arthroscopy performed on all 62 patients revealed glenoid labral tears in 32 patients. Two patients who had positive crank tests did not have labral tears but had partial-thickness, articular-side rotator cuff tears. The sensitivity of the crank test was 91%, the specificity was 93%, the positive predictive value was 94%, and the negative predictive value was 90%. With these data, the crank test fulfills the criteria as a single physical examination test that is highly accurate for the preoperative diagnosis of glenoid labral tears. Accordingly, expensive imaging modalities currently used in this patient population may be employed less in the future.
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Affiliation(s)
- S H Liu
- Department of Orthopaedic Surgery, UCLA School of Medicine 90095, USA
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32
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Abstract
Competitive swimming is one of the most demanding and time-consuming sports. Swimmers at elite level practice 20-30 h per week. During 1 year's practice, the average top level swimmer performs more than 500,000 stroke revolutions per arm. These innumerable repetitions over many years of hard training together with an increasing muscular imbalance around the shoulder girdle seem to be the main etiological factors in the development of the over-use syndrome swimmer's shoulder. Shoulder pain in swimmers has in general been regarded as synonymous with coracoacromial impingement, i.e. anterior shoulder pain due to rotator cuff tendinitis, but new knowledge suggests that a concomitant glenohumeral instability plays an additional role. The diagnostic complexity of the problem is as challenging as the search for the gold standard of treatment. The condition should ideally be diagnosed as early as possible, and intensive functional rehabilitation of the shoulder girdle including the scapular muscles should be started in order to restore muscle balance. The surgical possibilities include subacromial decompression in cases of purely mechanical impingement. If a painful glenohumeral instability persists after intensive functional rehabilitation, anterior capsulolabral reconstruction can be performed. Still, however, short- and long-term results show that surgery is less successful in elite athletes involved in overhead sports. Prevention protocols include education of coaches in primary injury prophylaxis and the institution of resistance strength training in prepubescent swimmers. Emphasis should be made to improve muscular balance around the glenohumeral and scapulothoracic joints.
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Affiliation(s)
- K Bak
- Department of Orthopaedics, Gentofte Hospital, Hellerup, Denmark
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33
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Abstract
Participation in organized sports and fitness activity continues to increase in the United States. As a result, more acute bone and soft-tissue injuries are occurring in this patient population. Chronic overuse syndromes are also more common today. It is important for radiologists to understand the mechanism of injury so that they can properly approach the imaging of these patients. Although magnetic resonance imaging (MRI) is frequently the technique of choice, other imaging methods are also important and may, in certain cases, be preferred to MRI. In this review, we discuss extremity injuries by anatomic region. The spine is not included. A tailored imaging approach to each anatomic region and type of injury is discussed.
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Affiliation(s)
- G E Byers
- Mayo Clinic Jacksonville, Jacksonville, Florida, USA
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34
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Magnusson SP, Constantini NW, McHugh MP, Gleim GW. Strength profiles and performance in Masters' level swimmers. Am J Sports Med 1995; 23:626-31. [PMID: 8526281 DOI: 10.1177/036354659502300518] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The purpose of this study was to profile shoulder, trunk, and thigh strength and shoulder range of motion in competitive Masters' level swimmers and to see if these variables were related to swimming performance. Twenty-four Masters' level swimmers (13 men and 11 women) were tested for isometric trunk flexion and extension, isokinetic knee extension and flexion, shoulder abduction, internal rotation, external rotation, and supraspinatus muscle strength; shoulder internal and external rotation range of motion; and 50-yard swimming time. Strength scores were adjusted for weight. The men were significantly stronger than the women in trunk extension and flexion. Shoulder range of motion, shoulder abduction strength, and thigh strength were equal for both the men and the women. The men were stronger than the women in internal and external shoulder rotation. Conversely, the women tested were significantly stronger than the men in the supraspinatus muscle test. The men were significantly faster than the women in the 50-yard swim. Inverse relationships existed between swimming time and trunk flexion, trunk extension, and shoulder internal rotation strength. Trunk flexion strength remained the only significant predictive variable of swimming time in a multiple regression analysis.
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35
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Abstract
Rehabilitation of the shoulder offers many challenges. Arthroscopic and advanced imaging techniques have facilitated significant changes in our perception and management of glenoid labral pathology. Despite this progress, controversies involving the glenoid labrum continue to exist. This paper presents an overview of glenoid labral histology, morphology, and vascularity. Labral injuries are investigated and categorized. The management of glenoid labral pathology is discussed along with ramifications for shoulder rehabilitation.
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36
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Abstract
The detachment of the superior labrum from anterior to posterior has previously been reported. This lesion has been classified into four types. It was our impression that not all superior labrum abnormalities fit into such a classification system and that the mechanism of injury was distinctly different. During a 5-year period, 84 of 712 (11.8%) patients had significant labral abnormalities; 52 of 84 patients (6.2%) had lesions that fit within the classification system (Type II, 55%; III 4%; IV, 4%), but 32 of 84 patients (38%) had significant findings that could not be classified. These unclassifiable lesions fit into three distinct categories. Two of three patients described a traction injury to the shoulder. Only 8% sustained a fall on an outstretched arm; 75% had a preoperative diagnosis of impingement based on consistent history and provocative testing; however, when examined under anesthesia, 43% of the shoulders were considered to have increased humeral head translation when compared with the other shoulder. Recognition of superior labrum-biceps tendon detachment should prompt the surgeon to investigate glenohumeral instability as the source of a patient's complaints.
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Affiliation(s)
- M W Maffet
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas 77030
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37
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Allegrucci M, Whitney SL, Irrgang JJ. Clinical implications of secondary impingement of the shoulder in freestyle swimmers. J Orthop Sports Phys Ther 1994; 20:307-18. [PMID: 7849751 DOI: 10.2519/jospt.1994.20.6.307] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Swimming has become a popular recreational activity as well as a highly competitive sport in the United States. The repetitive nature of swimming can predispose the shoulder to mechanical impingement and microtrauma, which may lead to laxity, rotator cuff fatigue, and subsequent secondary impingement. Improper stroke mechanics can place the swimmer's shoulder at further risk. The purpose of this paper is to describe the pathology of secondary impingement in freestyle swimmers and to discuss the clinical implications for rehabilitation of swimmers with the pathology. A thorough subjective and objective evaluation is necessary to design a successful rehabilitation program. The rehabilitation program for swimmers with secondary impingement includes modification of training, flexibility, range of motion, strengthening, and mobilization as indicated. Functional and proprioceptive training may also be useful techniques in the rehabilitation of swimmer's shoulder. Improper stroke mechanics can also have clinical implications on swimmer's shoulders with secondary impingement. The clinical implication of secondary impingement in freestyle swimmers suggests that the primary goal of rehabilitation is to promote equilibrium of the shoulder complex while accounting for the demands of the sport.
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Affiliation(s)
- M Allegrucci
- University of Pittsburgh Medical Center, Center for Sports Medicine, PA
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38
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Abstract
Detachment of the anterior inferior labrum and inferior glenohumeral ligament complex from the glenoid is a common lesion encountered in anterior shoulder instability while other types of labral lesions are associated with symptoms that mimic instability. Accurate delineation of labral lesion is, therefore, key in managing shoulder problems. In a prospective double-blinded fashion, we compared the magnetic resonance imaging findings with those noted at surgery in 33 patients with possible anterior shoulder instability. Of 28 surgically confirmed labral lesions, 21 were detected by imaging. Sensitivity was 75%, specificity 100%, while positive and negative predictive values were 100% and 41%, respectively. Overall accuracy was 79%. Based on a literature review and our clinical experience, we developed a classification of glenoid labra according to the type and severity of the lesions. Method of treatment correlated with clinical outcome, using this system, to a statistically significant level. Unfortunately, this system enabled accurate classification with magnetic resonance imaging in only 7 of 33 (21%) labra, with the precision necessary to affect surgical planning in our series. We conclude that magnetic resonance imaging is not useful in the surgical planning for most patients with obvious anterior shoulder instability.
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Affiliation(s)
- M R Green
- Division of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii
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39
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Suder PA, Hougaard K, Frich LH, Rasmussen OS, Lundorf E. Intraarticular findings in the chronically painful shoulder. A study of 32 posttraumatic cases. ACTA ORTHOPAEDICA SCANDINAVICA 1994; 65:339-43. [PMID: 8042491 DOI: 10.3109/17453679408995466] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
32 consecutive patients suffering from chronic shoulder pain for more than 6 months after a single, nondislocating shoulder trauma were examined clinically and by special radiographs, dynamic sonography, MRI and arthroscopy. Typical complaints were pain during loading, especially during over the head activities. Symptoms of a "dead arm" and instability were also present. Patients with previous dislocations, traumas or radiographic signs of degenerative shoulder lesions were excluded. The patients had a decreased active range of motion and positive signs of apprehension and impingement, but only 4 had clinical signs of shoulder instability. Diagnostic evaluation identified labral tears, partial and total rotator cuff lesions with subacromial impingement and tendinitis of the biceps tendon. Surgery was performed in 24 patients, using capsulolabral and rotator cuff reconstruction, arthroscopic labral resection and open subacromial decompression. In conclusion, patients with chronic posttraumatic shoulder pain have intraarticular injuries, especially tears of the glenoid labrum. History, clinical findings, radiography and sonography are seldom diagnostic. MRI is valuable, particularly for identification of labral pathology, but arthroscopy appears necessary for a preoperative assessment.
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Affiliation(s)
- P A Suder
- University Department of Orthopedics, Randers General Hospital, Denmark
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40
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Field LD, Savoie FH. Arthroscopic suture repair of superior labral detachment lesions of the shoulder. Am J Sports Med 1993; 21:783-90; discussion 790. [PMID: 8291627 DOI: 10.1177/036354659302100605] [Citation(s) in RCA: 124] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Twenty consecutive patients with superior labral anterior and posterior lesions of the shoulder involving the biceps attachment to the labrum (Snyder types II and IV) were repaired arthroscopically and reviewed post-operatively to evaluate the efficacy of the technique in the management of this recently described injury pattern. Follow-up time averaged 21 months (range, 12 to 42). All patients were managed by an arthroscopic repair technique that included debridement of the frayed labrum and abrasion of the superior glenoid neck, followed by the placement of multiple sutures into the torn labrum-biceps tendon complex using a Caspari suture punch. Patients were reexamined, and the results were quantitated with the shoulder evaluation form of the American Shoulder and Elbow Surgeons and with the Rowe rating scale. On evaluation, all patients obtained good or excellent results. This suture technique is recommended in the management of unstable superior labral detachment lesions of the shoulder.
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Affiliation(s)
- L D Field
- Upper Extremity Service, Mississippi Sports Medicine & Orthopaedic Center, Jackson 39202
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41
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Abstract
A retrospective, average 2-year review of 14 patients with a primary glenoid labral tear treated by arthroscopic debridement was conducted to evaluate the long-term results of labral debridement based on tear location in preoperatively stable shoulders. All patients with concomitant pathology requiring an additional open or arthroscopic procedure were eliminated from this study. Every patient complained of shoulder pain mainly with overhead activities and nine patients (64%) also described "clicking" with shoulder movement. All shoulders were stable to translation in all quadrants during the preoperative examination and examination under anesthesia. The functional results at 6 months' follow-up were 93% excellent or good. However, the results at > 1 year's follow-up (average 2 years) were only 71% excellent or good, with a statistically significant 50% of patients decreased in function. The best results were in the superior and anterior-inferior regions. Three patients with large anterior-superior lesions (60%) developed postoperative instability noted at > 6 months postsurgery, representing a significant difference between groups. One of these patients was able to regain a good functional result with rotator cuff strengthening therapy. Close observation of patients after large anterior-superior labral tear arthroscopic debridement is advised because they are at risk for the delayed onset of instability.
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Affiliation(s)
- L Z Payne
- Department of Orthopaedic Surgery and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
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42
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43
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Abstract
Occult instability is recognized as a major cause of shoulder dysfunction in throwing athletes. Few studies have characterized the findings of occult instability in nonthrowers. The purpose of this study was to examine shoulder instability in a group of weight lifters. The symptoms, physical findings, and results of treatment for 23 shoulders in 20 athletes are presented. All athletes presented with a complaint of progressive inability to perform exercises with the upper extremity in the abducted, externally rotated position (the "at-risk" position) because of pain. One hundred percent of the athletes experienced posterior shoulder pain when the shoulder was placed in forced abduction and external rotation. Thirteen shoulders in 10 patients responded to conservative management including aggressive rehabilitation and modification of technique to avoid the at-risk position. The other 10 shoulders, which did not respond to conservative treatment, required surgical treatment to alleviate the symptoms. All 20 patients have successfully returned to their previous weight lifting activities.
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Affiliation(s)
- M L Gross
- Orthopaedic and Sports Medicine Associates, Emerson, NJ 07650
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44
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Cordasco FA, Steinmann S, Flatow EL, Bigliani LU. Arthroscopic treatment of glenoid labral tears. Am J Sports Med 1993; 21:425-30; discussion 430-1. [PMID: 8346758 DOI: 10.1177/036354659302100317] [Citation(s) in RCA: 119] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We reviewed 52 consecutive patients who had undergone arthroscopic labral debridement. The average age was 29 and there were 35 men and 17 women. At operation, 27 patients had superior labrum anterior and posterior (SLAP) lesions, 20 patients had anteroinferior labral lesions, and 5 patients had posterior labral lesions. Despite the fact that, preoperatively, none of these patients had a history of dislocations or clinically evident instability, 70% of the patients with superior labral lesions, and all of those with anteroinferior and posterior lesions had instability on examination under anesthesia. The average followup was 36 months. At 1 year after arthroscopy, 78% of the patients with superior lesions had excellent relief compared with 30% of the patients in the anteroinferior group. At 2 years followup, these results decreased to 63% and 25%, respectively, and only 45% of the patients with superior labral lesions and 25% of those with anteroinferior lesions had returned to their previous athletic performance level. Four patients required a reoperation: 2 for instability and 2 for impingement. We conclude that occult instability is frequently present in patients with glenoid labral tears. The overall results are not encouraging, but this procedure may have an indication for short-term goals in competitive athletes or those who are willing to accept some compromise in function.
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Affiliation(s)
- F A Cordasco
- Shoulder Service, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York
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45
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Abstract
The prevalence of shoulder pain in United States competitive swimmers has not been extensively surveyed but is perceived as common. To evaluate this concern, a questionnaire survey was conducted on 1262 United States swimmers: 993 age group, 198 senior development, and 71 national team athletes. We sought to identify the incidence of interfering shoulder pain in this population and how it is influenced by various training tasks. The prevalence of current shoulder pain in these groups varied between 10% (age group) to 26% (national team) and increased with time in the sport. In those athletes with a painful shoulder, weight training, use of hand paddles, kickboard use, stretching, and various resistance activities aggravated the painful shoulder. This survey has identified that interfering shoulder pain is present in a substantial number of competitive swimmers.
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Affiliation(s)
- W C McMaster
- Division of Orthopaedic Surgery, University of California, Irvine, Orange 92668
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46
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Abstract
Torque production was assessed in the shoulders of competitive men and women swimmers for the motions of abduction, adduction, and external and internal rotation. Testing was performed on the Cybex II dynamometer and the results were compared to controls. In addition, the ratios of torque development for adduction:abduction and external rotation:internal rotation were evaluated. The results demonstrated a statistically significant increase in torque production in swimmers for most motions tested. Statistically significant ratio shifts were also noted. The ratio of adduction:abduction increased and that for external rotation:internal rotation decreased. We think these shifts in the torque ratios in swimmers' shoulders resulted from sport-specific repetitive activity that emphasizes adduction and internal rotation.
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Affiliation(s)
- W C McMaster
- Department of Surgery, College of Medicine, University of California, Irvine
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47
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Glasgow SG, Bruce RA, Yacobucci GN, Torg JS. Arthroscopic resection of glenoid labral tears in the athlete: a report of 29 cases. Arthroscopy 1992; 8:48-54. [PMID: 1550651 DOI: 10.1016/0749-8063(92)90135-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article is a retrospective review of 28 overhead-throwing and striking athletes who underwent 29 arthroscopic partial glenoid labral resections. Indications for the procedure were a sudden inability to perform because of pain and the presence of a palpable "click" on clinical examination. At a minimum of 2 years follow-up, there was a statistically significant difference in the functional outcome between patients with stable and those with unstable glenohumral joints. In those with stable joints, there was a 91% good or excellent functional outcome. In those with unstable joints, there was a 25% good functional outcome and a 75% fair or poor functional outcome. We also noted a statistically significant difference in labral tear location between the stable and unstable glenohumeral joints. Seven of eight superior labral tears were in stable shoulders. Fourteen of 19 anterior labral tears were in stable shoulders. Both posterior labral tears were in unstable glenohumeral joints. Injury of the glenoid labrum without anatomic instability was observed in 72% of patients. Arthroscopic resection of a longitudinal labral tear in a stable shoulder can relieve the patient's discomfort and allow him or her to return to athletic competition. No patient developed clinical subluxation as a result of labral debridement, nor did any patient convert from a subluxing shoulder to a dislocating shoulder following surgery. In patients with anterior instability and labral tears, labral debridement was not a successful alternative to formal stabilization.
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Affiliation(s)
- S G Glasgow
- University of Pennsylvania, Sports Medicine Center, Philadelphia 19104
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48
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Abstract
Arthroscopy is without doubt the most comprehensive procedure for shoulder lesions, providing even better inspection of the interior of the joint than conventional open procedures. In 174 diagnostic arthroscopies, it proved more reliable than the computed tomography scan, ultrasound, or arthrography. The results of ultrasonography proved disappointing despite the enthusiastic reports on this technique, probably due to imperfections of equipment and lack of expertise rather than any inherent defect in the method. Arthrography seems to have a high incidence of false results. Though an invasive method requiring anesthesia, arthroscopy offers many diagnostic advantages such as an assessment of the role of the long biceps tendon and glenohumeral ligaments in recurrent or ordinary dislocation and the recognition of rotator cuff lesions not detectable at arthrography. It is also possible to assess the nature of shoulder instability and so to plan the appropriate operative procedure. A major advantage of arthroscopy is the possibility of carrying out treatment in the same session, though many of the suggested procedures are very demanding in terms of technical skill and time; the complication rate is often excessive. It is therefore best to restrict operative arthroscopy to simpler procedures such as irrigation in joint infections, the trimming of infolded flaps of labrum or stubs of biceps tendon, and the removal of loose bodies, where results are excellent. Arthroscopic repair of the rotator cuff or stapling of the labrum are more questionable regarding successes, complications, and recurrence. The equipment for arthroscopic operations needs improvement. Perhaps the major advantage of arthroscopic diagnosis is that it directs open procedures to the essential, thus minimizing operative trauma.
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Affiliation(s)
- A Gächter
- Department of Orthpaedics and Traumatology, Universitatsklinik, Kantonspital Basel, Switzerland
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49
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Relationship of shoulder flexibility, strength, and endurance to shoulder pain in competitive swimmers. J Orthop Sports Phys Ther 1992; 16:262-8. [PMID: 18796745 DOI: 10.2519/jospt.1992.16.6.262] [Citation(s) in RCA: 93] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study was supported in part by the School of Health Related Professions Research and Development Fund, University of Pittsburgh, Pittsburgh, PA A common complaint of competitive swimmers is shoulder pain. The purposes of this study were to: 1) provide normative data on shoulder flexibility in swimmers, 2) determine if a correlation exists between flexibility and shoulder pain, and 3) determine the correlation between strength and endurance ratios to shoulder pain. The subjects were 28 Division I collegiate swimmers and four club swimmers. Shoulder flexibility measurements were obtained bilaterally using a universal goniometer. Strength and endurance ratios were obtained bilaterally using the Cybex II(R) isokinetic dynamometer and the Upper Body Exercise Table(R). The swimmers completed a questionnaire that included a shoulder pain performance scale. The Pearson product moment correlation coefficient and multiple regression (R) analysis were the applied statistics. The results demonstrated that no significant correlation (p > 0.001) existed between shoulder flexibility, strength ratios, and shoulder pain. There was a significant (p </= 0.001) negative Pearson's correlation between endurance ratios of external rotation, abduction, and shoulder pain in competitive swimmers. A multiple R of 0.78 was obtained for the combination of external rotation and abduction endurance ratios to shoulder pain, which was significant (p </= 0.001). Clinical implications suggest that when evaluating swimmers, clinicians need to be aware of the importance of assessing the endurance ratios of the shoulder abductors and the external rotators at faster speeds. With decreased endurance ratios, competitive swimmers may be more likely to develop shoulder pain. J Orthop Sports Phys Ther 1992;16(6):262-268.
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50
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