Swimmer's Shoulder

About Swimmers Shoulder

Swimmer's Shoulder is a musculoskeletal condition that causes pain in the shoulders. Also known as Shoulder Impingement Syndrome, Painful Arc Syndrome, Subacromial Impingement, Thrower's Shoulder, and Supraspinatus Syndrome, this condition is common with athletes, especially swimmers. Repetitive overhead activity of the shoulder may lead to injury of the tendons or bursa by the bones resulting in a Swimmer's Shoulder. Shoulders & upper extremities play an important role in movement during swimming and this sport requires efficient shoulder flexibility. Also, with mobility being difficult in water, it is important to use the right technique to prevent loosening of the joints. Hence, wrong technique or overuse of the joint, causes continuous pain and may affect the daily activities of the swimmer leading to inflammation of the rotator cuff tendons & bursa. If neglected, the patient may also suffer from Tendinitis, Bursitis, or thinning and tearing of the rotator cuff tendons. Apart from swimming, the other activities that may lead to this condition include painting, lifting, and other overhead sports, such as tennis, baseball, water polo, and volleyball. Causes While performing overhead shoulder activities, the acromion may pinch the rotator cuff & subacromial bursa causing pain and resulting in Shoulder Impingement Syndrome. The main reason for a Swimmer's Shoulder is narrowing of the subacromial space. The causes for this narrowing include:

1. Structural or anatomic abnormalities.
2. Age; Acromioclavicular Joint Arthritis (AC jointArthritis) which develops mainly in elderly people may cause an Impingement Shoulder.
3. Overuse of the rotator cuff.
4. Repetitive irritation in the rotator cuff below the acromion.
5. Shoulder instability; an unstable shoulder may lead to the humeral head of the shoulder to come out of the socket leading to impingement.

Signs and Symptoms The most important symptom of a Shoulder Impingement Syndrome is pain in the front or side of the shoulder that increases with overhead activities. At times the pain may affect the upper arm too. The other symptoms include:

1. Weakness
2. Decreased range of motion
3. Pain while sleeping
4. Grinding or popping sensation in the shoulder

Consultation A General Physician or an Orthopedic Surgeon is the subject matter expert. Tests and Investigations Physicians diagnose Shoulder Impingement Syndrome through a physical exam and by checking the patient's medical history. The physician may also ask the patient to perform some simple exercises to test the degree of pain as well as its origin. Neer's Sign and Hawkin's Test are the significant physical examinations in this regard. Another method of diagnosing this condition is the "Impingement Test". Here, the physician gives the patient a Lidocaine injection. If the pain subsides and the patient is able to move his limb, it is a case of Shoulder Impingement. X-Rays, MRIs, Ultrasonographies, and Arthrographies help in detecting variation in the bones & acromion, calcification, Acromioclavicular Arthritis, Rotator Cuff Tears, and more. These tests do not detect a Swimmer's Shoulder but help in diagnosing what caused it. Treatment Modalities Available Treatment of Swimmer's Shoulder is possible at home. Taking rest and avoiding overhead activities helps aggravation of the condition. Application of ice packs and intake of anti-inflammatory medications help reduce pain & inflammation.  Daily stretching in a warm shower may also give relief. Medical intervention becomes necessary if the symptoms do not subside. Cortisone injection into the bursa gives instant relief from pain & inflammation. Physiotherapy including exercises, electrical stimulation, ultrasound, or other modalities under a professional's guidance may help. To prevent this condition it is especially important for athletes to indulge in a shoulder-strengthening regime. Athletes having structural or anatomic abnormalities may need surgery. Young athletes may require Shoulder Stabilization Surgery and the elder ones may need a Subacromial Decompression Surgery which involves shaving off the arthritic bone and spurs from the acromion to give more space to the rotator cuff to move freely. Physical Activity Requirements during the Course of the Treatment The best treatment for a Swimmer's Shoulder is to avoid repetitive and overhead activities of the shoulder. After the pain and inflammation subsides, shoulder-strengthening exercises help preventing recurrence of the condition. Prevention to Avoid Occurrence and Recurrence By undertaking the following measures, swimmers can avoid occurrence or recurrence of Swimmer's Shoulder:

1. Indulge in bilateral breathing.
2. Adopt good and symmetrical body rotation
3. The fingertip of the hand must enter the water first and not the thumb. This is the right technique for using hands while swimming.
4. Develop and maintain a good upper body posture.
5. Target a bent arm catch and pull through.
6. At the front of the stroke, avoid midline cross over.

Physicians may recommend athletes suffering from Shoulder Impingement to avoid certain movements in their sports. As a result, they may have to limit or modify their activities. For example, instead of throwing overhead, a thrower may throw sidearm. This way he can prevent the acromion from impinging the rotator cuff and bursa. Support from Family Patients with a Shoulder Impingement Syndrome may experience unbearable pain which makes them agitated. Assurance from the family helps the patient to recover faster.