THE PAINFUL SHOULDER IN THE SWIMMING ATHLETE
Section snippets
Painful Areas
The earlier that a swimmer reports shoulder pain, the more specific the diagnosis can be. If the swimmer waits to report pain, inflammation has set in, and the pain is more global, masking the inciting symptoms. Global pain has led clinicians to make global diagnoses, such as swimmer's shoulder. Likewise, the treatment is then nonspecific with limited success. This limited success is demonstrated by the fact that more than half of shoulder injuries in swimmers recur.30 Also, if a swimmer tries
DIAGNOSIS
Originally, swimmer's shoulder, as described by Kennedy et al,16 was regarded as an outlet impingement syndrome, with impingement of the rotator cuff tendons under the coracoacromial arch. It has been suggested, however, that swimmers do not have a true outlet impingement but a tendinitis secondary to swimming as part of the increased laxity translation that is present in this population. Nowhere is the relationship between impingement, laxity, and instability more prevalent or more confusing
SUBTLE SIGNS OF INJURY
The earlier a potential injury is noted, the better the chance of recovery without significant anatomic damage. The subtle compensatory mechanics are most likely to be identified by the swimming coach. To be able to identify subtle signs of injury, the coach must first understand the basics of normal mechanics of the normal and pathologic muscle firing patterns, which have been discussed.
One of the signs of potential injury is a dropped elbow in the recovery phase of the freestyle stroke. By
CONSERVATIVE TREATMENT
The first step in conservative treatment is to eliminate acute inflammation. The earlier the injury is noted, the less inflammation, and the less time it takes to move past this step. Paddles, if they have been used, should be discouraged because they put undue stress on the shoulder and can lead to injury. A brief period of rest is beneficial to the swimmer; however, it is difficult to keep the competitive swimmer out of the pool for more than a few days. Nonsteroidal anti-inflammatory drugs
SUMMARY
The ability to return a swimmer back to normal is a blend of art and science. It entails a knowledge of normal mechanics, injury mechanics, subtle signs of injury, diagnostic tools, and exercises specific to the injury. All of this knowledge is for naught, however, unless the clinician also possesses a sharp eye and a feel for the appropriate rehabilitation progression. The science gives a platform from which to select the progression artfully. By applying the art and the science of swimming
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Address reprint requests to James E. Tibone, MD, Department of Orthopaedics, University of Southern California, 1510 San Pablo #322, Los Angeles, CA 90033