SWIMMER’S SHOULDER

If you’ve experienced pain, weakness or joint stiffness in the shoulder, please Schedule an appointment with one of our orthopedic specialists as soon as possible.

Swimmer’s shoulder causes shoulder pain and consists of a specific overuse injury of the shoulder tendons. Swimmer’s shoulder occurs when the tendons of the shoulder suffer from inflammation and swelling, compressing with the nearby bones, muscles, and other tendons. Some physicians also know Swimmer’s shoulder as shoulder impingement, subacromial impingement, or painful arc. 

Inflammation tends to affect the tendons in the rotator cuff (a group of muscles and tendons that hold the arm bone into the shoulder joint). These tendons may put pressure on the top part of the shoulder blade, also known as the acromion. This friction on the shoulder blade may then lead to bone spurs developing.

What is a Swimmer’s Shoulder?

Swimmer’s shoulder, which is also called shoulder impingement or subacromial impingement is associated with tendons and tissues that connect muscle to bones in the shoulder region. 

In this condition, the tendons underlining the shoulder joint becomes swollen and inflamed, resulting in the compression of surrounding bones, muscle, and tendons. It primarily occurs in swimmers who repeat the same stroke over time. Usually, the rotator cuff muscle and associated tendons are injured in Swimmer’s shoulder.

While a abrupt injury can cause impingement syndrome, it typically results from repetitive movements over time – like a swimmer repeating the same stroke. The good news is that most people can heal from a swimmer’s shoulder in a matter of months.³

Figure 1. SWIMMER’s SHOULDER

How does Swimmers Shoulder happen?

Swimming is accomplished by propulsive forces of the swim stroke by adduction and friction. The pectoralis major, latissimus dorsi, subscapularis, and serratus anterior are major are essential contributors to these swim strokes.4

Any imbalance in muscle movement due to sudden uphill in training yardage or problems with the technique can initiate the onset of pain. A drop elbow during the recovery phase is an early sign of a Swimmer’s shoulder.⁵

What are the causes?

Swimmers’ impingement can occur in athletes playing sports which involves active movements and muscle balance. 

• Rotator cuff tear
• Shoulder laxity
• Bone spurs at the edges
• Labral injury (cartilage)
• Problems with the tendon itself
• Osteoarthritis of the joint

Furthermore, some training errors can also cause a swimmer’s shoulder like overuse, misuse, or abuse. This swimmer’s shoulder can prove costly if left untreated and can lead to a labral tear or cuff tear.³

What are the symptoms?

The onset of symptoms occurs with poor posture, moving the hand associated with joint, neuromuscular control, or muscle performance.⁶

• Decreased motion of the joint
• Drooping of the joint 
• Crippling of the joint
• Instability of the joint
• Pain in the affected joint

How is shoulder impingement diagnosed?

A sportsman doctor or physio-therapist generally monitors the symptoms and performs a detailed physical examination checking for redness, pain, swelling, and tenderness by pressing around the shoulder joint. A check on the movement of the joint is also observed.

If the condition is serious, an X-ray can be performed to look for a broken or dislocated bone or tissue injury, and in severe cases, a CT scan or MRI can be done to investigate tendons tears.³

Figure 2. INFLAMED TENDON

What are the treatment options?

Sports doctors or physio-therapists are aimed to prevent the condition and in other cases to treat it early. They should also analyze training methods and stroke mechanics. Treatment is objective to reduce pain and inflammation and regain joint strength, and function. 

In most cases, the Swimmer’s shoulder or subacromial impingement resolves, and the underlining muscle and tendons injury heals with exercise and medications. In severe cases, shoulder surgery should be considered as the sole treatment option.³ 

Palliative measures

• Take proper rest 
• Avoiding straining 
• Apply ice to the joint
• Certain exercises 

Medications

Medications are targeted to relieve discomfort caused by inflammation and pain.2 

• Oral anti-inflammatory medications to reduce inflammation
• Cortisone injections (Steroid injections) to help alleviate the symptoms of pain in the joint

Physiotherapy

Physio-therapists direct certain exercises and stretch that assist in healing the Swimmer’s shoulder. The following exercises should be considered.¹

• Seated rows
• Plank hand step-ups
• Standing double arm external rotation

If you would like to contact an Orthopedic Upper Extremity Specialist in DFW Metroplex, give us a call at 817-697-4038, or contact us over the web. Tele-medicine appointments are also available.