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Home > Swimmer’s Shoulder: What You Need to Know from An Orthopaedic Physician

Swimmer’s Shoulder: What You Need to Know from An Orthopaedic Physician

Boyd W. Haynes III, MDBoyd W. Haynes, MD III 

Swimmer’s shoulder is a common condition that affects swimmers and others who engage in repetitive overhead activities, such as house painting. Also known as shoulder impingement syndrome, characterized by pain and dysfunction in the shoulder joint, this condition may be prevalent due to the repetitive overhead motions associated with competitive swimming.  It can significantly impact an athlete’s performance and quality of life. Early recognition, accurate diagnosis, and appropriate treatment are essential for successful rehabilitation and prevention of long-term complications.  In this article, I’ll provide an overview of swimmer’s shoulder, including its causes, symptoms, diagnosis, and treatment options.

Causes of Swimmer’s Shoulder

The primary cause of swimmer’s shoulder is the repeated stress placed on the shoulder joint during swimming strokes, particularly the freestyle and butterfly strokes. The repetitive overhead movements of the arm lead to muscular imbalances and structural changes, such as inflammation and tissue degeneration. Other contributing factors are:

  • poor swimming technique
  • inadequate warm-up or cool-down routines
  • insufficient shoulder strength
  • shoulder instability

Symptoms of Swimmer’s Shoulder

The most common symptom of swimmer’s shoulder is pain, typically a dull ache or sharp sensation in the front or outer aspect of the shoulder. The pain may radiate down the arm and worsen with overhead movements or activities that involve reaching, lifting, or throwing. Swimmers may also experience weakness, limited range of motion, and shoulder instability.  Pain will also continue at rest, and it may be difficult to sleep on the affected shoulder.  If allowed to continue untreated, the biceps tendon may even be weakened.

Diagnosis

I diagnose swimmer’s shoulder by ordering x-rays to rule out other mechanical issues, such as arthritis, and complete a comprehensive evaluation, which includes a thorough medical history and physical examination. I’ll ask many questions about your symptoms, how long you’ve had them, perform various range of motion and strength tests, and review the X-rays to evaluate the integrity of the shoulder structures.

Conservative Treatment

Once I make a diagnosis of swimmer’s shoulder, management typically involves a multidisciplinary approach that includes rest, physical therapy, and medication. Resting the affected shoulder allows the injured tissues to heal and recover. Physical therapy plays a crucial role in correcting muscular imbalances, improving shoulder stability, and enhancing range of motion. Therapeutic exercises, stretching, and manual therapy techniques are important, as well as modalities to reduce inflammation and pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), oral steroids and corticosteroid injections may be prescribed to manage pain and inflammation. In severe cases or when conservative measures fail, surgical intervention may be considered.

Surgical Intervention

In the rare instance that surgery is needed, I will perform an outpatient subacromial decompression of the shoulder.  This surgery involves removing inflamed, damaged tissue as well as any bone spurs or other mechanical issues that may be causing impingement.  This surgery will be performed arthroscopically, meaning that we make several small incisions and use a camera to see what is going on inside the shoulder joint as I manipulate surgical instruments through the other small incisions in the shoulder.  I can restore pain-free motion to the shoulder, close the small incisions and send the patient home to recover.

There will be a period of healing where I will prohibit you from moving your shoulder, then you will graduate to passive movement, then to physical therapy and on to more progressive strengthening and range of motion exercises.  Full recovery from shoulder impingement surgery can take anywhere from 6 months to a year.

Swimmer’s Shoulder Prevention

Preventing swimmer’s shoulder is paramount in maintaining an athlete’s long-term shoulder health. Strategies such as proper stroke technique, gradual training progression, regular rest periods, and incorporating shoulder-specific strengthening exercises into the training regimen can reduce the risk of developing this condition. Athletes should also maintain overall fitness, including core and upper body strength, as well as participate in adequate warm-up and cool-down routines.

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