Swimmer’s shoulder is an overuse injury caused by repetitive trauma. It can also be referred to as impingement syndrome. It is characterized by pain in the shoulder due to irritation or inflammation of the rotator cuff tendons or the bursa (subacromial bursa) sitting between the rotator cuff and the bony roof of the shoulder (coracoacromial arch).
What Is Swimmer’s Shoulder?
The rotator cuff is a series of four muscles that run along the scapula (shoulder blade) and around the glenoid (shoulder socket), surrounding and attaching to the humeral head (ball of the shoulder) by their tendons. The rotator cuff muscles work to keep the humeral head centered in the glenoid (socket) as we move our arm.
As a result of injury, overuse, fatigue, or relative weakness of the rotator cuff or scapular muscles, the humeral head may not stay well centered when the arm is elevated. This movement can result in contact (impingement) of the rotator cuff with the overlying bony-ligamentous roof (coracoacromial arch).
This contact can result in pain and inflammation from the bursa situated between these structures, leading to rotator cuff weakness and poor shoulder muscular control and creating a cycle of pain with repetitive use. This process does not usually result in a rotator cuff tear, but it can be extremely painful and make it difficult to raise the arm.
Causes and Risk Factors
Causes and risk factors for swimmer’s shoulder can include:
- Dramatic changes in shoulder activity
- Inactivity and rotator cuff or scapular muscle weakness
- Repetitive overhead use, such as swimming, painting, or throwing
- Age-related narrowing of the space between the roof of the shoulder (coracoacromial arch) and the rotator cuff
- Unstable Os acromiale
- Overhead sports, such as baseball, tennis, swimming, or volleyball
- Weightlifting and bodybuilding that focus on only certain muscle groups, creating muscle imbalances
- Repetitive overhead labor or work
- Previous injury to the rotator cuff, including impingement
- Poor physical conditioning, including strength and flexibility
- Inadequate warm-up or pre-season conditioning before practice or play
- Training errors
Symptoms
Frequent signs and symptoms of swimmer’s shoulder include:
- Pain around the shoulder, often along the side of the upper arm
- Pain that is worse when reaching away from the body or overhead
- Occasional aching when not using the arm
- Pain that awakens you at night
- Occasional loss of strength or difficulty raising the arm
- Occasional crepitation (a crackling sound) of the bursa when moving the arm
- Biceps pain and inflammation in the front of the upper arm
Diagnosis
If a proper course of conservative treatment does not relieve symptoms, an MRI may be ordered to rule out a rotator cuff tear. MRI is limited and sometimes may miss smaller or partial-thickness tears.
If a patient has failed therapy or has a negative MRI but a history suspicious for a tear, arthroscopic surgery may be recommended to potentially address a rotator cuff tear.
Treatment
Initial treatment consists of therapeutic exercises to restore rotator cuff and scapular muscle strength, endurance, and mechanics to allow proper, non-painful motion of the shoulder. Avoiding activities that aggravate symptoms will also help relieve inflammation and pain. Supervision by an experienced physical therapist is strongly recommended.
A steroid injection to the inflamed area around the tendon (within the bursa) is sometimes recommended for patients who are extremely limited by pain.
If conservative treatment does not relieve symptoms, arthroscopic surgery may be recommended to potentially address a rotator cuff tear or perform a subacromial decompression to open the space between the rotator cuff and roof of the shoulder (coracoacromial arch) and alleviate impingement contact and pain. Most young athletes do not need surgery.
Recovery and Outcomes
The prognosis for swimmer’s shoulder/impingement is usually excellent. A full recovery can usually be expected within six to eight weeks by eliminating aggravating activities and performing therapeutic exercises for the rotator cuff and scapular muscles.
For swimmers and other overhead athletes, it is important to gradually return to activity to avoid re-aggravation. Keeping in the pool by kicking or utilizing non-painful strokes can also be helpful while recovering.
Return to full activity is usually possible in six weeks following therapy alone but may take anywhere from three to six months if surgery is performed.
When to See Dr. Chudik
If shoulder pain persists or worsens, particularly with swimming, reaching, or other overhead activities, or symptoms continue despite activity modification and conservative treatment, contact Dr. Chudik’s office for an evaluation.
Call 630-324-0402, email contactus@chudikmd.com, or request an appointment online.