Shoulder Impingement/ Rotator cuff tendinitis:

Swimmer’s shoulder is a common issue for people involved in overhead activities like badminton players, painters, masons, swimmers, affecting 40% to 90% of them at some point. Also known as rotator cuff impingement syndrome, it occurs when the tendons and bursa (a fluid-filled sac) in the shoulder get irritated from abnormal rubbing and pinching.

Shoulder Impingment - Dr. Manish Singh- Orthopaedics & sports injury surgeon- Gaurs
Though called swimmers shoulder, Shoulder impingement is increasingly seen in general population who are involved in overhead activities, or who have to sit long hours on desk and have weak upper back muscles. Shoulder impingement is often considered as the initial part of the spectrum which includes, rotator cuff tears, and finally rotator cuff arthropathy.
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Anatomy of the Shoulder

The shoulder is a highly flexible joint made up of three bones:

  • Scapula (Shoulder Blade)
  • Clavicle (Collarbone)
  • Humerus (Upper Arm Bone)

These bones form the shoulder joint and are surrounded by various muscles, including the rotator cuff. The rotator cuff is a group of four muscles that keep the ball of the shoulder joint in place, enabling smooth arm movements. Ligaments also help stabilize the joint.

Symptoms of Shoulder impingement

Common signs of swimmer’s shoulder include:

  • Pain at the top of the shoulder
  • Swelling in the front or top of the shoulder
  • Difficulty reaching overhead
  • Pain when bearing weight through the arm

Symptoms often worsen during or right after swimming due to the arm positions and movements involved. Overhead actions, like those in freestyle strokes, can pinch the rotator cuff tendons or bursa, causing inflammation and pain. Loose shoulder ligaments can also contribute to instability and pinching.

If you experience these symptoms and swim regularly, it’s important to consult a physician for an accurate diagnosis and treatment plan.

Diagnosing Shoulder Impingment

To diagnose swimmer’s shoulder, a physician will typically perform:

  • Physical Examination: Checking for tenderness and strength
  • Special Tests: Such as Neer’s test, where the arm is raised overhead to check for pain, indicating possible rotator cuff impingement

Additional tests may include X-rays to view bone structures and MRI scans to assess soft tissues like tendons and bursa.

Treatment Options

Managing swimmer’s shoulder focuses on reducing pain and inflammation and improving shoulder mechanics. Treatment options include:

  • Rest: Avoid swimming and activities that aggravate the shoulder.
  • Medication: Over-the-counter anti-inflammatory drugs (e.g., Advil, Aleve) to reduce pain and swelling. For severe cases, stronger medications may be prescribed.
  • Physical Therapy: A physical therapist can develop a program to enhance shoulder mobility and strength. Treatments may include:
  • Exercises
  • Joint mobilizations
  • Heat and ice therapy
  • Electrical stimulation
  • Ultrasound
  • Stretching
  • Stabilization techniques
  • Taping and trigger point release
  • Injections: Cortisone injections can provide temporary relief by reducing inflammation and pain.
  • Surgery: If conservative treatments fail, arthroscopic surgery (subacromial decompression) may be needed to remove inflamed tissue and bone spurs. Recovery typically takes about eight weeks.

Exercises for Swimmer’s Shoulder

Certain exercises can help improve shoulder mobility and strength. Always consult with your physician or physical therapist before starting any exercise program. Recommended exercises include:

  • Internal Rotation Towel Stretch: Stretch the shoulder joint capsule by pulling a towel up your back.
  • Prone Scapula Squeeze: Enhance scapular control by lifting your arm while lying on your stomach.
  • Rotator Cuff Strengthening: Strengthen rotator cuff muscles with side-lying external rotations.

Recovery Time

Most cases of swimmer’s shoulder resolve within eight to ten weeks. However, severe cases might take up to three months. As your symptoms improve, gradually return to swimming and other activities, incorporating shoulder exercises two to three times a week to maintain strength and flexibility and prevent future issues.

Summary

Swimmer’s shoulder, marked by pinching and sharp pain, can limit your swimming and arm function. Treatment usually involves rest, anti-inflammatory medications, physical therapy, and possibly surgery. With proper management, most cases resolve within a few months, allowing you to return to swimming and other activities without pain.