Swimmer’s Shoulder is an overuse injury caused by repetitive trauma. It also can 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). The rotator cuff is a series of four muscles which run along the shoulder blade (scapula) and around the shoulder socket (glenoid) surrounding and attaching to the ball of the shoulder (humeral head) by their tendons. The muscles of the rotator cuff work to keep the humeral head centered in the socket (glenoid) as we move our arm. As a result of injury, overuse, or relative weakness of the rotator cuff or scapular muscles, the humeral head may not stay well centered when we elevate our arm. This movement of the humeral head 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 those structures which results rotator cuff weakness and poor shoulder muscular control. It creates 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 for someone to raise their arm.
Initial treatment consists of therapeutic exercises to restore rotator cuff and scapular muscle strength, endurance, and mechanics to allow proper non-painful shoulder motion. Avoiding activities that aggravate the symptoms also will help to relieve the inflammation and pain. Supervision by an experienced 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 a proper course of conservative treatment does not relieve the symptoms, a MRI may be ordered to rule out a rotator cuff tear. A MRI has limitations and sometimes may miss smaller or partial thickness tears. If the patient failed therapy or has a negative MRI, but a history suspicious for a tear (injury or older age), 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). This alleviates the impingement contact and pain. Return to full activity usually is possible in six weeks following therapy alone, but if surgery is performed, return to full activity may take three to six months.
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