SHOULDER PROBLEMS IN HIGH-LEVEL SWIMMERS - IMPINGEMENT, ANTERIOR INSTABILITY, MUSCULAR IMBALANCE

The objective was to study prevalence and underlying pathology of ''sw immer's shoulder''. Twenty-two competitive swimmers of national ''D-Ka der'' (elite development swimmers) were evaluated by means of question naire, clinical examination and isokinetic testing of external rotatio n and internal rotation. At the examination current interfering pain n ecessitating a cessation or reduction of practice was found in 5 (23 % ) athletes. At isokinetic testing 8 (36 %) athletes complained of shou lder pain. Any history of pain was seen in 14 (64 %) swimmers. A posit ive impingement sign was noted in 11 (50 %) athletes. Apprehension sig n which is indicative of anterior instability was found in 11 (50 %) s wimmers. Clinical equivalents of dysfunction of scapulothoracic muscle s such as scapular winging (5 athletes) and shoulder protraction (12 a thletes) were noted. For comparison of results of isokinetic testing a control group of non-swimmers was selected matching the group of swim mers exactly in terms of age, sex and dominant side. External rotation /internal rotation ratio of peak torque and total work at 60 deg/sec a nd 180 deg/sec was significantly lower in swimmers than in controls. T he ratio was independent of sex, dominant side, history of pain and pa in at examination. During internal rotation competitive swimmers produ ced significantly higher peak torques and total work than controls. Th ere was no significant difference in external rotation. In conclusion there are several different abnormalities of function contributing to the pathology of ''swimmer's shoulder'': - Laxity of anterior-inferior capsuloligamentous structures with atruamatic anterior instability du e to repetitive overload. - Impingement with rotator cuff tendinitis. - Muscular imbalance of the rotator cuff muscles and scapulothoracic d ysfunction.