Swimmer's Shoulder

author : AMSSM

comments : 1

The anatomy, diagnosis and treatment of swimmer's shoulder.

Member Question

I seem to have an odd shoulder pain.  I saw an orthopedic and physical therapist about it.  Stability is fine, no symptoms of torn tissues, etc.  The best way to put it was by my PT.  He said it appears that the head of my humurus may be rubbing on the recovery portion of my stroke causing inflamation. 

I am doing PT to stretch and strengthen, but swimming is hard.  My coach is working with me to increase my roll and to improve my posture and bilateral breathing, etc.

The weird part is if I roll until my shoulder is out of the water, then bring my hand up towards my shoulder (like a bicep curl) then push it forward keeping my elbow low to the water, the pain is greatly reduced.  If I raise my elbow, and 'swing' on the recovery similar to most swimmers, my shoulder audibly clicks and I get the soreness and pain.

I'm 43 and swam year-round from 8 to 18 and off and on since then with occasional shoulder pain, but no clicks.  I thought it could have been bone spurs, but the doctor said x-rays show no issues.

Answer from Nick Monson, DO
Member AMSSM 

The shoulder is a complex system with an amazing amount of mobility.  It is designed to provide the most range of motion (ROM) of any joint in the body.  The glenohumeral joint is the largest joint in the shoulder.  It is composed of the humerus (upper arm bone) and the glenoid portion of the scapula (shoulder blade bone).  The shoulder joint also involves the clavicle (collar bone).  There is a complex ligamentous system, which contributes to the primary stability of the shoulder with a musculotendinous system acting as a secondary stabilizer.  This support mechanism provides the shoulder with an ability to withstand large external forces while still being able to provide sufficient shoulder mobility to perform complex movements. 

It sounds as if your evaluation has shown no evidence of arthritis, muscular or other tissue tear or instability.  Your history is most commonly related with a diagnosis of “swimmer’s shoulder.”  Swimmer’s shoulder is a musculoskeletal condition that results in symptoms usually found in the front and/or side of the shoulder. Swimmer’s shoulder is a condition typically with a gradual onset related to repetitive activity and can be caused by many different factors.  Examples include: inflammation of a tendon or bursa (fluid containing sack that provides cushion), bony impingement (unlikely for you given your normal x-ray), incorrect technique or fatigue altering your normal technique, overuse, misuse, abuse, laxity in the joint or changes in the ligamentous system surrounding the shoulder.

Core principles for prevention and treatment involve an understanding of the underlying cause.   With multiple possibilities as the underlying cause of the “swimmer’s shoulder,” evaluation by a physician and working closely with your physical therapist is key.  By your question and previous work-up, I will assume that there is no significant tissue pathology that will require an orthopedic surgeon’s intervention.  

Working with a swim coach is an excellent idea.  They should have the experience and ability to identify irregularities in your technique and will make recommendations on modifications.   Further treatment with physical therapy is also key to improving this condition.  A comprehensive rehabilitation program should be started including strengthening of the rotator cuff and scapular stabilizers, stretching anterior chest musculature and implementing activity modifications that allow you to continue to participate in swimming on some level.  Modification in the strokes that are performed or the distances swam may be necessary.  In extreme cases, it is sometimes necessary that you would need to transition to a short dry-land period of exercise to allow adequate healing of the affected tissues.

In review, shoulder pain is the most common complaint of swimmers.  Swimmer’s shoulder is an injury which generally creeps up on you and can be quite debilitating for normal activity.  Modification of activity, and working closely with a health care team familiar with swimmer’s shoulder is key to improvement.  This is a treatable condition and with hard work and close adherence to recommendations from your health care team and swim coach, you will be back before you know it.  Thank you for the interesting question.

Nick Monson, DO

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date: November 28, 2012