The shoulder is a complex ball-and-socket like joint consisting of three main bones -the humerus (the upper part of the upper arm bone), the clavicle (the collarbone), and the scapula (or shoulder blade, the largest bone in the chest-shoulder region). The humerus forms the ball in the ball-and-socket-like joint and is attached by ligaments -connective tissue-to the scapula. Bursas -fluid-filled sacs or saclike cavities- surround and cushion the bones and allow for movement. Muscles, including the trapezius, deltoid, pectorals, and latissimus dorsi, travel over, under, and around the shoulder joint and add stability. Tendons (also connective tissue) connect these muscles to bone.
What the Shoulder Does: The shoulder allows movement of the hand and arm in space.
Swimmer’s shoulder is a strain and, sometimes, a microtear, in the supraspinatus muscle that lies on top of the shoulder between the neck and the top of the arm. It also can be a strain or tear, called an impingement syndrome, in the rotator cuff-an intertwined unit of muscles and tendons that surrounds and gives stability to the shoulder at the ball-socket joint. When trauma occurs to the rotator cuff, it may swell and “impinge” upon or rub against bone, causing pain.
Cause of Injury: The injury is usually associated with a repetitive motion over time. In swimming it also can be caused by an increase in distance or speed, or both, or by an improper swimming stroke. Other sports that can cause swimmer’s shoulder: the baseball pitch, the football pass, the tennis serve, racquetball, volleyball, basketball, golf, sailing, canoeing, kayaking, javelin throw, shot put, weight lifting, and rock climbing. Other activities that may cause swimmer’s shoulder: construction work, factory work, and other kinds of manual labor (painting, plastering, or housework); any prolonged activity in which the arm is extended above the head.
Symptoms: Pain on top and in the front of the shoulder. Pain in the shoulder at night. Pain and weakness when extending the arm forward or upward. You may feel as if you have a painful “bitch” in the shoulder. Sharp pain and limitation of motion in the shoulder joint (rotator cuff).
Immediate Treatment: If the arm cannot be extended above the head, if the arm cannot be moved at all (“frozen shoulder”), or if there is a sharp pain and weakness where the arm connects to the trunk of the body, see your physician to determine proper treatment. Stop the activity that is causing the pain. Place an ice pack on the shoulder as soon as possible. Cold treatments help stop internal bleeding and the accumulation of fluids in and around the injured area, thus decreasing swelling.
Medication: (If you have seen your physician, follow his or her advice.) Take aspirin, ibuprofen, or acetaminophen regularly to relieve pain and inflammation. Your physician may prescribe another mild analgesic (pain reliever) to help reduce pain or a nonsteroidal anti-inflammatory drug (NSAID) to help reduce pain and swelling, In some instances, your physician may suggest a low-dose injection of a corticosteroid or “steroid” drug, such as cortisone, that will help reduce inflammation.
TRAINING TIPS: Acetaminophen may not contain as much of the anti inflammatory agents as aspirin or ibuprofen. Ask your physician or pharmacist for guidance.
WARNING: Do not give aspirin to children under the age of 16. If pregnant or nursing, consult with your physician first before taking any medication.
Continued Care: Rest the arm for approximately 4 to 8 weeks. Use an ice pack for 2 to 4 days after ceasing the activity to reduce swelling and inflammation. Use a heating pad thereafter. Heat treatments help to enlarge the small blood vessels in and around the injured area, thus increasing blood circulation. (Blood carries vital nutrients to the injury and helps speed recovery.)
TRAINING TIP: Heat should be applied only after swelling has subsided, or swelling in the injured area may increase.
Do not engage in original activity until the pain has subsided. Ease into limited muscle workouts: gradually swing your arm as if throwing a ball, work with light weights, and work with a trainer or physical therapist on light shoulder exercises that use and strengthen the supraspinatus muscle. Use an ice pack to help reduce any swelling that may recur, then a heating pad to help repair the injury.
Medication: Take aspirin, ibuprofen, or acetaminophen to help reduce pain and inflammation.
Long-Term Effects of Injury: None, with proper treatment and rest, although some individuals may suffer recurring pain even with precautionary measures (see below). In rare cases, surgery may be recommended to remove scar tissue and bone from the rotator cuff area.
Prevention of Recurring Injury: Allow plenty of time for healing. Use weights and exercises advised by a trainer or physical therapist. These measures may have to be employed throughout a lifetime to avoid or reduce pain. Obtain the advice of a swimming instructor or baseball or football coach on proper technique. Use an ice pack to reduce swelling, then a heating pad to aid recovery.
See Your Physician: If pain continues, is severe, or limits motion in the shoulder.