Swimmers Shoulder is frequently described as an impingement problem in the rotator cuff area, felt as anterior shoulder pain (Anderson, Hall, & Martin, 2000; Bak & Fauno, 1997; Costill, Maglischo, & Richardson, 1992; Johnson, Gauvin, & Fredericson, 2003; Koehler & Thorson, 1996; Loosli & Quick, 1996; Mayo Clinic, 2000; Newton, Jones, Kraemer, & Wardle, 2002; Pollard, 2001; Pollard & Croker, 1999; Richardson, Jobe, & Collins, 1980; Tuffey, 2000; Otis & Goldingay, 2000; Weisenthal, 2001; Weldon & Richardson, 2001). Anderson, Hall, and Martin (2000) describe the initial symptoms as pain felt deep in the shoulder, often at night, and that increases with activity in the impingement position. The pain may only be felt in a painful arc between the waist and shoulder (Mayo Clinic 2000). This painful arc is described by Anderson, Hall, and Martin (2000) as being between 70º and 120º during active or resisted abduction about the shoulder. A study by Bak and Fauno (1997) reported swimmers described pain as localized in the anterior or anterior-lateral shoulder area. The pain may gradually increase over time, indicating an impingement, as opposed to a sudden onset of pain, which would indicate a tear (Chang 2002).
Both the Hawkins and Neer test could be positive, with the Hawkins test indicating a compression of tendons under the acromion, and the Neer indicating a rotator cuff pinching on the anterosuperior glenoid rim (Pink & Jobe, 1996). In a case review by Koehler and Thorson (1996), the following signs were noted in a swimmer with no previous history of shoulder problems that was now complaining of shoulder pain:
- Shoulder pain while swimming freestyle.
- A forward shoulder slouch while seated.
- Underdeveloped posterior shoulder musculature.
- A mild winging on the affected side's left scapula.
- Tenderness in the acromioclavicular joint and coracoid process in the impingement area.
- Tenderness in the affected side's bicep tendon and supraspinatus tendon.
- A full range of motion in all planes.
- Strength was slightly decreased in the supraspinatus and infraspinatus.
- Full strength in the internal rotators, arm extensors, and flexors.
- Moderate posterior and anterior laxity in both shoulders.
- A bilateral sulcus sign.
- Impingement and adduction-compression tests on the affected side were positive.
- An apprehension test on the affected side was negative.
They concluded that the swimmer had an impingement syndrome consistent with SS that included weakness in the rotator cuff and scapular stabilizers and multidirectional instability (Koehler & Thorson, 1996). Bak and Fauno (1997) state that the majority of swimmers with shoulder pain have signs of impingement, increased shoulder laxity anteroinferiorly, and a lack of scapulohumeral coordination, supporting Koehler and Thorson (1996). The pain from SS can be divided into four increasingly more severe categories (Costill, Maglischo, & Richardson, 1992):
- Pain only present after heavy workouts.
- Pain present during and after workouts.
- Pain present that interferes with performance.
- Pain that prevents participation.
If possible, at the first sign of any SS symptom, an evaluation for other symptoms should be undertaken before the condition escalates (Tuffey, 2000). It may also be possible to isolate the cause or causes of this occurrence of SS and develop an appropriate rehabilitation or prevention plan.