- Email: [email protected]
296 Shoulder laxity and impingement in elite swimmers
III •
Shoulder laxity and impingement in elite swimmers
M. Sein 1*, J. Walton1, J. Linklater2, R. Appleyard1, B. Kirkbride 3, D. Kuah 3&G. Murrell 1 1St George Hospital Campus, UNSW 2Castlereagh Imaging 3NSW Institute Of Sport
Introduction: Shoulder pain in elite swimmers is common and its cause is unknown. One hypothesis is that repetitive swimming leads to shoulder laxity which in turn leads to impingement. The aims of our study were (1) to determine which clinical signs and/or training conditions predict shoulder pain in swimmers; (2) which pathological lesion(s) is associated with this pain and (3) how this might occur. Methods and Materials: Under ethics approval, 80 elite swimmers (13-25 years) completed questionnaires on their swimming training, pain and shoulder function. They were given astandardized clinical shoulder examination and non-invasive electronic testing for inferior glenohumeral joint laxity. 52/80 also attended for a shoulder MRI. Results: MRI revealed supraspinatus tendinosis in 36/52 (690/0) swimmers, including all four international-level athletes. Most (91 %) swimmers indicated they had mild-moderate shoulder pain. Laxity and positive impingement sign correlated modestly yet significantly (r = 0.23, p<0.05). A positive impingement sign correlated strongly with supraspinatus tendinosis (r=0.49, p<0.001). The test for positive impingement sign had 100% sensitivity and 65% specificity for diagnosing supraspinatus tendinopathy. Number of hours swum/week (r = 0.35, P = 0.01) and weekly mileage (r = 0.34, P = 0.01) both correlated significantly with supraspinatus tendinopathy (Pearson correlations) whereas swimming stroke preference did not. Multiple logistic regression analysis performed with supraspinatus tendinopathy as the dependent variable showed that the combination of (1) hours swum/week and (2) weekly mileage correctly predict tendinopathy in 71 %of the elite swimmers. Conclusions: These data indicate that shoulder overuse contributes to impingement and supraspinatus tendinosis in elite swimmers.
III •
Surgical stabilization of the unstable shoulder in athletes. Is there a role for arthroscopy?
D. Biggs*, M. Haber &L. Mayo Central West Orthopaedics
Shoulder instability is a common problem in the sporting population. Athletes with shoulder instability problems often require surgical stabilization. The timing of and type of surgical reconstruction to be performed, is somewhat controversial. The surgery can be performed acutely, or only after a number of instability episodes have occurred. The surgery can be performed arthroscopically, or via the more traditional open approach. This paper reports my results of shoulder arthroscopic stabilization both in the acute and chronic setting, in a sporting population. Indications for, and the results of, open shoulder stabilization will be presented. Indications and contraindications for arthroscopic shoulder stabilization will be outlined. The indications for acute shoulder stabilization will also be discussed.
174
Shoulder laxity and impingement in elite swimmers
M. Sein 1*, J. Walton1, J. Linklater2, R. Appleyard1, B. Kirkbride 3, D. Kuah 3&G. Murrell 1 1St George Hospital Campus, UNSW 2Castlereagh Imaging 3NSW Institute Of Sport
Introduction: Shoulder pain in elite swimmers is common and its cause is unknown. One hypothesis is that repetitive swimming leads to shoulder laxity which in turn leads to impingement. The aims of our study were (1) to determine which clinical signs and/or training conditions predict shoulder pain in swimmers; (2) which pathological lesion(s) is associated with this pain and (3) how this might occur. Methods and Materials: Under ethics approval, 80 elite swimmers (13-25 years) completed questionnaires on their swimming training, pain and shoulder function. They were given astandardized clinical shoulder examination and non-invasive electronic testing for inferior glenohumeral joint laxity. 52/80 also attended for a shoulder MRI. Results: MRI revealed supraspinatus tendinosis in 36/52 (690/0) swimmers, including all four international-level athletes. Most (91 %) swimmers indicated they had mild-moderate shoulder pain. Laxity and positive impingement sign correlated modestly yet significantly (r = 0.23, p<0.05). A positive impingement sign correlated strongly with supraspinatus tendinosis (r=0.49, p<0.001). The test for positive impingement sign had 100% sensitivity and 65% specificity for diagnosing supraspinatus tendinopathy. Number of hours swum/week (r = 0.35, P = 0.01) and weekly mileage (r = 0.34, P = 0.01) both correlated significantly with supraspinatus tendinopathy (Pearson correlations) whereas swimming stroke preference did not. Multiple logistic regression analysis performed with supraspinatus tendinopathy as the dependent variable showed that the combination of (1) hours swum/week and (2) weekly mileage correctly predict tendinopathy in 71 %of the elite swimmers. Conclusions: These data indicate that shoulder overuse contributes to impingement and supraspinatus tendinosis in elite swimmers.
III •
Surgical stabilization of the unstable shoulder in athletes. Is there a role for arthroscopy?
D. Biggs*, M. Haber &L. Mayo Central West Orthopaedics
Shoulder instability is a common problem in the sporting population. Athletes with shoulder instability problems often require surgical stabilization. The timing of and type of surgical reconstruction to be performed, is somewhat controversial. The surgery can be performed acutely, or only after a number of instability episodes have occurred. The surgery can be performed arthroscopically, or via the more traditional open approach. This paper reports my results of shoulder arthroscopic stabilization both in the acute and chronic setting, in a sporting population. Indications for, and the results of, open shoulder stabilization will be presented. Indications and contraindications for arthroscopic shoulder stabilization will be outlined. The indications for acute shoulder stabilization will also be discussed.
174