Upper extremity overuse injuries in swimming. A discussion of swimmer's shoulder.

Treatment of shoulder pain includes the following: 1. Avoid all painful activities. 2. A 2-week course of nonsteroidal anti-inflammatory medication and ice. 3. Decreased anterior capsule stretching and increased posterior capsule stretching. 4. Increased rotator cuff exercise with emphasis on external rotators. 5. Scapular-positioning muscle exercises and increasing body roll. Shoulder pain can be prevented by the following: 1. Avoid all painful activities, and notify coach of shoulder pain immediately. 2. Do not use nonsteroidal anti-inflammatory medications or ice on a chronic basis. 3. Spend equal time stretching the posterior and anterior capsules. 4. Perform general rotator cuff exercises. 5. Perform scapular-positioning muscle exercises, with emphasis on body roll. [figure: see text] Shoulder pain in swimmers is common and can be debilitating. Most of the pain is caused by instability, which stems from swimming-specific demands that increase performance but decrease shoulder stability. These sport-specific demands are (1) increased shoulder range of motion, (2) increased internal rotation and adduction strength, and (3) prolonged, fatiguing, shoulder-intensive training. Instability leads to [figure: see text] inflammation and pain and can become a self-perpetuating process. Treatment consists of patient education, cessation of all activities that cause pain, activity modifications to increase shoulder stability, and pharmacologic treatment of the inflammation. In patients who do not improve using this regimen, surgery can be of benefit, either to reduce capsular laxity or to remove chronic inflammation and scar tissue. The patient must be aware of the risk of decreased performance.