Ultrasonographic Evaluation of the Shoulders and Its Associations with Shoulder Pain, Age, and Swim Training in Masters Swimmers

Abstract

Background and objectives: The long head of the biceps (LHB) and rotator cuff tendinopathy is the major cause of shoulder pain in competitive swimmers. The risk of tendinopathy increases with aging; however, the structural changes of LHB and rotator cuff in populations of masters swimmers have not been well examined. The purpose of this study was to investigate the prevalence of ultrasonographic abnormalities of the shoulders in masters swimmers, and the association of pain, age, and swim training with structural changes in this population. Materials and Methods: A total of 60 subjects participated in this study, with 20 masters swimmers with shoulder pain, 20 asymptomatic masters swimmers, and 20 sex- and age-matched controls. All swimmers completed a self-reported questionnaire for shoulder pain, their history of competition, and training volume. Each subject underwent ultrasonographic examination of both shoulders for pathologic findings in the LHB tendon, rotator cuff (supraspinatus (SSP) and subscapularis (SSC)) tendons, and subacromial bursa (SAB) of both shoulders and had thickness measured. Results: The prevalence of tendinosis (LHB, 48.8%; SSP, 17.5%; SSC, 15.9%), partial tear (SSP, 35.0%), and calcification (SSC, 10.0%) were higher in swimmers than in controls. LHB and SSP tendinosis were associated with shoulder pain. Older age and later start of competition were associated with an increased risk of LHB tendinosis and SSC calcification. Earlier initiation of swimming and longer history of competition were associated with an increased risk of SSP and SSC tendinosis. The thicker SSP tendon significantly increased the risk of tendinosis and partial tear. Conclusions: A high prevalence of structural changes in the rotator cuff and biceps tendons in masters swimmers reflects the effect of shoulder symptoms, aging, and swim training.

Self‐reported bio‐psycho‐social factors partially distinguish rotator cuff tendinopathy from other shoulder problems and explain shoulder severity: A case‐control study

“…Similarly, clinical tests of RC tendinopathy include loading because of the presumed pathogenesis (Girdwood et al., 2017; Hegedus et al., 2012). Therefore, we recommend that variables related to activity should be examined in usual care as activity including high load may result in RC tendon alterations (Suzuki et al., 2021).…”

Exercise for rotator cuff tendinopathy: Proposed mechanisms of recovery

“…15 Patients with RC tendinopathy often have changes to multiple aspects of tendon structure. 15,50,51 The primary RC tendon involved in RC tendinopathy is the supraspinatus tendon, thus the majority of the literature is focused on this tendon. Tendon factors may modulate the effects of resisted exercise and thus are important mechanistic biomarkers.…”

“…Subacromial impingement is no longer considered the primary mechanism in RC tendinopathy now. 6,9,21–25 Cross-sectional studies have explored supraspinatus tendon thickness in RC tendinopathy 22,23,50,71–76 (see Supplemental Table 2). The majority of the studies report increased tendon thickness with RC tendinopathy.…”

Shoulder structures and strength in competitive preadolescent swimmers: A longitudinal ultrasonographic study

“…During these training sessions, ~2500–9600 shoulder rotations are completed per day 2,3 making these athletes prone to injuries of the shoulder complex 4 . Likewise, shoulder pain is commonplace in swimmers, 5–8 with decreased acromiohumeral distance (AHD) and increased supraspinatus tendon thickness (STT) reported as predisposing factors 9–14 …”

“…1,2 During these training sessions, $2500-9600 shoulder rotations are completed per day 2,3 making these athletes prone to injuries of the shoulder complex. 4 Likewise, shoulder pain is commonplace in swimmers, [5][6][7][8] with decreased acromiohumeral distance (AHD) and increased supraspinatus tendon thickness (STT) reported as predisposing factors. [9][10][11][12][13][14] Biomechanical studies showed that propulsive forces in swimming are mainly shoulder adduction and internal rotation, 15,16 and swimmers are at risk of shoulder injury, especially during front crawl-style arm rotation.…”