Abstract
Background: Shoulder pain is the most common and well-documented site of musculoskeletal pain in elite swimmers. Structural abnormalities on magnetic resonance imaging (MRI) of elite swimmers’ symptomatic shoulders are common. Little has been documented about the association between MRI findings in the asymptomatic shoulder versus the symptomatic shoulder.Objective: To assess clinically relevant MRI findings in the shoulders of symptomatic and asymptomatic elite swimmers.Method: Twenty (aged 16–23 years) elite swimmers completed questionnaires on their swimming training, pain and shoulder function. MRI of both shoulders (n = 40) were performed and all swimmers were given a standardised clinical shoulder examination. Results: Both shoulders of 11 male and 9 female elite swimmers (n = 40) were examined. Eleven of the 40 shoulders were clinically symptomatic and 29 were asymptomatic. The most common clinical finding in both the symptomatic and asymptomatic shoulders was impingement during internal rotation, with impingement in 54.5% of the symptomatic shoulders and in 31.0% of the asymptomatic shoulders. The most common MRI findings in the symptomatic and asymptomatic shoulders were supraspinatus tendinosis (45.5% vs. 20.7%), subacromial subdeltoid fluid (45.5% vs. 34.5%), increased signal in the AC Joint (45.5% vs. 37.9%) and AC joint arthrosis (36.4% vs. 34.5%). Thirty-nine (97.5%) of the shoulders showed abnormal MRI features.Conclusion: MRI findings in the symptomatic and asymptomatic shoulders of young elite swimmers are similar and care should be taken when reporting shoulder MRIs in these athletes. Asymptomatic shoulders demonstrate manifold MRI abnormalities that may be radiologically significant but appear not to be clinically significant.
Highlights
Competitive swimmers registered with the USA Swimming national governing body average a distance of 60–80 km per week and 1.56 million overhead rotations per year.[3]
In a study by Sein et al, 84% of the swimmers studied had a positive impingement sign and 69% of those demonstrated supraspinatus tendinopathy on magnetic resonance imaging (MRI). They concluded that supraspinatus tendinopathy was the major cause of shoulder pain in elite swimmers and this was induced by intensive swimming training.[4]
Miniaci et al advocated baseline shoulder MRI for all baseball pitchers owing to the difficulty in interpreting signal changes in these athletes.[7]
Summary
Shoulder pain is the most common musculoskeletal complaint in competitive swimmers.[1,2] Competitive swimmers registered with the USA Swimming national governing body average a distance of 60–80 km per week and 1.56 million overhead rotations per year.[3]. Elite swimmers demonstrate MRI changes of the shoulder similar to the imaging changes found on MRIs of persons with painful clinical syndromes.[2] There seems to be limited information regarding MRI findings in overhead athletes who are asymptomatic. In a study by Sein et al, 84% of the swimmers studied had a positive impingement sign and 69% of those demonstrated supraspinatus tendinopathy on MRI They concluded that supraspinatus tendinopathy was the major cause of shoulder pain in elite swimmers and this was induced by intensive swimming training.[4] it was not possible to draw conclusions in the asymptomatic shoulders, as this portion of the studied group only constituted 9% of the total sample. Little has been documented about the association between MRI findings in the asymptomatic shoulder versus the symptomatic shoulder
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