Higher signal/noise quotient value of subscapularis tendon on the throwing side in elite female water polo athletes: a cross-sectional study

Oxidative stress, inflammation and angiogenesis markers in elite female water polo athletes throughout a season

The shoulder.

The impact of chronic, intense exercise, such as in elite athletes, on phospholipids fatty acids (FA) composition has not been studied in women so far. This study aimed to investigate FA profiles in plasma and erythrocytes phospholipids in elite female water polo (N = 15) and football (N = 19) players in comparison with sedentary women. In spite of similar dietary patterns, as assessed by a food frequency questionnaire, plasma FA profile in the football players showed significantly higher proportions of stearic acid, oleic acid, and monounsaturated FA (MUFA), and significantly lower proportions of total and n-6 polyunsaturated FA (PUFA) than in the water polo and control group. The water polo players had higher percentages of palmitoleic acid and arachidonic acid than the control subjects. Erythrocyte FA profile differed among groups. We found significantly higher proportion of oleic acid and MUFA in the football group than in the controls, and decreased stearic acid and elevated palmitic and palmitoleic acid in the water polo players than in the other 2 groups. Both groups of athletes had significantly lower percentages of n-6 dihomo-γ-linolenic acid, n-6 PUFA, and total PUFA compared with the controls. The estimated activities of elongase and desaturases in erythrocytes were also altered in the athletes. Our results indicate that long-term, intense physical training significantly affects FA status of plasma and erythrocyte phospholipids in women. The observed differences between the water polo and the football players suggest that the type of regular training may contribute to the altered metabolism of FA, although possible genetic differences among the 3 study groups cannot be ruled out.

Current evidence for concussions is mixed in water polo players. Surveys suggest rates as high as 36%, whereas surveillance studies at international competitions often fail to report them at all. The goal of this study was to examine the incidence of concussions in elite female water polo players from surveillance tools implemented longitudinally. Retrospective chart analysis of 10 years spanning between 2012 and 2022. National teams or professional sports. Female players from the Canadian senior national water polo teams that participated in international competitions and trained more than 10 hours per week in a competitive environment. Included player position, recurrence, and time loss before full return to play. Prevalence of concussion diagnosis. Forty-three concussions were identified over the 10 years observed at a median count of 3 concussions per year. Cumulative days lost spanned between 25 and 348 days per team*year. Altogether, this produced a median rate of 14.3 injuries per 100 player*years. Goalkeepers in the sample suffered the highest rates of concussion (25.8%), compared with players in other positions (22.8% of centers and 16.7% of drivers). This study found evidence for prevalence of concussions in elite female water polo players. Improved guidelines preceded a significant reduction in time loss after the year 2017. This adds to a body of knowledge suggesting that improved surveillance methods are needed to detect and care for concussions in this population.

This study was conducted with the following aims: (a) to describe the effect of playing position on anthropometrics and throwing velocity in elite female water polo players and (b) to observe any relationships between anthropometric parameters and throwing velocity. To achieve these aims, we analyzed a total of 46 female elite players (age: 22.5 ± 5.1 years; height: 172.0 ± 6.9 cm, body mass: 67.4 ± 7.5 kg) members of the top 4 teams of the Spanish Honour Division women league (21 offensive wings players, 17 center, and 8 goalkeepers). Wings were significantly shorter and had smaller arm spans than goalkeepers and center players. Goalkeepers demonstrated longer forearm lengths than wing and center players. No other significant differences were evident between positions in terms of anthropometric, strength, or throwing velocity variables The somatotype of the offensive wing players was mesomorphic, whereas centers were endomorph (classified as endomesomorphic). Height, arm span, muscular mass, biepicondylar breadth of the humerus, arm girth (relaxed and tensed), and forearm girth were related to throwing velocity. In conclusion, only a small number of anthropometric differences exist between players of different positions in elite female water polo. Shorter players with smaller arm spans may be better suited to the wings, whereas athletes with longer forearms may be better suited to the goalkeeper position. Taller, more muscular athletes with wider arm spans, broader humeri, and wider arms (relaxed and flexed) tended to throw with increased velocity. Trainers should focus on increasing the modifiable characteristics (muscle mass and arm girths) that contribute to throwing velocity in this population.

Nitrate-rich beetroot juice is thought to have ergogenic effects, particularly in conditions where oxygen availability is limited. Whether these effects also apply to elite athletes is currently unknown. The aim of this study was to assess the effects of beetroot juice supplementation on dynamic apnea and intermittent sprint performance in elite female water polo players. In a double-blinded, randomized, crossover manner, the Dutch National female water polo team (N = 14) was subjected to two 6-day supplementation periods (1 and 2), with either 140ml/day of nitrate-rich (BR; ∼800mg/day nitrate) or nitrate-depleted (PLA) beetroot juice. Following blood sampling on Day 6, the athletes performed a maximal-distance front crawl swimming test without breathing (dynamic apnea test). In addition, intermittent sprint performance was assessed by performing 16 swim sprints of 15m, in a 4 × 4 block with 30-s recovery between blocks (intermittent test). Distance covered during the dynamic apnea test did not differ between BR (49.5 ± 7.8m) and PLA (46.9 ± 9.1m, p = .178). However, when correcting for test order, the distance covered was significantly larger in BR versus PLA when BR was ingested in Period 2 (50.1 ± 8.5 vs. 42.8 ± 5.7m, p = .002), whereas no difference was observed when BR was ingested in Period 1 (48.8 ± 7.4 vs. 52.3 ± 10.4m, p = .10). The time to complete the intermittent test was not different between BR and PLA (316.0 ± 7.9 vs. 316.3 ± 6.9s, p = .73). In conclusion, beetroot juice supplementation does not improve intermittent performance in elite female water polo players, but there may be a potential for ergogenic effects during dynamic apnea.

This study compared female athletes with different aquatic sports expertise in their neuromuscular activation before, during, and after a shoulder internal rotation fatigue protocol. Eleven water polo players, 12 swimmers, and 14 controls completed concentric maximal voluntary external and internal shoulder rotations before and after a fatigue protocol consisting of concentric internal rotations at 50% of maximal voluntary contraction for at least 3 min or until reporting a rating of perceived effort RPE of 8/10 or higher. Muscle activation was measured for the maximal voluntary contractions, as well as for the first (T1), middle (T2), and third (T3) minute of the fatigue protocol using surface electromyography (EMG) on pectoralis major, anterior and posterior deltoid, upper and middle trapezius, and latissimus dorsi. Intramuscular EMG was used for supraspinatus, infraspinatus, and subscapularis. Pre-fatigue internal rotation torque was significantly correlated with shorter task duration (r = −0.39, p = 0.02), with water polo players producing significantly greater torque than controls but having significantly lower endurance. Swimmers demonstrated decreased latissimus dorsi activation at T3 compared to T2 (p = 0.020, g = 0.44) and T1 (p = 0.029, g = 0.74), differing from water polo players and controls who exhibited increased agonist activation and decreased activation of stabilizers. Comparing the pre-fatigue to the post-fatigue maximal shoulder rotations, water polo players had decreased activation in subscapularis (p = 0.018, g = 0.67); all groups had decreased activation in latissimus dorsi (p < 0.001), though swimmers demonstrated a large effect (g = 0.97); and controls had decreased activation in supraspinatus (p = 0.005, g = 0.71). Together, these results suggest that sports expertise may be associated with different muscle activation both while and after fatigue is induced. Further research should continue to explore sports-specific patterns of muscle recruitment and fatigue adaptations, as well as if certain strategies are adaptive or maladaptive. This may have important consequences for injury prevention among athletes who perform repetitive overhead movements in their sports and who are susceptible to overuse injuries.

The Belly-Off Sign: A New Clinical Diagnostic Sign for Subscapularis Lesions

The purpose of this research was to identify possible predisposing neuromuscular factors for knee injuries, particularly anterior cruciate ligament tears in female athletes by investigating anterior knee laxity, lower extremity muscle strength, endurance, muscle reaction time, and muscle recruitment order in response to anterior tibial translation. We recruited four subject groups: elite female (N = 40) and male (N = 60) athletes and sex-matched nonathletic controls (N = 40). All participants underwent a subjective evaluation of knee function, arthrometer measurement of anterior tibial translation, isokinetic dynamometer strength and endurance tests at 60 and 240 deg/sec, and anterior tibial translation stress tests. Dynamic stress testing of muscles demonstrated less anterior tibial translation in the knees of the athletes (both men and women) compared with the nonathletic controls. Female athletes and controls demonstrated more anterior tibial laxity than their male counterparts and significantly less muscle strength and endurance. Compared with the male athletes, the female athletes took significantly longer to generate maximum hamstring muscle torque during isokinetic testing. Although no significant differences were found in either spinal or cortical muscle reaction times, the muscle recruitment order in some female athletes was markedly different. The female athletes appeared to rely more on their quadriceps muscles in response to anterior tibial translation; the three other test groups relied more on their hamstring muscles for initial knee stabilization.

Rare case of intra-articular biceps incarceration following traumatic massive rotator cuff tear

To compare the Multistage Shuttle Swim Test (MSST), Water Polo Intermittent Shuttle Test (WIST) and 5 200 m Incremental Swimming Test (IST) responses in elite female water polo players. Fourteen Australian Women's National Water Polo Squad members performed the MSST and WIST, and 13 players from a National Water Polo League club performed the IST, MSST and WIST on separate occasions (no goalkeepers were involved). Peak heart rate, blood lactate and ratings of perceived exertion were obtained for all tests. Expired air was collected following all tests for the National League players. The National Squad players scored significantly better (ie, distance covered) in the MSST and WIST than the National League players (effect sizes=1.60 to 1.79, P<.001). The MSST and WIST scores were significantly correlated (r=.80 to 0.88, P<.001). The MSST scores were significantly correlated with peak oxygen uptake (VO2peak; mL.kg(-1).min(-1)) obtained for all tests (r=.58 to 0.59, P<.05). In contrast, there were no significant correlations between the WIST scores and VO2peakobtained for any of the tests (r=.43 to 0.52, P>.05). Differences in VO2peakfor the IST, MSST and WIST were nonsignificant (P>.05). The MSST and WIST can discriminate players of different competition standards. The MSST can be used to estimate a player's aerobic fitness and peak heart rate. The WIST appears to better mimic the intermittent activity pattern of the game, but its application to female players, to assess maximal intermittent endurance swimming performance, requires further evaluation.

Background No study to date has isolated the anatomical nature of the transverse humeral ligament and its relationship to the biceps tendon and the anterosuperior portion of the rotator cuff. Hypothesis There is no separate identifiable transverse humeral ligament, but rather the fibers covering the intertubercular groove are composed of a sling formed by fibers from the subscapularis and supraspinatus tendons. Study Design Descriptive laboratory study. Methods A total of 14 shoulder examinations were performed on 7 matched pairs of fresh-frozen cadaveric shoulders. Magnetic resonance imaging scans were performed, followed by gross and microscopic anatomical dissection. Results In the location of the transverse humeral ligament, magnetic resonance imaging and gross dissection revealed the continuation of superficial fibers of the subscapularis tendon from the tendon body across the intertubercular groove to attach to the greater tuberosity, whereas deeper fibers of the subscapularis tendon inserted on the lesser tuberosity. Longitudinal fibers of the supraspinatus tendon and the coracohumeral ligament were also noted to travel the length of the groove, deep to the other interdigitating fibers but superficial to the biceps tendon. Histologic studies confirmed these gross dissection patterns of fiber attachment and also revealed the absence of elastin fibers, which are more commonly seen in ligamentous structures and are typically absent from tendinous structures. Conclusion There is no identifiable transverse humeral ligament, but rather the fibers covering the intertubercular groove are composed of a sling formed mainly by the fibers of the subscapularis tendon, with contributions from the supraspinatus tendon and the coracohumeral ligament. Clinical Relevance According to our findings, dislocations of the long head of the biceps must disrupt at least the deep fibers of the annular sling created mainly by the subscapularis tendon insertion. This finding provides anatomical support for the findings of a positive biceps tendon subluxation or dislocation and subscapularis tear during glenohumeral arthroscopy with a normal-appearing subscapularis during open surgery or subacromial arthroscopy.

Isolated loss of external rotation of the shoulder with the arm at the side is a rare clinical finding in patients presenting with a shoulder problem. Most patients with shoulder stiffness are first seen with a loss of mobility involving at least two planes of motion that usually results from primary or secondary adhesive capsulitis1,2. Soft-tissue tumors of the shoulder girdle are rare3. Among soft-tissue tumors, desmoid tumors are very rare and they most frequently occur in the shoulder girdle and the thigh of adolescents and young adults4. Desmoid tumors are slow-growing benign fibrous neoplasms arising from soft tissue and muscle. They have a notoriously high recurrence rate5,6. Adequate surgical resection can be challenging, and early diagnosis is intuitively beneficial in facilitating surgical management before the tumor has invaded and distorted the regional anatomy. We present the cases of two patients with a desmoid tumor originating in the subscapularis muscle who were first seen with vague progressive shoulder pain and a clinical examination pertinent for only marked limitation of active and passive external rotation of the shoulder with the arm at the side. The patients were informed that data concerning their cases would be submitted for publication. CASE 1. A fifty-three-year-old woman who was right-hand dominant and worked as an administrator presented with progressive pain in the left shoulder, including mild night pain, of insidious onset occurring over a two-year period. The pain was described as a dull ache of variable intensity deep within the shoulder. She reported that she had not had any fevers or other systemic symptoms. The only prior treatment was a subacromial injection of lidocaine and corticosteroid, which had been given by her primary care physician, and it had provided no relief. Plain radiographs …

To examine shoulder appearances at magnetic resonance (MR) imaging in long-term dialysis recipients. Twenty-two chronic dialysis recipients underwent 1.0-T MR imaging with a combination of T1-, T2-, and T2*-weighted sequences. Rotator cuff tendon thickening was graded as present or absent by a musculoskeletal radiologist, who also measured the supraspinatus and subscapularis tendon thicknesses with electronic calipers. The long-axis dimension and location of focal osseous lesions, in addition to their T1, T2, and T2* signal intensities, were noted. Supraspinatus (n = 9) and subscapularis (n = 10) tendon thickening was frequently observed. Six (27%) of the 22 patients had combined thickening of the supraspinatus and subscapularis tendons without substantial involvement of the infraspinatus or teres minor tendons. These patients had undergone dialysis longer (median, 19.2 years; range, 16.3-22.8 years) than had the other patients (median, 11.7 years; range, 5.8-19.3 years; P: =.004). The 29 intraosseous lesions had high, intermediate, and low T2 signal intensity in six (21%), nine (31%), and 14 (48%) instances, respectively. Supraspinatus and/or subscapularis tendon thickening is common in chronic dialysis recipients. Bone lesions in such patients are of variable T2 signal intensity and usually subchondral or adjacent to the greater tuberosity.

Introduction: Anterior cruciate ligament (ACL) reconstruction (ACLR) is the gold standard for treating ACL injuries, particularly in soccer players who are at a high risk of knee injury. While professional athletes often return to sport (RTS) within 7-10 months after ACLR, non-elite players experience significant delays. There is a need to investigate neuromuscular deficits and functional asymmetries in the non-elite group, which may persist even after clearance for RTS. This study aims to evaluate the functional movement patterns, single-leg balance, and isokinetic knee strength in non-elite soccer players preparing to RTS. Additionally, correlations between the aforementioned parameters were explored.Methods: A cohort of 69 male, non-elite soccer players (mean age: 24.32±8.56 years) who underwent ACLR with a hamstring graft was recruited. Functional assessments were conducted at the mean time of nine months post-surgery, and all participants were clinically cleared by the surgeon. The evaluation included the Functional Movement Screen™ (FMS), single-leg balance tests (SLBT) on stable and unstable platforms, and isokinetic strength tests (IST) for knee flexion and extension at 60 deg·s-1 and 180 deg·s-1. Limb symmetry indices (LSIs) were calculated. Statistical analyses included t-tests, Mann-Whitney U tests, and Spearman correlations.Results: The mean FMS score was 15.45±2.23, indicating moderate functional movement quality. SLBT results revealed no significant (P>0.05) inter-extremity differences in stability indices, regardless of platform setting (stable or unstable). However, significant deficits in quadriceps and hamstring strength were observed in the ACLR extremity. At 60 deg·s-1, the mean peak torque/body weight (PT/BW) ratio for knee extension was 2.01±0.65 Nm.kg-1 for the ACLR side versus 2.60±0.57 Nm.kg-1 for the contralateral side (P<0.0001). Similar asymmetries were observed at 180 deg·s-1 (1.51±0.44 vs. 1.88±0.35 Nm.kg-1; P<0.0001). LSIs for quadriceps were markedly reduced, averaging 76.97±17.72% at 60 deg·s-1 and 79.89±17.11% at 180 deg·s-1. At 60 deg·s-1, the mean PT/BW ratio for knee flexion was 1.24±0.34 Nm.kg-1 for the ACLR side versus 1.39±0.32 Nm.kg-1 for the contralateral side (P=0.009) at 180 deg·s-1 (1.03±0.27 vs. 1.16±0.25 Nm.kg-1; P=0.003). LSIs for the hamstring were averaging 89.34±13.91% at 60 deg·s-1 and 88.44±14.58% at 180 deg·s-1. Weak negative correlations were found between FMS scores and stability indices (e.g., r=-0.26 for overall stability index on unstable platform; P=0.031), while moderate positive correlations were observed between PT/BW ratios and FMS scores (r=0.36-0.60; P<0.001).Conclusions: Significant strength asymmetries in quadriceps and hamstring muscles persist in non-elite soccer players after ACLR. While balance deficits were minimal, weak correlations between FMS scores and stability indices suggest a link between functional movement quality and dynamic control. These findings highlight the need for targeted strength training in rehabilitation and the importance of comprehensive assessments, including functional performance tests, strength evaluations, and balance analysis, to ensure safe RTS. Achieving clinical clearance does not equate to full recovery, emphasizing the necessity for a multidimensional approach to RTS decisions.