What Is Swimmer's Shoulder?

Whether you’re an athlete who frequently uses the upper body or have an occupation that requires reaching for objects all day, there’s a strong chance you’ll eventually suffer from shoulder pain.

This pain, which is commonly referred to as swimmer’s shoulder, can make it difficult to perform even the most basic tasks such as lifting your arm. 

Paul Allegra, M.D., an orthopedic surgeon and sports medicine physician at INTEGRIS Health Medical Group Orthopedics Central, warns that “shoulder pain can be secondary to a multitude of factors, including multidirectional instability, rotator cuff tendinitis, subacromial impingement or rotator cuff tears.” He says if symptoms persist, you should seek treatment from a medical professional.

What happens when you have swimmer’s shoulder?

Swimmer’s shoulder is a colloquial term to describe a type of shoulder pain that is common in people who perform overhead motions.

The shoulder contains three bones (the scapula, clavicle and humerus), two joints (acromioclavicular joint and glenohumeral joint) and many muscles, tendons and ligaments. 

The rotator cuff, which consists of four muscles and their tendons, helps attach the humerus (upper arm bone) to the scapula (shoulder blade). Together, they help lift the arm, internally rotate the arm, externally rotate the arm and help hold your arm straight out.

The shoulder blade has a bony outer edge called the acromion. There is a narrow space below the acromion and above the upper arm bone called the subacromial space that houses rotator cuff tendons and the subacromial bursa – a fluid-filled sac that reduces friction and provides cushioning during movement.

Swimmer’s shoulder usually occurs when the tendons become inflamed (shoulder tendinitis), the subacromial bursa becomes inflamed (bursitis) or the space between the acromion and rotator cuff becomes too narrow. The result is pain, fatigue, instability and a decreased range of motion in the shoulder.

Despite the name, swimmer’s shoulder isn’t limited to people who spend most of their time in the water. It can affect anyone who constantly lifts or reaches up with their arm. Examples include baseball players (especially pitchers), softball players (repeated overhand throwing), volleyball players (repeated downward spiking motion), tennis players (repeated overhand serve), construction workers, painters and electricians. 

Why does swimmer’s shoulder occur?

Most often, swimmer’s shoulder is a direct result of a shoulder impingement.

Whenever you raise the arm or internally rotate it, the space between the acromion and rotator cuff becomes narrower and the rotator cuff tendons can rub against the acromion. Over time, repeated overhead motions cause tiny tears that make it harder for the joint to move smoothly. The more friction that occurs, the more swelling develops in the rotator cuff. In turn, inflamed tendons create pain and irritation by pressing on nearby tissue, bones and other tendons.

In other cases, overuse or age can strain the rotator cuff tendons, causing them to become painful and inflamed. The bursa can also become inflamed due to overuse. Whenever it swells, shoulder range of motion can be severely limited. 

Some people are born with a flat acromion or have bone spurs that develop. In either scenario, the structural differences tighten the space around the rotator cuff and make it more prone to impingement.

What does swimmer’s shoulder feel like?

Pain and discomfort associated with swimmer’s shoulder typically occurs at the front and on the side of the shoulder joint – your doctor may refer to this as the anterolateral region, which anatomically means “toward the front” and “toward the edge.” Pain may radiate from the front of the shoulder to the side of the arm. You may also feel a deep pain that radiates at the back of the shoulder.

Usually, this pain occurs when you extend the arm overhead or behind the back. You may only notice pain during periods of overuse and activity. The pain may subside or decrease when not in use. For example, it may only hurt when reaching up but feel normal at rest.

Aside from pain, you may also notice reduced strength in your shoulder or increased joint laxity, meaning the shoulder feels too loose or too flexible. 

Treating swimmer’s shoulder

For mild or moderate cases of swimmer’s shoulder, the condition can be treated with conservative methods. More severe cases may require surgery.

Conservative treatments

Rest: Whenever inflammation occurs, rest is the first thing recommended to help calm the area – performing stretches and exercises to an injured area may only make it worse. This means to stop doing whatever motion caused the injury in the first place. If you’re a swimmer, stop swimming or if you’re a baseball player, stop throwing. If the injury occurs in the workplace, consider placing items at a lower height to avoid reaching.

Non-steroidal anti-inflammatory drugs (NSAIDs): As you rest, medications such as over-the-counter NSAIDs can help reduce pain and swelling. Ibuprofen, aspirin and naproxen are the most common NSAIDs.

Steroid injections: If rest and NSAIDs don’t calm the inflammation, your doctor may refer you to an orthopedic specialist for a steroid injection. The injection, also called a cortisone shot, provides a targeted dose of medication to the affected area to temporarily reduce pain and inflammation.

Physical therapy: Once the pain and inflammation improve, a physical therapist can compile a program of stretches and strengthening exercises to help restore motion and improve shoulder stability. They may also use ice, heat, dry needling, ultrasound, massage and other techniques to help relax the muscles and tendons in the shoulder.

Surgical options

Subacromial decompression: This procedure involves the removal of bone and tissue from the acromion to allow more space for the shoulder muscles and tendons to move freely. An arthroscopic or open technique can be used for decompression surgery. Arthroscopic surgery involves inserting surgical tools through a few tiny incisions in the shoulder. The surgery is performed by using a small camera so the surgeon can see inside. An open surgery is more invasive and requires an incision to parts of the shoulder to view the rotator cuff and acromion.

Bursectomy: This procedure removes inflamed bursa that is causing pain and inflammation.

Rotator cuff repair: In some cases, chronic repetitive overhead motions can cause complete tendon tears that require surgery. Rotator cuff surgery reattaches torn tendons to the humerus bone.

Shoulder impingement exercises

Physical therapy for swimmer’s shoulder isn’t just limited to the shoulder itself. It’s important to also strengthen areas around the rotator cuff, including the thoracic spine and pectoral muscles.

Tight pectoral muscles can lead to improper shoulder positioning that places more strain on the rotator cuff. Likewise, the latissimus dorsi is important for shoulder flexion. A tight latissimus dorsi doesn’t allow for full rotation and places excess strain on the shoulder. A weak thoracic spine can create stiffness or spinal curvature that makes it harder to move the shoulder.

Here are three common exercises your physical therapist may recommend to help with shoulder impingement from swimmer's shoulder.

Shoulder external rotators: Stand in front of a wall and place your hands against the wall with your feet a few feet back. Bring the foot of the shoulder you’re stretching closer to the wall and place your arm at a 90-degree angle with your elbow pressed against the wall. Move your chest close to the wall until you feel a stretch in the front part of the shoulder. Hold for 30 seconds and complete this three times. This stretch helps regain external shoulder rotation. 

Thoracic spine mobility preacher stretch: Kneel down and place a chair or bench at abdominal height in front of you. Prop your elbows on the chair or bench with the palms facing behind you. Slowly drop your chest toward the floor while driving the elbows into the chair. Hold for three seconds and release. Perform 10 repetitions. This stretch works both the thoracic spine and the lats.

Pec major doorway stretch: Stand in front of a doorway and bring your arm against the wall at a 90-degree angle. While engaging your core, slowly step forward so you feel the stretch in your chest and shoulders. Hold for 15 seconds. Repeat three times. This stretch helps loosen tight chest muscles.

Although swimmer’s shoulder is a painful condition, it can usually be treated with conservative treatments. Contact an INTEGRIS Health orthopedic surgeon for a comprehensive evaluation of your shoulder. You can also ask your doctor for a referral to a physical therapist. At INTEGRIS Health Jim Thorpe Outpatient Rehabilitation – Orthopedic Services, our team can provide you with an exercise and strengthening program to restore function, increase range of motion and help with the pain.

For your convenience, INTEGRIS Health Medical Group now offers a quick and convenient treatment for patients with sports-related injuries at the Saturday Sports Medicine Clinic. The clinic is open every Saturday from 9 a.m. to noon and is located at 4833 INTEGRIS Health Parkway, Suite 150. For more information, call 405-657-3990.