title: Clinical and Ultrasonographic Evaluations of the Shoulders of Elite Swimmers.
abstract: Shoulder pain is a common problem in competitive swimmers, but the structural alterations in elite-level competitive swimmers are not well known.
  
  
  
  Adaptive changes are common in the rotator cuff, bursa, labrum, and capsule in elite swimmers, and such abnormalities are related to factors concerning training and correlate with symptoms.
  
  
  
  Cross-sectional study; Level of evidence, 3.
  
  
  
  The study population was the 2008 United States Olympic swimming team. All athletes completed standardized scales on shoulder pain and function and provided data on their training history and history of shoulder pain or injuries. Each athlete also underwent a comprehensive physical examination of both shoulders, followed by an evaluation of the rotator cuff, biceps, and bursa using ultrasound with dynamic images to assess for subcoracoid impingement and subacromial impingement.
  
  
  
  A history of shoulder pain was reported by 29 of 42 (66%) athletes. Morphological changes consistent with tendinosis were common in the biceps (33/46 shoulders; 72%) and supraspinatus/infraspinatus (44/46 shoulders; 96%). Subcoracoid impingement was seen in 17 of 46 shoulders (37%), with subacromial impingement seen in 34 of 41 shoulders (83%). There was an increased odds ratio (OR) for biceps tendinosis in older swimmers (OR, 1.92; 95% CI, 1.23-3.00; P = .004) and in swimmers who had missed a competition because of shoulder pain (OR, 9.76; 95% CI, 1.13-84.3; P = .038). There was an increased OR for rotator cuff tendinosis in swimmers who reported worse scores for pain with activities (OR, 0.10; 95% CI, 0.01-0.78; P = .028) and in those with a positive sulcus sign (OR, 33.2; 95% CI, 3.09-355; P = .004). There was an increased OR for impingement in swimmers with a positive sulcus sign (OR, 5.40; 95% CI, 0.80-36.3; P = .083), worse pain scores (OR, 0.44; 95% CI, 0.22-0.87; P = .019), and a partial rotator cuff tear (OR, 31.2; 95% CI, 3.58-272; P = .002).
  
  
  
  We found a high prevalence of rotator cuff and biceps tendinopathy, which was associated with increased symptoms. Tendinosis was also more common in swimmers with a positive sulcus sign, suggesting a role for shoulder laxity.
authors: Hospital for Special Surgery, New York, New York, USA rodeos@hss.edu.
authors: Scott A
authors: SA
authors: Rodeo
authors: Hospital for Special Surgery, New York, New York, USA.
authors: Joseph T
authors: JT
authors: Nguyen
authors: Hospital for Special Surgery, New York, New York, USA.
authors: John T
authors: JT
authors: Cavanaugh
authors: Hospital for Special Surgery, New York, New York, USA.
authors: Yashika
authors: Y
authors: Patel
authors: Department of Radiology, New York University Langone Medical Center, New York, New York, USA.
authors: Ronald S
authors: RS
authors: Adler
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000293:injuries; D010808:Physical Examination; D000070636:Rotator Cuff Injuries / Q000000981:diagnostic imaging / Q000209:etiology; D012782:Shoulder; D019534:Shoulder Impingement Syndrome / Q000000981:diagnostic imaging / Q000209:etiology; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000000981:diagnostic imaging; D020069:Shoulder Pain / Q000000981:diagnostic imaging / Q000209:etiology; D013550:Swimming / Q000293:injuries* / Q000502:physiology; D052256:Tendinopathy / Q000209:etiology; D014463:Ultrasonography
keywords: impingement; rotator cuff; shoulder; swimming; tendinosis