Swimmer's shoulder is a broad term often used to diagnose shoulder injury in swimmers. However, research has elucidated several specific shoulder injuries that often are incurred by the competitive swimmer. Hyperlaxity, scapular dyskinesis, subacromial impingement, labral damage, os acromiale, suprascapular nerve entrapment, and glenohumeral rotational imbalances all may be included within a differential diagnosis for shoulder pain in the competitive swimmer. An understanding of the mechanics of the swim stroke, in combination with the complex static and dynamic properties of the shoulder, is essential to the comprehension and identification of the painful swimmer's shoulder. It is important for the athlete, coach, and clinician to be aware of the discerning characteristics among these different injuries to ensure a proper diagnosis and treatment plan to aid the swimmer in his or her return to competition.
On Thursday, artistic swimmer Anita Alvarez will compete for the first time in nine months. Last June, at the World Aquatics Championships in Budapest, Hungary, the two-time Olympian finished her free solo routine, passed out, and sunk to the bottom of the pool.
Anita still had one more event: the team final two days later. "I was feeling better," she says, and the team routine is often easier than duets and solos. Also, she was the flyer, on top of all the lifts, and the team hadn't really practiced with another swimmer in that position. So Alvarez went to the pool that morning, gelled her hair and prepared to compete, but there had been a meeting in her absence, and she was told no-go. During the final, she stood on the pool deck, hair still gelled, watching the U.S. finish ninth of 12 teams.
"The days before were very hard," Fuentes says. "We talked a lot to prepare mentally. Personally, I was scared. As a coach, you don't like to see your swimmers going through that. But the goal was: We cannot swim [or compete] unless we find out what happened. We had to do it."
Advertise in SWIMMER and reach the nation's Masters swimmers. That's 50,000-plus individual members on more than 1,200 clubs and workout groups across the United States. A national nonprofit corporation, U.S. Masters Swimming provides organized workouts and competitions for adults 18 and older. USMS is open to all adult swimmers: those who swim for fitness or competition, triathletes, and open water swimmers.
Students sitting in a classroom attending the final day of the Advanced Helicopter Rescue School also heard the call. The students leapt at the chance to assist in the rescue. Any one of the swimmers could have gone, but ultimately it was a game of rock, paper, scissors that allowed Branch to join the senior instructors in the rescue.
Swimmers have significant susceptibility for shoulder injuries due to the involvement of the shoulders required for various strokes and the high volume of repetitions required during training. Swimmer's shoulder is a term can represent numerous shoulder pathologies. These include impingement syndrome, rotator cuff tendinitis, labral injuries, ligamentous laxity or muscle imbalance causing instability, muscular dysfunction, and neuropathy from nerve entrapment. Interprofessional team members must be able to differentiate between these different etiologies. This activity describes the pathophysiology, etiology, presentation and management of swimmer's shoulder and stresses the role of team-based interprofessional care for affected patients.
Objectives:Identify the etiology of swimmer's shoulder.Describe the presentation of swimmer's shoulder.Outline the treatment and management options available for swimmer's shoulder.Summarize how an optimally functioning interprofessional team would coordinate care to enhance outcomes for patients with swimmer's shoulder.Access free multiple choice questions on this topic.
Swimming is a unique activity because it requires primarily the upper body for the propulsive force, with 90% of the driving force provided primarily by the torque generated from the shoulder. To swim at an elite level, each swimmer must log between 60,000 and 80,000 meters per week, which is equivalent to 30,000 strokes per arm. Fundamentally, the swim stroke requires the shoulder to move to range-of-motion extremes while tremendous muscular force is exerted upon the shoulder. 
The incidence of swimmer's shoulder, depending on the study, ranges from 3% to 70%. When defined as shoulder pain that interferes with training or progress in training, the incidence is reported as approximately 35% in elite and senior level swimmers. 
Eliminating acute inflammation is the priority in shoulder rehabilitation. After a swimmer, first experiences pain, ice, NSAIDs, and rest can prevent progression. If pain continues or worsens, a 7-day to 10-day course of NSAIDs and rest is ideal but often proves difficult if the injury occurs during the middle or late part of the season. At a minimum, effort should be made to reduce yardage to below the point of pain. For swimmers with impingement, tendinitis, or scapular dyskinesis, a subacromial and/or glenohumeral corticosteroid injection may be beneficial diagnostically and for pain reduction.
Stretches that focus on the posterior capsule are important for preventing and reversing impingement. When they are coupled with overstretching of the anterior capsule, swimmers can create imbalances that worsen impingement. The swimmer can stretch the posterior capsule by horizontally adducting the arm and using the contralateral arm to pin it against the body.
Disproportionately increased adduction strength and internal rotation are unavoidable consequences of swimming. Overdevelopment of the pectoralis major and latissimus dorsi muscle groups creates a force that displaces the humeral head anteriorly, leading to joint instability. Additionally, rotator cuff strengthening will lead to muscular balance restoration, which will reduce or eliminate impingement. As muscle endurance and strength improve, sport-mimicking exercises can be attempted, followed by low-yardage workouts at slow speeds, as long as the swimmer is pain-free, and progressing slowly until the swimmer can return to competition.
Surgery is appropriate for structural pathologies. An athlete may elect symptomatic management rather than surgery so that he or she may continue competing until the pain begins to interfere with daily life. For swimmers with persistent multidirectional instability, a capsular plication or inferior capsular shift procedure should be considered. Athletes should be aware. However, that training volumes may need to be reduced permanently to avoid pain. A subacromial exploration and removal of the hypertrophied, inflamed, and scarred tissue (thereby maintaining the structural integrity of the shoulder) is an option for athletes who obtain only limited relief from physical therapy. For swimmers with a labral tear in whom nonsurgical treatment has failed, the next treatment option is labral debridement or repair.
Most swimmers do have a good outcome with treatment, but recurrence is not uncommon. Hence, the efforts of a strong interprofessional team for ongoing management will yield the best patient results. 
Many biological species, including bacteria, protozoa and spermatozoa, use flagella to swim in complex fluids1. These swimmers function at small characteristic length scales in the low Reynolds number (Re) regime, where viscous forces dominate inertial forces. To generate propulsion at this scale, the swimmers must produce a time-irreversible deformation of the flagella2. Spermatozoa, for example, generate complex bending patterns in their flagella by sliding microtubules relative to each other3,4,5, whereas bacteria rotate helix-shaped flagella to generate propulsion6. Although such low Re swimmers are ubiquitous in nature, there have been only a few experimental realizations of flagellar propulsion using synthetic materials, all of which rely on external magnetic drivers. These include a magnetic cork-screw swimmer7,8 and a flagellar swimmer formed by a string of magnetic beads connected by DNA molecules9. These swimmers are twisted or deflected by an external oscillatory magnetic field to generate propulsive thrust. In addition, bacteria and spermatozoa have been used to propel microspheres and other microfabricated structures, relying on the natural propulsive mechanism of the driving flagella10,11. To date, there is no demonstration of a self propelled, synthetic flagellar swimmer operating at low Re, despite potential applications in the in vivo or in vitro transport and delivery of cargo. Accompanied by required advances in the construction of cellular circuits, such a swimmer could respond to external stimulation, such as gradients in chemistry, temperature and light, and autonomously navigate in a complex fluidic environment.
Here we demonstrate a functional motile platform that can be further developed into such a biohybrid machine. To produce microscale flagellar propulsion, we must address two significant hurdles. First, for independent swimming, the swimmer must either be flexible or have moving joints. Second, a suitably scaled driving mechanism must be integrated with the synthetic flagellum to produce the required deformation force. Here we utilize a novel fabrication process12 to produce highly compliant polydimethylsiloxane (PDMS) filaments on which we directly culture contractile cells. We use a slender-body hydrodynamics model to design the flagella such that given proper placement of contractile cells, forward swimming is achieved. The resultant one-dimensional swimmer mimics the structure of the spermatozoon (Fig. 1a), consisting of a long, slender tail and a short, rigid head, with cardiomyocytes selectively cultured on the tail. Periodic contractions of the cardiomyocytes generate a bending wave that propagates from the actuation site to the free end of the tail, producing a net thrust that propels the swimmer forward. 041b061a72