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Swimmers and Divers, How Does Surgical Intervention Change?

This article explores the differences in surgical treatment of shoulder injuries in swimmers and divers. It covers topics such as kinematics, body characteristics, observed pathology, and surgical correction in both sports. The article also discusses common mechanisms of injury and provides information on shoulder pathology specific to swimmers and divers. Additionally, it includes details on the surgical correction procedures and rehabilitation.

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Swimmers and Divers, How Does Surgical Intervention Change?

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  1. Swimmers and Divers,How Does Surgical Intervention Change? Ben Rubin, M.D. Orthopaedic Specialty Institute Orange, CA

  2. Is There a Difference in the Surgical Treatment of Shoulders in Swimmers and Divers?

  3. Swimmers vs. Divers • Kinematics • Body characteristics • Mechanisms of injury • Observed pathology • Surgical correction

  4. Diving Kinematics • Phases • Approach – open chain • Press – open chain • Flight – open chain • Entry – closed chain • Arm position

  5. Diving Kinematics • Arm position

  6. Swimming Kinematics • Phases • Catch – closed chain • Hand entry • Catch • Pull through – closed • Insweep • Finish • Recovery – open chain • Arm position

  7. Body Characteristics • Postural dysfunction

  8. Body Characteristics • Postural dysfunction • Scapular dyskinesis • Proximally derived • Distally derived

  9. Body Characteristics • Postural dysfunction • Scapular dyskinesis • Joint laxity

  10. Body Characteristics • Postural dysfunction • Scapular dyskinesis • Joint laxity • Aerobic fitness

  11. Body Characteristics • Postural dysfunction • Scapular dyskinesis • Joint laxity • Aerobic fitness • Training schedule

  12. Mechanisms of Injury • Always try to correlate symptoms with mechanics of sport • Diving • Pain with front throw or back throw • Circling • Entry • Swimming • Catch, pull through, recovery

  13. Entry Statistics • Velocity • 1 meter 18.75 mph • 10 meter 36.8 mph • Force at impact • 2.0 – 2.4 Gs • Submerged 128-140 msec • 53% decrease in velocity • All without a splash

  14. Mechanisms of Injury • Diving • Macrotrauma • Dislocation, subluxation • Occasional RCT with dislocation • Microtrauma • Repetitive subluxation (assoc. RCT) • MDL becoming instability • Scapular dyskinesis (proximal vs. distal) • “Overuse” – capsule and/or cuff strain • Usually associated with laxity/instability

  15. Mechanisms of Injury • Swimming • Microtrauma • MDL becoming instability • Scapular dyskinesis (scapulothoracic weakness or imbalance) • “Overuse” – capsule and/or cuff strain • Macrotrauma • Injuries out of the water

  16. Shoulder Pathology • When evaluating the shoulders of young athletes, be careful not to describe symptoms (biceps and/or cuff tendinitis, “impingement syndrome”, etc.) • Make a core diagnosis which explains the symptoms • Primary SAI is extremely rare in swimmers and divers

  17. Shoulder Pathology in Divers • Labral tears and detachments • SLAP lesions (ant, post, combined)

  18. Shoulder Pathology in Divers • Labral tears and detachments • Bankart lesions (ant, post, both) • Hill Sachs lesion

  19. Shoulder Pathology in Divers • Labral tears and detachments • ALPSA lesion

  20. Shoulder Pathology in Divers • Capsule attenuation • Unidirectional instability • MDL with UDI • MDI • Rotator interval lesion • HAGL lesion • MGHL deficiency (congenital)

  21. Shoulder Pathology in Divers • Rotator cuff tears • Partial thickness • PASTA lesions • Tensile failure • Full thickness (rare) • Internal impingement (rare)

  22. Shoulder Pathology in Swimmers • Capsule attenuation • MDL unidirectional instability • Unidirectional and MDI may be a continuum • Rotator interval • MGHL deficiency • GIRD • Tensile injury to cuff

  23. Correction of Pathology • Evaluate and modify technique prn • Correct scapular dyskinesis if proximally derived • Teach scapular positioning if distally derived • Program must be sport specific • EUA (always compare sides) • Diagnostic arthroscopy

  24. Surgical Correction • Suture capsulorrhaphy • Rotator interval plication prn

  25. Surgical Correction • Bankart repair with suture capsulorrhaphy

  26. Surgical Correction • SLAP repair

  27. Surgical Correction • Rotator cuff repair or debridement

  28. Surgical Correction • Reexamine under anesthesia • Insure stability without compromising ROM required for sport • Refine rehabilitation based on postop ROM and stability

  29. Rehabilitation • Core based functional rehabilitation which is sport specific

  30. THANKSFORLISTENING

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