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Swimmers and Divers, How Does Surgical Intervention Change?

Swimmers and Divers, How Does Surgical Intervention Change?. Ben Rubin, M.D. Orthopaedic Specialty Institute Orange , CA. Is There a Difference in the Surgical Treatment of Shoulders in Swimmers and Divers?. Swimmers vs. Divers. Kinematics Body characteristics Mechanisms of injury

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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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