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Kuhn JE. Adaptive pathology: new insights into the physical examination and imaging of the thrower's shoulder and elbow. J Shoulder Elbow Surg 2024; 33:474-493. [PMID: 37652215 DOI: 10.1016/j.jse.2023.07.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 09/02/2023]
Abstract
Throwing with high velocity requires extremes of glenohumeral external rotation of the abducted arm where particularly high forces in the shoulder and elbow are endured. Repeated throwing leads to dominant-arm bony remodeling of the humerus, glenoid, and elbow, and multiple soft tissue changes that would be considered abnormal. Many of these features are thought to be adaptive and protective. The purpose of this work is to (1) define the concept of adaptive pathology; (2) review the mechanics of the throwing motion; (3) review pertinent physical examination and imaging findings seen in asymptomatic throwers' shoulders and elbows and describe how these changes develop and may be adaptive-allowing the thrower to perform at high levels; and then (4) review the principles of surgical treatment in the throwing athletes, which should focus on reducing symptoms, but not necessarily restoring the thrower's anatomy to normal.
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Affiliation(s)
- John E Kuhn
- Vanderbilt Sports Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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Barrenetxea-Garcia J, Murua-Ruiz A, Mielgo-Ayuso J, Nuell S, Calleja-González J, de Villarreal ES. Recovery in water polo: how much do we have to know? A systematic review. J Exerc Rehabil 2022; 18:225-234. [PMID: 36110255 PMCID: PMC9449089 DOI: 10.12965/jer.2244306.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022] Open
Abstract
Water polo (WP) is a high-intensity intermittent aquatic sport, with a predominance of swimming skills and nonswimming activities and incomplete recovery periods. Consequently, recovery after exercise is a fundamental part of sports performance. The main purpose of this systematic review was to evaluate the effects of different recovery strategies in WP performance. The studies were found by searching in the databases of PubMed, Web of Science, and Scopus. Methodological quality and risk of bias were assessed in accordance with the Cochrane Collaboration Guidelines samples. A summary of results including five studies was followed. The results show that supplementation with cherry juice before training does not imply improvements in recovery; the full-body photobiomodulation therapy reduces muscle damage; reducing training load during the season increased the natural logarithm of the root mean square of successive differences and perceived state of recovery, and the heart rate variability stabilizes and could progressively increase at the end of a tournament; and when an increase in internal training load is less than 60%–70% autonomic cardiac disturbances during preseason training do not occur. Recovery in WP is a very limited field of study that needs future research in active recovery, hydrotherapy, massage, rest and sleep to help coaches formulate recommendations.
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Affiliation(s)
| | - Antxon Murua-Ruiz
- Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Vitoria,
Spain
| | - Juan Mielgo-Ayuso
- Department of Health Sciences, Faculty of Health Sciences, University of Burgos, Burgos,
Spain
| | - Sergi Nuell
- Tecnocampus, Escola Superior de Ciències de la Salut, Universitat Pompeu Fabra, Mataró,
Spain
| | - Julio Calleja-González
- Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Vitoria,
Spain
- Corresponding author: Julio Calleja-Gonzalez, Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Portal de Lasarte, 71, 01007 Vitoria, Spain,
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LEBLANC M, LEE BJ, HAWKINS SA. Effect of fatigue and sex on isokinetic torque values in water polo athletes. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2021. [DOI: 10.23736/s0393-3660.19.04261-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Galluccio F, Bellucci E, Porta F, Tofani L, De Paulis A, Bianchedi D, Barskova T, Matucci-Cerinic M. The waterpolo shoulder paradigm: results of ultrasound surveillance at poolside. BMJ Open Sport Exerc Med 2017; 3:e000211. [PMID: 29021905 PMCID: PMC5633731 DOI: 10.1136/bmjsem-2016-000211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Waterpolo consists of a combination of swimming and throwing with close contact between players. The shoulder is the most frequently injured joint, with a combination of rotator cuff tear and tendinopathy, long head biceps tendinopathy, superior labral lesions and shoulder impingement. This unique combination is a challenge for the clinician who must determine which of these shoulder pathologies is responsible for the onset of pain and the best strategy to rehabilitate the joint and prevent recurrence. AIM The aim of this study was to estimate with ultrasound the frequency and characteristics of shoulder injuries in waterpolo players competing in different leagues. METHODS Forty-two players from two clubs in the premier and second Italian league were enrolled in the study. Standard and dynamic shoulder ultrasound scans were performed on all athletes. RESULTS Ultrasound investigation showed that almost all players had injuries of the shoulders; only four players did not show any shoulder modification. Thirteen athletes who had shoulder pain during the ultrasound examination showed subacromion deltoid bursitis and/or long head biceps tendinitis. No statistically significant differences in the frequency and characteristics of shoulder modifications or injuries were detected between players of the premier or second league. CONCLUSION Shoulder injuries are very common in waterpolo players and comprise a peculiar and complex combination of rotator cuff tendinopathy and tears, long head biceps tendinopathy, impingement, subacromion deltoid bursitis and superior labral lesions. The use of ultrasound has been shown to be of considerable help in highlighting the modifications of the shoulder structures at an early asymptomatic stage. The ability to perform real-time scanning at the poolside makes ultrasound a useful tool in the rapid management and regular follow-up of shoulder modifications in everyday practice in sport medicine.
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Affiliation(s)
- Felice Galluccio
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Eleonora Bellucci
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Francesco Porta
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Lorenzo Tofani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Amato De Paulis
- Section of Autoimmune Diseases, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Diana Bianchedi
- Anti-doping and Health Care Committee of the Italian Football Federation, Rome, Italy
| | - Tatiana Barskova
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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Klein M, Tarantino I, Warschkow R, Berger CJ, Zdravkovic V, Jost B, Badulescu M. Specific Shoulder Pathoanatomy in Semiprofessional Water Polo Players: A Magnetic Resonance Imaging Study. Orthop J Sports Med 2014; 2:2325967114531213. [PMID: 26535326 PMCID: PMC4555536 DOI: 10.1177/2325967114531213] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Shoulders of throwing and swimming athletes are highly stressed joints that often show structural abnormalities on magnetic resonance imaging (MRI). However, while water polo players exhibit a combination of throwing and swimming movements, a specific pattern of pathological findings has not been described. PURPOSE To assess specific MRI abnormalities in shoulders of elite water polo players and to compare these findings with a healthy control group. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS After performing a power analysis, volunteers were recruited for this study. Both shoulders of 28 semiprofessional water polo players and 15 healthy volunteers were assessed clinically (based on the Constant score) and had bilateral shoulder MRIs. The shoulders were clustered into 3 groups: 28 throwing and 28 nonthrowing shoulders of water polo athletes and 30 shoulders of healthy control subjects. RESULTS Twenty-eight male water polo players with an average age of 24 years and 15 healthy subjects (30 shoulders) with an average age of 31 years were examined. Compared with controls, significantly more MRI abnormalities in the water polo players' throwing shoulders could be found in the subscapularis, infraspinatus, and posterior labrum (P = .001, P = .024, and P = .041, respectively). Other structures showed no statistical differences between the 3 groups, including the supraspinatus tendon, which had abnormalities in 36% of throwing versus 32% of nonthrowing shoulders and 33% of control shoulders. All throwing shoulders showed abnormal findings in the MRI, but only 8 (29%) were symptomatic. CONCLUSION The shoulders of semiprofessional water polo players demonstrated abnormalities in subscapularis and infraspinatus tendons that were not typical abnormalities for swimmers or throwing athletes. CLINICAL RELEVANCE The throwing shoulders of water polo players have specific MRI changes. Clinical symptoms do not correlate with the MRI findings.
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Affiliation(s)
- Maria Klein
- Department of Orthopaedic Surgery, Universitätsspital Basel, Basel, Switzerland
| | - Ignazio Tarantino
- Department of Surgery, Kantonsspital St Gallen, St Gallen, Switzerland
| | - René Warschkow
- Department of Surgery, Kantonsspital St Gallen, St Gallen, Switzerland
| | | | - Vilijam Zdravkovic
- Department of Orthopaedics and Traumatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Bernhard Jost
- Department of Orthopaedics and Traumatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Michael Badulescu
- Department of Orthopaedics and Traumatology, Kantonsspital St Gallen, St Gallen, Switzerland
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Kuhn JE. Current concepts: rotator cuff pathology in athletes--a source of pain or adaptive pathology? Curr Sports Med Rep 2014; 12:311-5. [PMID: 24030304 DOI: 10.1249/jsr.0000000000000000] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Magnetic resonance imaging (MRI) findings are common in patients and athletes with shoulder pain. Historically these anatomic derangements have been thought to be the source of the patient's symptoms, and approaches have been focused on restoring the anatomy. This manuscript will address three objectives: (1) suggest that the approach to rotator cuff disease should be based on the patient's history and physical examination, and not necessarily on the anatomic disorders apparent on imaging; (2) review the data that supports the contention that rotator cuff disease is not the source of pain in the symptomatic shoulder, and (3) describe the concept of adaptive pathology. The findings on the MRI in the thrower's painful shoulder may be adaptive, and these alterations may be required to allow performance at high levels in sport.
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Affiliation(s)
- John E Kuhn
- Vanderbilt University Medical Center, Nashville, TN
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Kibler WB, Kuhn JE, Wilk K, Sciascia A, Moore S, Laudner K, Ellenbecker T, Thigpen C, Uhl T. The disabled throwing shoulder: spectrum of pathology-10-year update. Arthroscopy 2013; 29:141-161.e26. [PMID: 23276418 DOI: 10.1016/j.arthro.2012.10.009] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 08/31/2012] [Accepted: 10/03/2012] [Indexed: 02/02/2023]
Abstract
In the 10 years since the current concept series entitled "The Disabled Throwing Shoulder: Spectrum of Pathology" was conceived and written, many studies have been reported that add much more information to the understanding of the disabled throwing shoulder (DTS). The editors of Arthroscopy and the authors of the original series believed that an update to the original series would be beneficial to provide an organized overview of current knowledge that could update the thought process regarding this problem, provide better assessment and treatment guidelines, and guide further research. A dedicated meeting, including current published researchers and experienced clinicians in this subject, was organized by the Shoulder Center of Kentucky. The meeting was organized around 5 areas of the DTS that were highlighted in the original series and appear to be key in creating the DTS spectrum and to understanding and treating the DTS: (1) the role of the kinetic chain; (2) the role and clinical evaluation of the scapula; (3) the role of deficits in glenohumeral rotation, glenohumeral internal rotation deficit, and total range-of-motion deficit in the causation of labral injury and DTS; (4) the role of superior labral (SLAP) injuries and rotator cuff injuries; and (5) the composition and progression of rehabilitation protocols for functional restoration of the DTS. The meeting consisted of presentations within each area, followed by discussions, and resulted in summaries regarding what is known in each area, what is not known but thought to be important, and strategies to implement and enlarge the knowledge base.
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Affiliation(s)
- W Ben Kibler
- Shoulder Center of Kentucky, Lexington, 40504, USA
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Sizer PS, Phelps V, Brismée JM, Cook C, Dedrick L. Ergonomic Pain--Part 2: Differential Diagnosis and Management Considerations. Pain Pract 2004; 4:136-62. [PMID: 17166197 DOI: 10.1111/j.1533-2500.2004.04209.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Work-related musculoskeletal disorders (MSDs) can produce ergonomic pain in several different regions of the body, including the shoulder, elbow, wrist and hand, lumbar spine, knee, and ankle/foot. Each family of disorders is distinctive in presentation and requires diagnosis-specific interventions. Because of the complex nature of these disorders, management approaches may not always eliminate symptoms and or completely restore patient function to a level found prior to symptom onset. As a consequence, ergonomic measures should be implemented to reduce the overload on tissue and contribute to patient recovery. However, functional limits may persist and the clinician must make further decisions regarding a person's functional status in the chronic stages of the patient's care.
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Affiliation(s)
- Phillip S Sizer
- Texas Tech University Health Science Center, School of Allied Health, Doctorate of Science Program in Physical Therapy, Lubbock, Texas 79430, USA
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Sizer PS, Phelps V, Gilbert K. Diagnosis and Management of the Painful Shoulder. Part 2: Examination, Interpretation, and Management. Pain Pract 2003; 3:152-85. [PMID: 17163914 DOI: 10.1046/j.1533-2500.2003.03022.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Diagnosis, interpretation and subsequent management of shoulder pathology can be challenging to clinicians. Because of its proximal location in the schlerotome and the extensive convergence of afferent signals from this region to the dorsal horn of the spinal cord, pain reference patterns can be broadly distributed to the deltoid, trapezius, and or the posterior scapular regions. This pain behavior can make diagnosis difficult in the shoulder region, as the location of symptoms may or may not correspond to the proximity of the pain generator. Therefore, a thorough history and reliable physical examination should rest at the center of the diagnostic process. Effective management of the painful shoulder is closely linked to a tissue-specific clinical examination. Painful shoulder conditions can present with or without limitations in passive and or active motion. Limits in passive motion can be classified as either capsular or noncapsular patterns. Conversely, patients can present with shoulder pain that demonstrates no limitation of motion. Bursitis, tendopathy and rotator cuff tears can produce shoulder pain that is challenging to diagnose, especially when they are the consequence of impingement and or instability. Numerous nonsurgical measures can be implemented in treating the painful shoulder, reserving surgical interventions for those patients who are resistant to conservative care.
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Affiliation(s)
- Phillip S Sizer
- Texas Tech University Health Science Center, School of Allied Health, Physical Therapy Program, Lubbock, Texas 79430, USA
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Abstract
Water polo is a contact sport combining the skills of swimming, swim conditioning, throwing and, occasionally, the elements of wrestling and boxing. As such, the athletes frequently sustain upper extremity injuries involving the shoulder, the elbow, or the hand and fingers; moreover, injuries may result from either overuse or acute trauma. Successful treatment of these injuries requires an understanding of the peculiarities of the game and the likely mechanisms of injury, and the experience to properly recognize when they occur.
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Affiliation(s)
- J M Colville
- Stanford University School of Medicine, Palo Alto, California, USA
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