Docstoc

Swimmers and Divers_ How Does Surgical Intervention Change_

Document Sample
Swimmers and Divers_ How Does Surgical Intervention Change_ Powered By Docstoc
					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
• Observed pathology
• Surgical correction
           Diving Kinematics
• Phases
  – Approach – open chain
  – Press – open chain
  – Flight – open chain
  – Entry – closed chain
• Arm position
        Diving Kinematics
• Arm position
      Swimming Kinematics
• Phases
  – Catch – closed chain
    • Hand entry
    • Catch
  – Pull through – closed
    • Insweep
    • Finish
  – Recovery – open chain
• Arm position
       Body Characteristics
• Postural dysfunction
       Body Characteristics
• Postural dysfunction
• Scapular dyskinesis
  – Proximally derived
  – Distally derived
        Body Characteristics
• Postural dysfunction
• Scapular dyskinesis
• Joint laxity
         Body Characteristics
•   Postural dysfunction
•   Scapular dyskinesis
•   Joint laxity
•   Aerobic fitness
         Body Characteristics
•   Postural dysfunction
•   Scapular dyskinesis
•   Joint laxity
•   Aerobic fitness
•   Training schedule
      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
             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
      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
      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
      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
 Shoulder Pathology in Divers
• Labral tears and detachments
  – SLAP lesions (ant, post, combined)
 Shoulder Pathology in Divers
• Labral tears and detachments
  – Bankart lesions (ant, post, both)
  – Hill Sachs lesion
 Shoulder Pathology in Divers
• Labral tears and detachments
  – ALPSA lesion
 Shoulder Pathology in Divers
• Capsule attenuation
  – Unidirectional
    instability
  – MDL with UDI
  – MDI
  – Rotator interval
    lesion
  – HAGL lesion
• MGHL deficiency
  (congenital)
 Shoulder Pathology in Divers
• Rotator cuff tears
  – Partial thickness
     • PASTA lesions
     • Tensile failure
  – Full thickness (rare)
• Internal impingement (rare)
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
     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
        Surgical Correction
• Suture capsulorrhaphy
• Rotator interval plication prn
        Surgical Correction
• Bankart repair with suture capsulorrhaphy
       Surgical Correction
• SLAP repair
        Surgical Correction
• Rotator cuff repair or debridement
        Surgical Correction
• Reexamine under anesthesia
  – Insure stability without compromising ROM
    required for sport
  – Refine rehabilitation based on postop ROM
    and stability
            Rehabilitation
• Core based functional rehabilitation
  which is sport specific
 THANKS
   FOR
LISTENING

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:4
posted:1/6/2013
language:English
pages:30