With inflammation, there will be swelling and. thickening of the rotator cuff and thus the efficient passage of the supraspinatus tendon through the

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1 Br. J. Sp. Med; Vol 24, No. 3 Epidemiology of shoulder impingement in upper rm sports events Y.P.C. Lo', SRP, Y.C.S. Hsu2, FRCS nd K.M. Chn3, FRCS 1 Lecturer in Physiotherpy, Hong Kong Polytechnic, Hong Kong 2 Lecturer in Orthopedic Surgery nd Trumtology, Chinese University, Hong Kong 3 Reder in Orthopedic Surgery nd Trumtology, Chinese University, Hong Kong An epidemiologicl survey ws conducted to collect dt relting to the prevlence nd frequency of shoulder pin nd other relted prolems mong different thletic groups tht demnded vigorous upper rm ctivities. A questionnire ws dministered on site thus ensuring tht the response rte ws 100 percent. Anlysis of results reveled tht of the 372 respondents there were 242 mle (65.1 percent) nd 130 femle sujects (34.9 percent), with seven (1.9 percent) ove the ge of 40, 119 (32 percent) etween the ges of 25 nd 40, nd 246 (66.1 percent) elow 25 yers of ge. A totl of 163 thletes (43.8 percent) indicted tht they hd shoulder prolems, 109 (29 percent) suffering pin. Diffuse pin ws indicted y 20 respondents (5.4 percent), while loclized pin during movement ws reported in 89 (23.9 percent). The prevlence of shoulder pin rnked highest mong volley ll plyers (N = 28) followed y swimmers (N = 22), while dminton, sketll nd tennis prticipnts were eqully ffected (N = 10). Keywords: Shoulder injuries, upper rm sports, impingement, epidemiology The rottor cuff comprises four muscles: the suprspintus superiorly, the suscpulris nteriorly, nd the infrspintus nd teres minor posteriorly. Of these muscles, more prolems tend to rise from the suprspintus since it psses in close proximity to the undersurfce of the corco-cromil ligment, the cromio-dviculr joint nd the ony roof formed y the cromion. Impingement of the rottor cuff etween the undersurfce of the cromion nd/or corcro-cromil rch nd the greter humerl tuerosity occurs s soon s the upper rm is elevted ove shoulder level. Moseley' nd Rothmn nd Prke2 reported tht there ws 'criticl zone' t the suprspintus tendon where the vsculture of this structure could e ffected during movement. Chronic irrittion of this poorly vsculrized region my led to n inflmmtory response which in turn my cuse tendinitis3. Address for correspondence: Mr Y.P.C. Lo, Physiotherpy Section, Deprtment of Rehilittion Sciences, Hong Kong Polytechnic, Hung Hom, Hong Kong 1990 Butterworth-Heinemnn Ltd /90/ With inflmmtion, there will e swelling nd thickening of the rottor cuff nd thus the efficient pssge of the suprspintus tendon through the sucromil spce will e hmpered. Impingement syndromes in the shoulder re common in individuls using their upper rms t or ove shoulder level for prolonged periods4'. On the other hnd, Chrd et l. suggested tht overuse due to sport usully hd fvourle outcome since the specific cuse of the prolem could e voided6. Shoulder impingement syndrome (SIS) is common, the incidence vrying etween sports An extensive epidemiologicl survey ws conducted with the im of collecting informtion which might enle thletes nd relted personnel to prevent SIS. Mterils nd methods Design of questionnire The questionnire ws in four prts: (i) demogrphic dt (ge, sex, height, weight, hnd domince nd occuptionl ckground); (ii) sport prticiption dt (event, nture of involvement nd frequency); (iii) generl performnce; nd (iv) relted shoulder prolems. Pilot study A pilot study ws crried out mong physiotherpy students in the Hong Kong Polytechnic. A totl of 48 questions hd to e nswered y those with shoulder prolems nd previous injuries. Those without symptoms hd to nswer 35 questions. The entire questionnire could e completed in seven to ten minutes. Survey The sujects of this study were limited to competitive nd regulr recretionl thletes who prticipted in vigorous upper rm orgnized sporting ctivities. They hd either regulr sports commitments in their work (physicl eduction techers or instructors) or regulr trining or sports competition (district or college representtives). Br. J. Sports Med., Vol 24, No

2 Since SIS ws more common in those who hd prolonged/repeted upper extremity ctivities t or ove shoulder level, prticipnts in dminton, sketll, gymnstics, sqush, swimming, tle tennis, tennis, field events nd volley ll were pproched. The Juilee Sports Centre USC) t Shtin ecme the min resource centre. The survey ws conducted t the sports field where the thletes were trined nd/or hd their competitions. The questionnires were completed on site nd returned immeditely. The response rte of the questionnire ws 100 percent thnks to excellent co-opertion from coches, triners nd thletes. d=242,65% i= 130, 35% > N. 40 yers = 7, ye3rs 2% = 11 9; 32 U- D. < 25 yers = 246, 66% Figure 1. : Sex distriution; nd : ge distriution (yers) (N = 372) Righ 9% Unffected = 209, Fgr 56% Figure 2. : Hnd dominnce nd; : sides ffected (N = 372) )% Results The responses were converted into numericl vlues nd the dt were nlysed y mens of Sttisticl Pckge for Socil Science, Personl Computer (SPSS/PC). The ge nd sex distriutions of the 372 respondents is shown in Figure 1, the hnd-dominnce nd sides ffected in Figure 2. With regrd to their sports ckground, 70 respondents (18.8 percent) designted themselves s full time prticipnts. This group induded the physicl eduction techers or instructors, triners nd those who were on scholrship for full-time trining. A totl of 156 respondents (41.9 percent) were in the elite or competitive thletes' ctegory, minly representtives from colleges, sports ssocitions, or Hong Kong tem memers in certin sports events. The residul 146 (39.2 percent) were recretionl thletes tking prt in sports events regulrly, t lest once week (Figure 3). The respondents' sports events re shown in Figure 4 nd their experience nd frequency of prticiption shown in Figure 5 nd in Tles 1 nd 2. Sujects' indictions of their rm-level or mximum effort re set out in Figure 6 nd in questioning s to which movement they would perform most forcefully, 127 sujects (34.1 percent) chose flexion. Externl rottion ws indicted y 54 respondents (14.5 percent) nd extension/downwrd push y 85 (22.8 Elite= 156, 42% Figure 3. : Sports I prticiption (N = 372) Recretion = 115, I=146, 31% ckground Figure 4. Rnge of sport events (N = 372) Tle 1. Frequency of sports prticiption Competition = 257, 69% nd; : nture of < 1 per week - 34 (9.1%) Once per week - 57 (15.) twice per week - 83 (22.) thrice perweek - 58 (15.6%) four times per week - 25 (6.7%) > 4 per week (30.9%) Tle 2. Durtion of prticiption per session < 1 hour - 31 (8.) 1-2 hours (48.4%) 2-3 hours (32.8%) > 3 hours - 39 (10.5%) 174 Br. J. Sports Med., Vol 24, No. 3

3 Twice = 83, 22% <1 yer =10. Thrice= 5 57, I7t _-] I< once= 34, 9% > 3 yers 275, 74% Four times =25, 4 times -1 5, 31 % 7% Figure 5. : History of prticiption in sport event nd; : frequency of involvement per week (N = 372) At shoulder level Others= 22, 6% =67, 18% Comintion =29 8% ER = 31, 8% AlrngesAuto 18449% Aducto n houlder 78, 21% Flexion = 3 96 Below shoulder Unffected = =43,12% Figure 6. : Movement with mximl effort nd; : pinful movements (N = 372) Nil= 31, 8% min= 29, 8% >30min= min=126 A. 34% Yes=341, 92% <10min=174,47% Figure 7. : Avilility of wrming-up prior to citivity nd; : durtion (N = 372) Pin=n109, 29 Crepitus.. =17,5 Weknes 25, 7% Decresed ROM =9,2% Others =3 1% Loclized =89 24 pin Unffected 209, 56% Nc e).%a Diffuse pin =20, 5% v pin= 263, 71% Figure 8. : Mjor shoulder prolem (N = 163) nd; : nture of pin (N = 109) Tle 3. Shoulder pin nd miscellneous shoulderprolems mong thletes of different events Sport Pin Otherprolems Totl Volley ll 28 (74%) 10 (26%) 38 Bdminton 10 (52.6%) 9 (47.4%) 19 Bsketll 10 (50%) 10 (50%) 20 Gymnstic 4(80%) 1 (20%) 5 Sqush 6 (66.7%) 3 (33.) 9 Swimming 22 (66.7%) 11(33.) 33 Tle tennis 3 (60%) 2 (40%) 5 Tennis 10 (90.9%) 1 (9.09%) 11 Field event 3 (37.5%) 5 (62.5%) 8 Others 13 (86.7%) 2 (13.) 15 Totl 109 (66.87%) 54 (33.1) 163 Recretionl = 41 38% Elite = 51, 47% Full-time = 17, 16% Full-time= 16, 30% Figure 9. Shoulder prolems mong thletes from different sport ckgrounds; : thletes with shoulder pin; : thletes with other shoulder prolems percent). While 64 thletes (17.2 percent) climed throwing s their hrdest movement, 42 respondents (11.3 percent) selected comintion of vrious upper rm movements (Figure 6). Of the 372 respondents, 31 (8.3 percent) did not do ny wrming-up exercises efore ctivity. The 341 thletes (91.7 percent) who did wrm-up, did so for vrious times illustrted in Figure 7. The mjor concern of the study ws to find out the incidence of shoulder pin during upper rm ctivities nd whether ny loclized pin reported ws due to suprspintus tendinitis. Respondents identifying such symptoms would e further evluted y stndrdized ssessment method for SIS. It ws found tht 163 respondents (32.8 percent) hd shoulder prolems with the symptoms set out in Figure 8, nd the qulity of their pin in Figure 8. Cross-tultion reveled high level of pin in respondents with shoulder symptoms which included crepitus, wekness nd decresed movement rnges (Tle 3). The frequency of pin nd other shoulder prolems ssocited in different thletic groups is indicted in Figures o ientiy the correltion etween wrming up exercise nd the presence of shoulder prolems, the dt reflected tht there were 13 sujects (42 percent) from the nil wrming-up group (N = 31) nd 150 thletes (44 percent) from the wrming-up group (N = 341) with shoulder complints (Figure 13). Br. J. Sports Med., Vol 24, No

4 The incidence, frequency nd type of previous injury re shown in Figures 14 nd 15. Some respondents were not sure of the type of their previous injuries. Decresed ROM= 3, 9% Wekness = 9 27% Others= 2, 6% Crepitus = 2, 6% Figure 10. Nture of shoulder prolem mong full-time prticipnts (N = 33) Decresed ROM=4. 6% Wekness =7, 11% Crepitus =3, 5% Pin= 51, 77% 52% Others= 1, 2% Figure 11. Nture of shoulder prolem mong elite thletes (N = 66) Wekness 9, 14 Crepitus 12, 19% Decresed ROM =2, Pin=41, 64% Figure 12. Nture of shoulder prolem mong recretionl prticipnts (N = 64) Discussion The prevlence of shoulder prolems in upper rm sports ws high percent of respondents - with pin s the min complint followed y wekness nd crepittion. Pin in the shoulder during movement ws more pronounced in the elite group. The predominnce of mle sujects reporting shoulder pin correltes with the findings of Bckx et l.9, Collins et l.'0 nd Winge et l.8 who ll commented tht the choice of sport would e significnt determinnt of rte nd pttern of injury. With shoulder prolem -13, 42% _c- No shoulder prolem With shoulder prolem = 150, 44%6 _ No shoulder prolem = 18, 58% = 191, 56% Figure 13. Correltion of wrming-up ctivities with shoulder prolems : no wrm-up (N = 31); : with wrm-up (N = 341) Posittive = 123, Once=49 Thrice=7,2% ~~~~~~1 Twice =36, 10% 3 times 3 ~~~8% Negtive=249, Nil ~~~67% Figure 14. Previous shoulder injuries : previous shoulder injuries; : episodes shoulder injuries Nil = 249, Disloction = 1 1, = 249, 67% presence of of previous i Arsion = 1, 0% Others = 19, 5% 'ontusion = 12, 22% Figure 15. Nture of initil shoulder injury (N = 123) 176 Br. J. Sports Med., Vol 24, No. 3

5 Hnd dominnce did contriute to the occurrence of shoulder symptoms, 106 respondents (28.5 percent) eing ffected on their dominnt sides nd only 22 (5.9 percent) on the non-dominnt side. Arm overuse leding to symptoms ws descried y Hwkins nd Hoeik4 nd DeBenedette5. The use of the dominnt hnd lone in rcket sports nd certin throwing events might exert mximl stress on the sucromil structures of the most ctive side. Among the 123 respondents who hd sustined previous shoulder injuries, the prevlence of shoulder pin (67.5 percent) ws similr to tht in the nil previous injury group (66.3 percent). The proility of sustining further musculoskeletl shoulder prolems ws twice s high if there were previous shoulder injuries. Acknowledgements We re much indeted to Dr. M. K. Chin for providing sujects from his deprtment t the Juilee Sports Centre. Specil thnks should lso e given to Miss Josephine Yeung of the ove centre nd the physiotherpy students of the Hong Kong Polytechnic for supporting in the study. Copies of the Shoulder Impingement Profile Study questionnire re ville on request from the uthors. Shoulder impingement in upper rm sports events: Y.P.C. Lo, et l. References 1 Moseley, H.F. The vsculr supply of the rottor cuff Surgicl Clinics of North Americ 1963, 43, Rothmn, R.H. nd Prke, W.W. The vsculr ntomy of the rottor cuff Clinicl Orthopedics 1965, 41, Hwkins, R.J. nd Kennedy, J.C. Impingement syndrome in thletes Americn Journl of Sports Medicine 1980, 8(3), Hwkins, R.J. nd Hoeik, P.E. (1983) Impingement in the theletic shoulder Clinics in Sports Medicine 1983, 2(2), DeBenedette, V. Rottor cuff prolems mong top thletes The Physicin nd Sportsmedicine 1989, 17(5), Chrd, M.D. et l. The long-term outcome of rottor cuff tendinitis - review study British Journl of Rheumtology 1988, 27, Chinn, C.J. et l. Upper extremity rnge of motion, grip strength, nd girth in highly skilled tennis plyers Physicl Therpy 1974, 54, Winge, S. et l. Epidemiology of injuries in Dnish Chmptionship Tennis Intnertionl Journl of SPorts Medicine 1989, 10, Bckx, F.J.G. et l. Sports injuries in school-ged children: n epidemiologic study Americn Journl of SPorts Medicine 1989, 17(2), Collins, K. et l. Overuse injuries in trithletes: study of the 1986 Sefir Trithlon Americn Journl of Sports Medicine 1989, 17(5) Br J Sports Med: first pulished s /jsm on 1 Septemer Downloded from on 14 Jnury 2019 y guest. Protected y copyright. Br. J. Sports Med., Vol 24, No