Swimmer's shoulder in adolescents and adults: a review

Swimming, both as a recreational and professional sport, is widely practiced in Russia and globally. This sport is unique in that it combines strength exercises for the upper and lower extremities with cardiovascular training without weight-bearing load. However, the high repetition of movements characteristic of the conventional freestyle stroke may predispose professional swimmers to musculoskeletal injuries, predominantly of the shoulder joint. The lack of comprehensive information in the Russian scientific data on swimmer’s shoulder determines the relevance of this review. For this scientific review, articles in Russian and English published between 1974 and 2025 were selected from PubMed, Google Scholar, CyberLeninka, and Google using the following keywords: плечо пловца (swimmer’s shoulder), плавание (swimming), ротаторная манжета плеча (rotator cuff), импинджмент-синдром плечевого сустава (shoulder impingement syndrome), спорт (sport). A total of 56 sources were included, 18 of which were published within the past 10 years. The incidence of musculoskeletal injuries of various localizations in swimmers ranges from 2.6 to 4.0 cases per 1000 hours of swimming, with shoulder injuries leading (23%–51% and 33%–41% in men and women, respectively). Despite advances in sports medicine and rehabilitation, a global trend toward an increase in shoulder injuries among swimmers has been observed. Swimmer’s shoulder is a collective term describing multiple conditions accompanied by pain in the shoulder joint in athletes engaged in swimming. The main etiologic factors in the development of swimmer’s shoulder are high training intensity and the lack of a well-designed and balanced training program, which affect overall muscle balance, the scapulothoracic articulation, the rotator cuff, and shoulder joint motion. The most common mechanisms of shoulder pain in swimmers are impingement syndrome, anteroinferior instability, scapular dyskinesis, and rotator cuff muscle imbalance. Shoulder pain persisting for 1 month during intensive training is experienced by 91% of junior athletes and is most often associated with impingement syndrome or supraspinatus tendinopathy. As a rule, active rest, temporary reduction or cessation of swimming, and the use of nonsteroidal anti-inflammatory drugs make it possible to relieve pain and allow the athlete to return to training shortly. In cases of labral tear, rotator cuff tear, or shoulder instability, surgical treatment is indicated. Timely and accurate diagnosis and treatment, together with a rational training regimen both in water and on land, allow the athlete to avoid severe shoulder injuries and resume training.