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Capsulitis: A Common Cause of "Swimmer's Shoulder"

by Dr. Edward Weldon III, MD., Orthopedic Surgeon

Shoulder pain is a common problem for swimmers because the act of swimming is so dependent on the range of motion. Mild pain in a swimmer's shoulder can make swimming feel unpleasant, if not impossible. One common symptom of capsulitis is inflammation of the shoulder capsule. Capsulitis is caused by repetitive micro-trauma, which creates small imperfections in the mechanics of the shoulder, leading to inflammation and pain. Capsulitis, more commonly called swimmer's shoulder, can cause stiffness, which may alter the mechanics of the shoulder. Thus, a self-perpetuating cycle is formed that can last for years if not properly treated. More often than not capsulitis can be treated without surgery.

Symptoms

The symptoms of shoulder capsulitis include: 1) shoulder pain with swimming, 2) increased pain in the morning, 3) pain while stretching, and 4) in advanced cases, noticeable shoulder stiffness with a decreased range-of-motion. The pain is often felt from the shoulder down, but not past the elbow.

Diagnosis

A trained physician ca make the diagnosis of shoulder capsulitis based on a patient's history, physical exam, and radiographic studies.

Treatment

The treatment of capsulitis is aimed at breaking each point in the Capsulitis Cycle.

1. Improve shoulder mechanics during swimming:
   • Increase body-roll
   • Breathe on both sides
   • Avoid using paddles or pull-buoys
   • Seek advice from a knowledgeable coach
2. Decrease inflammation/pain:
   • A 2-week course of around-the-clock anti-inflammatory medications, as prescribed by your doctor
   • Or a steroid injection for advanced cases
   • Avoid medications which simply block the pain such as narcotics
3. Resolve Stiffness:
   • Resolution of the stiffness can be achieved by following a simple home stretching program. The shoulder should be stretched in a gentle manner so as not to stir up more inflammation. The hallmark of this program is 5x per day stretching. Stretching less may actually do more harm than good.
   • A knowledgeable therapist may be of benefit. The therapist acts as a guide and an educator, not a motivator. The bulk of the work is to be done at home following a home stretching program. Modalities (ultrasound, heat, etc.) may be of some benefit, but the emphasis of treatment should always be the home stretching program.

Dr. Edward Weldon III, MD.
Orthopedic Surgeon
Bone & Joint Center at Straub