Wetenschap en waterpolo


Instability and impingement of the shoulder of the high performance athlete in overhead stress
Sportverletz Sportschaden. 1993 Sep;7(3):115-21
Gohlke F, Lippert MJ, Keck O.
Orthopadische Universitatsklinik Wurzburg.

The present prospective study was performed on 89 competitive sportsmen (league players of handball, basketball, volleyball and water polo). The evaluation was based on information obtained from a review of training methods, a standardised anamnestic, physical and sonographic examination directed at pain, function, flexibility and all signs of impingement and instability of the shoulder counted in a score. The incidence of shoulder pain, which handicapped during training and play within the last 6 months was for water polo 60%, handball 40%, volleyball 25% and basketball 3.5%. Analysing these problems we found severe problems predominantly in handball, fewer in water polo or volleyball. According to data obtained from sports with throwing activity we found a high incidence of shoulder disorders. Using basketball players as a control group with less throwing activity our results would suggest that this mechanism seems to be the most important. The high incidence of severe disorders in handball players is additionally caused by traumatic injuries. Ultrasonography shows predominantly incomplete tears of the deep surface of the supraspinatus tendon near to the insertion with exception of the basketball players. Only in 5 shoulders (2.8%) we found the coincidence of clear signs of instability and subacromial pathology. The term "instability impingement" has not proved to be very helpful and has turned out to be far too diffuse to establish a diagnosis.

Magnetic resonance morphologic changes in shoulder joints of world class water polo players
Sportverletz Sportschaden. 1993 Sep;7(3):109-14.
Jerosch J, Castro WH, Drescher H, Assheuer J.
Klinik und Poliklinik für Allgemeine Orthopädie, Westfälischen Wilhelms-Universität, Münster.

In a prospective study we examined the dominant shoulder of 11 athletes from the 1992 German Olympic water polo team. Their mean age was 25.4 +/- 3.5 years. Water polo had been practised generally for 14.1 +/- 4.3 years and professionally for 11.6 +/- 3.9 years. The weekly training amounted to between 12.5 and 19.5 hours. All athletes were submitted to standardised clinical, sonographical and MRI tests. In 5 cases we found anamnestic and/or clinical indications of rotator cuff pathology. In all 5 cases the supraspinatus tendon was affected, and in three cases both the supra- and the infraspinatus tendon were involved. Sonographically, no specific pathology except a thickened rotator cuff was seen. Remarkable changes were revealed by magnetic resonance imaging. In 8 cases changes were present in the insertion of the rotator cuff at the humeral head. The subacromial bursa was not pathologic. The tendon of the long head of the biceps was pathologically changed in 9 cases. In 7 athletes a so-called biceps halo and in two an osteophyte in the area of the bicipital groove was visible. In all of the 11 dominant shoulder joints massive hypertrophy of the articular capsule and pathologic changes of the anterior glenoid labrum existed. Occult osseous lesions were detected in 5 athletes, and osseous lesions of the humeral head in 8 athletes. In all athletes we could document degenerative changes at the acromioclavicular joints such as effusion in 7 cases, arthritis in two cases, and evident synovitis in two cases.

Clinical relevance: Many of the changes detected by MRI were not symptomatic.

A prospective controlled investigation of the cognitive effects of amateur boxing
J Neurol Neurosurg Psychiatry. 1993 Oct;56(10):1055-61
Butler RJ, Forsythe WI, Beverly DW, Adams LM.
Department of Clinical Psychology, High Royds Hospital, Ilkley, Leeds, UK.

Eighty six amateur boxers underwent a series of neuropsychological assessments on three occasions--pre bout, immediate post bout and follow up within two years; 31 water polo players and 47 rugby union players acted as controls. The neuropsychological tests were selected as being sensitive to subtle cognitive dysfunction and formed part of a battery of other neurological and ophthalmic assessments. No evidence of neuropsychological dysfunction due to boxing was found, either following a bout or a series of bouts at follow up. None of a range of parameters including number of previous contests, recovery from an earlier bout, number of head blows received during a bout and number of bouts between initial assessment and follow up, were found to be related to changes in cognitive functioning.

Efficacy of percutaneous administration of anti-inflammatory drugs in swimmers and water-polo players
Clin Ter. 1993 Dec;143(6):507-9.
Picardi E, De Iasio R.
Cattedra di Fisiologia dello Sport, I Facolta di Medicina e Chirurgia, Universita degli Studi di Napoli, Federico II.

It can be concluded from the research reported above that diclofenac diethylammonium (NSAID) in cases of professional swimmers and waterpolo players who have either an ache or suffered a severe hit, when applied externally offers rapid and excellent results.

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