***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To further define the impingement occurring between the undersurface of the rotator cuff and the posterosuperior glenoid rim as a cause of shoulder pain in waterpolo athletes . EXPERIMENTAL DESIGN A prospect i ve design was used in the last three years . SETTING Data were collected in Science Sports Institute of Rome . PARTICIPANTS Eleven top level waterpolo players of both sexes all members of Italian National Waterpolo teams complaining of shoulder pain . INTERVENTION All the eleven cases were previously examined with clinical test and X-ray and MR imaging in conventional and functional views , and then underwent arthroscopy . RESULTS In four cases , X-ray showed erosions of the posterosuperior glenoid and in 5 cases , osteochondral defects on the posterior aspect of humeral head . In eleven cases , MR detected posterosuperior labral damages , partial tears of the undersurface of the rotator cuff and posterosuperior glenoid impingement . Furthermore arthroscopy detected in all cases the pathological findings associated with the posterosuperior glenoid impingement . CONCLUSIONS Even if the shoulder pain in the overhead athlete may be multifactorial , this study provides further evidence that the posterosuperior glenoid impingement may be the major cause of shoulder pain in waterpolo athletes Background Epidemiological information on injury/illness is required to develop effective injury prevention strategies . Aim To assess the frequency and characteristics of injuries/illnesses ( 1 ) in the 4 weeks prior to and ( 2 ) during the Fédération Internationale de Natation ( FINA ) World Championships 2015 compared with 2013 and 2009 . Method ( 1 ) Athletes answered a retrospective question naire , and ( 2 ) the medical staff reported injuries/illnesses prospect ively during the championships . Results ( 1 ) A quarter of responding athletes reported symptoms in the 4 weeks prior to the championships . More than half of all affected athletes presented with substantial severity , 80 % took medication , 70 % had overuse injuries and 30 % did not modify their training regime despite symptoms . At the start of the championships , 70 % of affected participants were still symptomatic . ( 2 ) During the championships , injury and illness incidence was 12.9 per 100 athletes . The most common injuries were shoulder sprains ( 5.7 % ) and muscle cramps of the lower back ( 5.7 % ) . The most common illnesses were infections of the respiratory ( 33.9 % ) and gastrointestinal tract ( 23.5 % ) . Risk factors included discipline and age , but not gender . Incidence was highest in athletes competing in high diving ( HD ) , water polo ( WP ) and diving ( DIV ) for injuries , and WP and swimming ( SW ) for illnesses . The significantly higher incidence of injuries and illnesses at the FINA World Championships 2015 compared with 2013 and 2009 was most probably due to a similarly improved response rate of the medical staff . Conclusions In aquatic sports , surveillance and health promotion should focus on prevention of out-of-competition overuse injuries and athlete education Background Injury and illness surveillance is the foundation for the development of prevention strategies . Objective To examine injuries among the aquatic disciplines in the 4 weeks prior to and during the 2013 FINA World Championships . Methods The study was comprised of two components : ( 1 ) a retrospective athlete survey recording injuries in the 4 weeks prior to the Championships and ( 2 ) a prospect i ve recording of injuries and illnesses by the medical teams of the participating countries and the local host medical team . Results One-third of the 1116 responding athletes reported an injury/physical complaint in the 4 weeks prior to the Championships . Significantly more women ( 36.7 % ) than men ( 28.6 % ) reported injuries . Divers reported the highest rate of injury/physical complaints ( 55.7 % ) . At the start of the Championships , 70 % of injured respondents ( n=258 ) were still symptomatic ; however , full participation was expected by 76 % . During the Championships , 186 new injuries were reported ( 8.3/100 registered athletes ) with the highest injury incidence rate in water polo ( 15.3/100 registered athletes ) . The most common injured body part was the shoulder ( 21 % ) . A total of 199 illnesses were reported during the Championships ( 9.0/100 registered athletes ) with the most common diagnosis of illness being gastrointestinal infection . Environmental exposure ( allergy , otitis and jellyfish stings ) was responsible for 27 % of all illnesses in open water swimming . Conclusions Injuries pose a significant health risk for elite aquatic athletes . A prospect i ve study would improve underst and ing of out-of-competition injuries . Future injury and illness surveillance at FINA World Championships is required to direct and measure the impact of prevention strategies Background : The ability to identify pitchers at risk for injury could be valuable to a professional baseball organization . To our knowledge , there have been no prior studies examining the predictive value of preseason strength measurements . Hypothesis : Preseason weakness of shoulder external rotators is associated with increased risk of in-season throwing-related injury in professional baseball pitchers . Study Design : Cohort study ( prognosis ) ; Level of evidence , 2 . Methods :  Preseason shoulder strength was measured for all pitchers in a professional baseball organization over a 5-year period ( 2001 - 2005 ) .  Prone internal rotation ( IR ) , prone external rotation ( PER ) , seated external rotation ( SER ) , and supraspinatus ( SS ) strength  were tested during spring training before each season . The players were then prospect ively followed throughout the season for incidence of throwing-related injury . Injuries were categorized on an ordinal scale , with no injury , injury treated conservatively , and injury result ing in surgery delineated 0 , 1 , and 2 , respectively . Subset analyses of shoulder injuries and of players with prior surgery were also performed . The association between strength measurements and injury was analyzed using Spearman rank correlation . Results : A statistically significant association was observed for PER strength ( P = .003 ) , SER strength ( P = .048 ) , and SS strength ( P = .006 ) with throwing-related injury requiring surgical intervention . Supraspinatus strength was also significantly associated with incidence of any shoulder injury ( P = .031 ) . There was an association between the ratio of PER/IR strength and incidence of shoulder injury ( P = .037 ) and some evidence for an association with overall incidence of throwing-related injury ( P = .051 ) . No associations were noted in the subgroup of players with prior surgery . Conclusion : Preseason weakness of external rotation and SS strength is associated with in-season throwing-related injury result ing in surgical intervention in professional baseball pitchers . Thus , preseason strength data may help identify players at risk for injury and formulate strengthening plans for prevention To investigate the effects of two different strength-training programs with the same workload ( impulse ) on throwing velocity in water polo , 30 water polo players ( M age = 17.1 yr . , SD = 4.9 ; M mass = 71.2 kg , SD = 14.7 ; M height = 1.75 m , SD = 0.09 m ) were r and omly divided in two groups based upon throwing performance with water polo ball . The medicine-ball training group performed 3 × 6 reps with a 3-kg medicine ball , while the combination training group completed 1 × 9 repetitions with the 3-kg medicine ball , followed by 3 × 14 repetitions with a water polo ball . Both groups trained eight weeks twice per week in addition to their regular water polo  training . Throwing velocity was measured with a Doppler radar gun before and after the training period . Testing included throws with a water polo ball on l and and in water , as well as with 1-kg and 3-kg medicine balls on l and . Statistically significant increases were found in mean peak throwing velocity with the water polo , 1-kg , and 3-kg medicine balls after training . No differences between the groups were found , except in throwing velocity with water polo on l and , with a statistically significantly larger increase for the combination training group ( + 7.6 % ) than the medicine-ball training group ( + 3.4 % ) . These findings indicate that after training with the same workload ( impulse ) , increases in throwing velocity in water polo are similar and suggesting workload may be a critical variable for training results In order to examine the physical and physiological dem and s of water polo , we assessed the profile of elite water polo players . Nineteen male professional water polo players ( age : 25.5±5.0 years , height : 184.5±4.3 cm body mass : 90.7±6.4 kg ) underwent body composition assessment by dual-energy X-ray absorptiometry .  We also evaluated peak oxygen consumption V̇O2peak , lactate threshold ( LT ) , energy cost of swimming ( Cs ) , anaerobic capacity and isokinetic shoulder strength . Body fat ( % ) was 16.8±4.4 , lean mass ( LM ) 75.1±4.9 kg and bone mineral density ( BMD ) 1.37±0.07 g·cm−2 . V̇O2peak was 57.9±7 ml·kg−1 · min−1 . LT was identified at 3.9±0.7 mmol·l−1 at a swimming velocity ( v ) of 1.33±0.05 m·s−1 with a heart rate of 154±7 bpm , corresponding to an intensity of 83±9 of V̇O2peak . The average Cs of swimming at the LT was 1.08±0.04 kJ·m−1 . Cs at LT was correlated to body mass index ( BMI ) ( r=0.22 , P=0.04 ) and to swimming performance at 400 m ( r=0.86 , P=0.01 ) and 4 × 50 m ( r=0.84 , P<0.01 ) . Internal rotator muscles were stronger compared to the external rotators by a 2:1 ratio . This study provides a quantitative representation of both physical and physiological dem and s of water polo and proposes a comprehensive battery of tests that can be used for assessing the status of a team Background Analysis of injury and illness prevalence in elite sport provides the basis for the development of prevention programmes . Objectives To analyse the frequency and characteristics of injuries and illnesses occurring during the 13th Federation Internationale de Natation ( FINA ) World Championships 2009 . Design Prospect i ve recording of newly incurred injuries and illnesses . Methods The 13th FINA World Championships hosted 2592 athletes from 172 countries in the disciplines of swimming , diving , synchronised swimming water polo and open water swimming . All team physicians or physiotherapists were asked to complete daily a st and ardised reporting form for all newly incurred injuries and illnesses for their teams . To cover teams without medical staff , the physicians of the Local Organizing Committee also su bmi tted daily report forms . Results 171 injuries were reported result ing in an incidence of 66.0 per 1000 registered athletes . The most affected body parts were the shoulder ( n=25 ; 14.6 % ) , and head ( n=21 ; 12.3 % ) . Half of the injuries occurred during training . The most common cause of injury was overuse ( n=61 ; 37.5 % ) . 184 illnesses were reported result ing in an incidence of 71.0 per 1000 registered athletes . The respiratory tract was most commonly affected ( n=91 ; 50.3 % ) and the most frequently classified cause was infection ( n=81 ; 49.2 % ) . The incidence of injuries and illnesses varied substantially among the five disciplines , with the highest incidence of injury in diving and the lowest in swimming . Conclusions As the risk of injury varied with the discipline , preventive measures should be discipline specific and focused on minimising the potential for overuse . As most of the illnesses were caused by infection of the respiratory and gastrointestinal tract , preventive interventions should focus on eliminating common modes of transmission CONTEXT Shoulder injuries are common in athletes involved in overhead sports , and scapular dyskinesis is believed to be one causative factor in these injuries . Many authors assert that abnormal scapular motion , so-called dyskinesis , is related to shoulder injury , but evidence from 3-dimensional measurement studies regarding this relationship is mixed . Reliable and valid clinical methods for detecting scapular dyskinesis are lacking . OBJECTIVE To determine the interrater reliability of a new test design ed to detect abnormal scapular motion . DESIGN Correlation design using ratings from multiple pairs of testers . SETTING University athletic training facilities . PATIENTS OR OTHER PARTICIPANTS A sample of 142 athletes ( from National Collegiate Athletic Association Divisions I and III ) participating in sports requiring intense overhead arm use . INTERVENTION(S ) Participants were videotaped from the posterior aspect while performing 5 repetitions of bilateral , weighted ( 1.4-kg [ 3-lb ] or 2.3-kg [ 5-lb ] ) shoulder flexion and frontal-plane abduction . Videotapes from r and omly chosen participants were subsequently viewed and independently rated for the presence of scapular dyskinesis by 6 raters ( 3 pairs ) , with each pair rating 30 different participants . Raters were trained to detect scapular dyskinesis using a self-instructional format with st and ardized operational definitions and videotaped examples of normal and abnormal motion . MAIN OUTCOME MEASURE(S ) Scapular dyskinesis was defined as the presence of either winging or dysrhythmia . Right and left sides were rated independently as normal , subtle , or obvious dyskines 
    Output:
    
Shoulder injuries were more likely to become chronic compared to all other reported injuries .
Injury data during the last three World Championships indicates an increasing rate of shoulder injuries-per-year with participation in aquatic sports .