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World J Orthop. Dec 18, 2016; 7(12): 776-784
Published online Dec 18, 2016. doi: 10.5312/wjo.v7.i12.776
Evaluation and treatment of internal impingement of the shoulder in overhead athletes
Keith T Corpus, Christopher L Camp, David M Dines, David W Altchek, Joshua S Dines
Keith T Corpus, Christopher L Camp, David M Dines, David W Altchek, Joshua S Dines, Shoulder and Sports Medicine Service, Hospital for Special Surgery, New York, NY 10021, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Keith T Corpus, MD, Department of Academic Training, Shoulder and Sports Medicine Service, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, United States. corpuske@hss.edu
Telephone: +1-312-6187775
Received: April 28, 2016
Peer-review started: April 28, 2016
First decision: May 17, 2016
Revised: September 14, 2016
Accepted: October 5, 2016
Article in press: October 7, 2016
Published online: December 18, 2016
Abstract

One of the most common pathologic processes seen in overhead throwing athletes is posterior shoulder pain resulting from internal impingement. “Internal impingement” is a term used to describe a constellation of symptoms which result from the greater tuberosity of the humerus and the articular surface of the rotator cuff abutting the posterosuperior glenoid when the shoulder is in an abducted and externally rotated position. The pathophysiology in symptomatic internal impingement is multifactorial, involving physiologic shoulder remodeling, posterior capsular contracture, and scapular dyskinesis. Throwers with internal impingement may complain of shoulder stiffness or the need for a prolonged warm-up, decline in performance, or posterior shoulder pain. On physical examination, patients will demonstrate limited internal rotation and posterior shoulder pain with a posterior impingement test. Common imaging findings include the classic “Bennett lesion” on radiographs, as well as articular-sided partial rotator cuff tears and concomitant SLAP lesions. Mainstays of treatment include intense non-operative management focusing on rest and stretching protocols focusing on the posterior capsule. Operative management is variable depending on the exact pathology, but largely consists of rotator cuff debridement. Outcomes of operative treatment have been mixed, therefore intense non-operative treatment should remain the focus of treatment.

Keywords: Internal impingement, Overhead athlete, Partial rotator cuff tear, Scapular dyskinesis, Posterior capsular contracture, SLAP tear

Core tip: “Internal impingement” is a term used to describe a constellation of symptoms which result from the greater tuberosity of the humerus and the articular surface of the rotator cuff abutting the posterosuperior glenoid when the shoulder is in an abducted and externally rotated position. The pathophysiology in symptomatic internal impingement is multifactorial, involving physiologic shoulder remodeling, posterior capsular contracture, and scapular dyskinesis. Mainstays of treatment include intense non-operative management focusing on rest and stretching protocols focusing on the posterior capsule.