Evaluation and treatment of internal impingement of the shoulder in overhead athletes

Table 1 Keys to diagnosing internal impingement

History	Shoulder stiffness
	Need for prolonged warm-up
	Decline in performance (loss of velocity of control)
	Posterior shoulder pain in late cocking phase
Physical exam	Posterior glenohumeral joint line tenderness
	Increased external rotation, decreased internal rotation
	Scapular dyskinesis
	Positive anterior relocation test
	Positive posterior impingement sign
Imaging	Bennett lesion (exostosis of posteroinferior glenoid rim)
	Sclerosis of greater tuberosity, posterior humeral head cysts, rounding of posterior glenoid rim
	Posterosuperior labral tears
	Partial-thickness articular-sided rotator cuff tears (supraspinatus, infraspinatus)

Table 2 Jobe’s clinical classification of internal impingement[35]

Stage	Presentation/symptoms
I: Early	Shoulder stiffness and need for prolonged warm–up, no pain with ADLs
II: Intermediate	Pain localized to the posterior shoulder in the late cocking phase, no pain with ADLs
III: Advanced	Similar symptoms to Stage II, but refractory to a period of adequate rest and rehabilitation

ADL: Activities of daily living.