Search for


search for




 

Internal impingement of the shoulder in sports activity: common overuse injury
Arthrosc Orthop Sports Med 2023;10:55-66
Published online November 1, 2023;  https://doi.org/10.14517/aosm23014
© 2023 Korean Arthroscopy Society and Korean Orthopedic Society for Sports Medicine.

Jaeheon Lee, Hwa Pyung Kim, Min Soo Shon

Department of Orthopedic Surgery, National Medical Center, Seoul, Korea
Correspondence to: Min Soo Shon, https://orcid.org/0000-0002-0012-595X
Department of Orthopedic Surgery, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul 04564, Korea. Tel: +82-2-2260-7198, Fax: +82- 2-2278-9570, E-mail: minsoo.shon@nmc.or.kr
Received September 6, 2023; Revised October 7, 2023; Accepted October 7, 2023.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Sports-related shoulder injuries are a common condition and are particularly prevalent as an overuse injury caused by repeated microtrauma. This study aimed to provide updated information on pathophysiology, clinical diagnosis, effective treatment, and the importance of preventing internal impingement of the shoulder as a common overuse shoulder injury. Current literature indicates multiple factors that can contribute to developing internal impingement, including anatomical, biomechanical, and other pathologic lesion-associated factors. Internal impingement is diagnosed based on a thorough patient history and physical examination. Magnetic resonance imaging is a gold standard imaging to confirm the diagnosis and rule out other causes of shoulder pain. Treatment, and especially, shoulder internal impingement rehabilitation in athletes should be comprehensive, integrative, and systematic. The best way to prevent internal impingement is to strengthen and stretch the rotator cuff muscles and avoid overhead activities that cause pain. The first-line treatment option is nonsurgical treatment, while patients with more severe symptoms may require surgical treatment.
Keywords : Shoulder; Rotator cuff; Posterior labrum; Internal impingement; Sports
References
  1. Bahr R. No injuries, but plenty of pain? On the methodology for recording overuse symptoms in sports. Br J Sports Med 2009; 43:966-72.
    Pubmed CrossRef
  2. American Academy of Orthopaedic Surgeons (AAOS). The One-SportTM injury [Internet]. Rosemont (IL): AAOS; [cited 2022 Dec 11].
    Available from: https://orthoinfo.org/onesportinjury
  3. Padaki AS, Ahmad CS, Hodgins JL, Kovacevic D, Lynch TS, Popkin CA. Quantifying parental influence on youth athlete specialization: a survey of athletes’ parents. Orthop J Sports Med 2017;5:2325967117729147.
    Pubmed KoreaMed CrossRef
  4. Zaremski JL, Zeppieri G Jr, Tripp BL. Sport specialization and overuse injuries in adolescent throwing athletes: a narrative review. J Athl Train 2019;54:1030-9.
    Pubmed KoreaMed CrossRef
  5. Chéron C, Le Scanff C, Leboeuf-Yde C. Association between sports type and overuse injuries of extremities in adults: a systematic review. Chiropr Man Therap 2017;25:4.
    Pubmed KoreaMed CrossRef
  6. Fuller CW, Ekstrand J, Junge A, et al. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Br J Sports Med 2006;40:193-201.
    Pubmed KoreaMed CrossRef
  7. Franco MF, Madaleno FO, de Paula TMN, Ferreira TV, Pinto RZ, Resende RA. Prevalence of overuse injuries in athletes from individual and team sports: a systematic review with meta-analysis and GRADE recommendations. Braz J Phys Ther 2021;25:500-13.
    Pubmed KoreaMed CrossRef
  8. Aasheim C, Stavenes H, Andersson SH, Engbretsen L, Clarsen B. Prevalence and burden of overuse injuries in elite junior handball. BMJ Open Sport Exerc Med 2018;4:e000391.
    Pubmed KoreaMed CrossRef
  9. Ben Kibler W, Sciascia A, Tokish JT, et al. Disabled throwing shoulder 2021 update: part 1-anatomy and mechanics. Arthroscopy 2022;38:1714-26.
    Pubmed CrossRef
  10. Medina G, Bartolozzi AR 3rd, Spencer JA, Morgan C. The thrower’s shoulder. JBJS Rev 2022;10:e21.00194.
    Pubmed CrossRef
  11. Drakos MC, Rudzki JR, Allen AA, Potter HG, Altchek DW. Internal impingement of the shoulder in the overhead athlete. J Bone Joint Surg Am 2009;91:2719-28.
    Pubmed CrossRef
  12. Perry J. Anatomy and biomechanics of the shoulder in throwing, swimming, gymnastics, and tennis. Clin Sports Med 1983;2:247-70.
    Pubmed CrossRef
  13. Walch G, Boileau P, Noel E, Donell ST. Impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim: an arthroscopic study. J Shoulder Elbow Surg 1992;1:238-45.
    Pubmed CrossRef
  14. Andersson SH, Bahr R, Clarsen B, Myklebust G. Preventing overuse shoulder injuries among throwing athletes: a cluster-randomised controlled trial in 660 elite handball players. Br J Sports Med 2017;51:1073-80.
    Pubmed CrossRef
  15. Clarsen B, Myklebust G, Bahr R. Development and validation of a new method for the registration of overuse injuries in sports injury epidemiology: the Oslo Sports Trauma Research Centre (OSTRC) overuse injury questionnaire. Br J Sports Med 2013;47:495-502.
    Pubmed CrossRef
  16. Tooth C, Gofflot A, Schwartz C, et al. Risk factors of overuse shoulder injuries in overhead athletes: a systematic review. Sports Health 2020;12:478-87.
    Pubmed KoreaMed CrossRef
  17. Kibler WB, Sciascia A, Tokish JT, et al. Disabled throwing shoulder: 2021 update: part 2-pathomechanics and treatment. Arthroscopy 2022;38:1727-48.
    Pubmed CrossRef
  18. Fessa CK, Peduto A, Linklater J, Tirman P. Posterosuperior glenoid internal impingement of the shoulder in the overhead athlete: pathogenesis, clinical features and MR imaging findings. J Med Imaging Radiat Oncol 2015;59:182-7.
    Pubmed CrossRef
  19. Crockett HC, Gross LB, Wilk KE, et al. Osseous adaptation and range of motion at the glenohumeral joint in professional baseball pitchers. Am J Sports Med 2002;30:20-6.
    Pubmed CrossRef
  20. Sweitzer BA, Thigpen CA, Shanley E, et al. A comparison of glenoid morphology and glenohumeral range of motion between professional baseball pitchers with and without a history of SLAP repair. Arthroscopy 2012;28:1206-13.
    Pubmed CrossRef
  21. McFarland EG, Hsu CY, Neira C, O’Neil O. Internal impingement of the shoulder: a clinical and arthroscopic analysis. J Shoulder Elbow Surg 1999;8:458-60.
    Pubmed CrossRef
  22. Kaplan LD, McMahon PJ, Towers J, Irrgang JJ, Rodosky MW. Internal impingement: findings on magnetic resonance imaging and arthroscopic evaluation. Arthroscopy 2004;20:701-4.
    Pubmed CrossRef
  23. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part I: pathoanatomy and biomechanics. Arthroscopy 2003;19:404-20.
    Pubmed CrossRef
  24. Jobe CM. Evidence far superior glenoid impingement on the rotator cuff. Paper presented at: Personal communication at the 4th Congress of the European Society of the Shoulder and Elbow Surgery; 1990 Oct; Milan.
  25. Saini G, Lawrence RL, Staker JL, Braman JP, Ludewig PM. Supraspinatus-to-glenoid contact occurs during standardized overhead reaching motion. Orthop J Sports Med 2021;9:23259671211036908.
    Pubmed KoreaMed CrossRef
  26. Spiegl UJ, Warth RJ, Millett PJ. Symptomatic internal impingement of the shoulder in overhead athletes. Sports Med Arthrosc Rev 2014;22:120-9.
    Pubmed CrossRef
  27. Murray PJ, Shaffer BS. Clinical update: MR imaging of the shoulder. Sports Med Arthrosc Rev 2009;17:40-8.
    Pubmed CrossRef
  28. Tirman PF, Bost FW, Garvin GJ, et al. Posterosuperior glenoid impingement of the shoulder: findings at MR imaging and MR arthrography with arthroscopic correlation. Radiology 1994;193:431-6.
    Pubmed CrossRef
  29. Lawrence RL, Soliman SB, Roseni K, Zauel R, Bey MJ. In vivo evaluation of rotator cuff internal impingement during scapular plane abduction in asymptomatic individuals. J Orthop Res 2023;41:718-26.
    Pubmed CrossRef
  30. Lawrence RL, Saini G, Staker JL, Ludewig PM. Comparison of rotator cuff to glenoid proximity based on scapulothoracic upward rotation classification. Braz J Phys Ther 2023;27:100505.
    Pubmed KoreaMed CrossRef
  31. Keller RA, De Giacomo AF, Neumann JA, Limpisvasti O, Tibone JE. Glenohumeral internal rotation deficit and risk of upper extremity injury in overhead athletes: a meta-analysis and systematic review. Sports Health 2018;10:125-32.
    Pubmed KoreaMed CrossRef
  32. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part III: the SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy 2003;19:641-61.
    Pubmed CrossRef
  33. Weng YH, Huang TS, Huang CY, Chen HY, Tsai YS, Lin JJ. Glenohumeral internal rotation deficit on pitching biomechanics and muscle activity. Int J Sports Med 2022;43:538-44.
    Pubmed CrossRef
  34. Paul RW, Sheridan S, Reuther KE, Kelly JD 4th, Thomas SJ. The contribution of posterior capsule hypertrophy to soft tissue glenohumeral internal rotation deficit in healthy pitchers. Am J Sports Med 2022;50:341-6.
    Pubmed CrossRef
  35. Harryman DT 2nd, Sidles JA, Clark JM, McQuade KJ, Gibb TD, Matsen FA 3rd. Translation of the humeral head on the glenoid with passive glenohumeral motion. J Bone Joint Surg Am 1990;72:1334-43.
    CrossRef
  36. Calcei JG, Boddapati V, Altchek DW, Camp CL, Dines JS. Diagnosis and treatment of injuries to the biceps and superior labral complex in overhead athletes. Curr Rev Musculoskelet Med 2018;11:63-71.
    Pubmed KoreaMed CrossRef
  37. Liu SH, Boynton E. Posterior superior impingement of the rotator cuff on the glenoid rim as a cause of shoulder pain in the overhead athlete. Arthroscopy 1993;9:697-9.
    Pubmed CrossRef
  38. Ludewig PM, Cook TM. Translations of the humerus in persons with shoulder impingement symptoms. J Orthop Sports Phys Ther 2002;32:248-59.
    Pubmed CrossRef
  39. Mihata T, McGarry MH, Tibone JE, Fitzpatrick MJ, Kinoshita M, Lee TQ. Biomechanical assessment of Type II superior labral anterior-posterior (SLAP) lesions associated with anterior shoulder capsular laxity as seen in throwers: a cadaveric study. Am J Sports Med 2008;36:1604-10.
    Pubmed CrossRef
  40. Andrews JR, Broussard TS, Carson WG. Arthroscopy of the shoulder in the management of partial tears of the rotator cuff: a preliminary report. Arthroscopy 1985;1:117-22.
    Pubmed CrossRef
  41. Walch G, Liotard JP, Boileau P, Noël E. [Postero-superior glenoid impingement. Another impingement of the shoulder]. J Radiol 1993;74:47-50. French.
  42. Kibler WB, Kuhn JE, Wilk K, et al. The disabled throwing shoulder: spectrum of pathology-10-year update. Arthroscopy 2013; 29:141-61.e26.
    Pubmed CrossRef
  43. Kirchhoff C, Imhoff AB. Posterosuperior and anterosuperior impingement of the shoulder in overhead athletes-evolving concepts. Int Orthop 2010;34:1049-58.
    Pubmed KoreaMed CrossRef
  44. Burkhart SS, Morgan CD, Kibler WB. Shoulder injuries in overhead athletes. The “dead arm” revisited. Clin Sports Med 2000; 19:125-58.
    Pubmed CrossRef
  45. Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med 1998;26:325-37.
    Pubmed CrossRef
  46. Braun S, Kokmeyer D, Millett PJ. Shoulder injuries in the throwing athlete. J Bone Joint Surg Am 2009;91:966-78.
    Pubmed CrossRef
  47. Itami Y, Mihata T, McGarry MH, et al. Effect of increased scapular internal rotation on glenohumeral external rotation and elbow valgus load in the late cocking phase of throwing motion. Am J Sports Med 2018;46:3182-8.
    Pubmed CrossRef
  48. Mihata T, Jun BJ, Bui CN, et al. Effect of scapular orientation on shoulder internal impingement in a cadaveric model of the cocking phase of throwing. J Bone Joint Surg Am 2012;94:1576-83.
    Pubmed CrossRef
  49. Kibler WB, Sciascia AD, Grantham WJ. The shoulder joint complex in the throwing motion. J Shoulder Elbow Surg 2023 Jul 26 [Epub]. https://doi.org/10.1016/j.jse.2023.06.031
    CrossRef
  50. Kibler WB. Scapular involvement in impingement: signs and symptoms. Instr Course Lect 2006;55:35-43.
  51. Sheean AJ, Kibler WB, Conway J, Bradley JP. Posterior labral injury and glenohumeral instability in overhead athletes: current concepts for diagnosis and management. J Am Acad Orthop Surg 2020;28:628-37.
    Pubmed CrossRef
  52. Jobe FW, Pink MM. Operative techniques in upper extremity sports injuries. St. Louis, MO: Mosby; 1996.
  53. Paley KJ, Jobe FW, Pink MM, Kvitne RS, ElAttrache NS. Arthroscopic findings in the overhand throwing athlete: evidence for posterior internal impingement of the rotator cuff. Arthroscopy 2000;16:35-40.
    Pubmed CrossRef
  54. Tirman PF, Smith ED, Stoller DW, Fritz RC. Shoulder imaging in athletes. Semin Musculoskelet Radiol 2004;8:29-40.
    Pubmed CrossRef
  55. Sonnery-Cottet B, Edwards TB, Noel E, Walch G. Results of arthroscopic treatment of posterosuperior glenoid impingement in tennis players. Am J Sports Med 2002;30:227-32.
    Pubmed CrossRef
  56. Cools AM, Cambier D, Witvrouw EE. Screening the athlete’s shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology. Br J Sports Med 2008;42:628-35.
    Pubmed CrossRef
  57. Heyworth BE, Williams RJ 3rd. Internal impingement of the shoulder. Am J Sports Med 2009;37:1024-37.
    Pubmed CrossRef
  58. Cools AM, Declercq G, Cagnie B, Cambier D, Witvrouw E. Internal impingement in the tennis player: rehabilitation guidelines. Br J Sports Med 2008;42:165-71.
    Pubmed CrossRef
  59. Curtis AS, Deshmukh R. Throwing injuries: diagnosis and treatment. Arthroscopy 2003;19 Suppl 1:80-5.
    Pubmed CrossRef
  60. Budoff JE, Nirschl RP, Ilahi OA, Rodin DM. Internal impingement in the etiology of rotator cuff tendinosis revisited. Arthroscopy 2003;19:810-4.
    Pubmed CrossRef
  61. Corpus KT, Camp CL, Dines DM, Altchek DW, Dines JS. Evaluation and treatment of internal impingement of the shoulder in overhead athletes. World J Orthop 2016;7:776-84.
    Pubmed KoreaMed CrossRef
  62. Jobe CM. Superior glenoid impingement. Orthop Clin North Am 1997;28:137-43.
    Pubmed CrossRef
  63. Johnson JE, Fullmer JA, Nielsen CM, Johnson JK, Moorman CT 3rd. Glenohumeral internal rotation deficit and injuries: a systematic review and meta-analysis. Orthop J Sports Med 2018;6:2325967118773322.
    Pubmed KoreaMed CrossRef
  64. Kibler WB, Grantham WJ, Pike JSM, Sciascia AD. Glenoid labral injuries are more common posteriorly than superiorly and are combined across multiple areas of the glenoid. Arthrosc Sports Med Rehabil 2021;4:e535-44.
    Pubmed KoreaMed CrossRef
  65. Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart SM. Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med 2006;34:385-91.
    Pubmed CrossRef
  66. Meister K, Buckley B, Batts J. The posterior impingement sign: diagnosis of rotator cuff and posterior labral tears secondary to internal impingement in overhand athletes. Am J Orthop (Belle Mead NJ) 2004;33:412-5.
  67. Bennett GE. Shoulder and elbow lesions distinctive of baseball players. Ann Surg 1947;126:107-10.
    Pubmed KoreaMed CrossRef
  68. Ferrari JD, Ferrari DA, Coumas J, Pappas AM. Posterior ossification of the shoulder: the Bennett lesion. Etiology, diagnosis, and treatment. Am J Sports Med 1994;22:171-5; discussion 175-6.
    Pubmed CrossRef
  69. Mithöfer K, Fealy S, Altchek DW. Arthroscopic treatment of internal impingement of the shoulder. Tech Shoulder Elb Surg 2004;5:66-75.
    CrossRef
  70. Wright RW, Steger-May K, Klein SE. Radiographic findings in the shoulder and elbow of Major League Baseball pitchers. Am J Sports Med 2007;35:1839-43.
    Pubmed CrossRef
  71. Wörtler K. [Shoulder injuries in overhead sports]. Radiologe 2010;50:453-9. German.
    Pubmed CrossRef
  72. Thomas SJ, Swanik CB, Higginson JS, et al. A bilateral comparison of posterior capsule thickness and its correlation with glenohumeral range of motion and scapular upward rotation in collegiate baseball players. J Shoulder Elbow Surg 2011;20:708-16.
    Pubmed CrossRef
  73. Burkhart SS. Internal impingement of the shoulder. Instr Course Lect 2006;55:29-34.
  74. Meister K. Internal impingement in the shoulder of the overhand athlete: pathophysiology, diagnosis, and treatment. Am J Orthop (Belle Mead NJ) 2000;29:433-8.
  75. Kibler WB, Stone AV, Zacharias A, Grantham WJ, Sciascia AD. Management of scapular dyskinesis in overhead athletes. Oper Tech Sports Med 2021;29:150797.
    CrossRef
  76. Reinold MM, Gill TJ, Wilk KE, Andrews JR. Current concepts in the evaluation and treatment of the shoulder in overhead throwing athletes, part 2: injury prevention and treatment. Sports Health 2010;2:101-15.
    Pubmed KoreaMed CrossRef

November 2023, 10 (2)
Full Text(PDF) Free

Social Network Service
Services