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Internal Impingement, Shoulder
Michael J. Tuite, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Pathologic internal impingement, posterosuperior glenoid impingement, posterior glenoid impingement
            • Definitions

              • Pain with abduction and external rotation, decreased throwing velocity
                • Clinical diagnosis
                • Typically in overhead throwing athletes, e.g., professional baseball pitchers
                • Common features
                  • Posterosuperior labral fraying/tear
                    • Severe cases: Posterior superior labrum anterior-posterior (SLAP) tear
                  • Articular surface partial-thickness fraying/tear of posterior rotator cuff
                  • Thick posterior capsule and posterior band of inferior glenohumeral ligament (PBIGL)
                  • Lax, stretched anterior capsule

            IMAGING

            • General Features

              • Radiographic Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          • Gross Pathologic & Surgical Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Fessa CK et al: Posterosuperior glenoid internal impingement of the shoulder in the overhead athlete: pathogenesis, clinical features and MR imaging findings. J Med Imaging Radiat Oncol. 59(2):182-7, 2015
                                        2. Mistry A et al: Microinstability and internal impingement of the shoulder. Semin Musculoskelet Radiol. 19(3):277-83, 2015
                                        3. Spiegl UJ et al: Symptomatic internal impingement of the shoulder in overhead athletes. Sports Med Arthrosc. 22(2):120-9, 2014
                                        4. Chambers L et al: Microinstability and internal impingement in overhead athletes. Clin Sports Med. 32(4):697-707, 2013
                                        5. Manske RC et al: Shoulder posterior internal impingement in the overhead athlete. Int J Sports Phys Ther. 8(2):194-204, 2013
                                        6. Reinold MM et al: Microinstability of the shoulder in the overhead athlete. Int J Sports Phys Ther. 8(5):601-16, 2013
                                        7. Chang EY et al: Superior labrum anterior and posterior lesions and microinstability. Magn Reson Imaging Clin N Am. 20(2):277-94, x-xi, 2012
                                        8. Mihata T et al: Excessive glenohumeral horizontal abduction as occurs during the late cocking phase of the throwing motion can be critical for internal impingement. Am J Sports Med. 38(2):369-74, 2010
                                        9. Muraki T et al: Effect of posteroinferior capsule tightness on contact pressure and area beneath the coracoacromial arch during pitching motion. Am J Sports Med. 38(3):600-7, 2010
                                        10. Tyler TF et al: Correction of posterior shoulder tightness is associated with symptom resolution in patients with internal impingement. Am J Sports Med. 38(1):114-9, 2010
                                        11. Drakos MC et al: Internal impingement of the shoulder in the overhead athlete. J Bone Joint Surg Am. 91(11):2719-28, 2009
                                        12. Heyworth BE et al: Internal impingement of the shoulder. Am J Sports Med. 37(5):1024-37, 2009
                                        13. Grainger AJ: Internal impingement syndromes of the shoulder. Semin Musculoskelet Radiol. 12(2):127-35, 2008
                                        14. Ouellette H et al: Spectrum of shoulder injuries in the baseball pitcher. Skeletal Radiol. 37(6):491-8, 2008
                                        15. Ouellette H et al: Imaging of the overhead throwing athlete. Semin Musculoskelet Radiol. 2005 Dec;9(4):316-33. Review. Erratum in: Semin Musculoskelet Radiol. 11(1):91, 2007
                                        16. Tuite MJ et al: Shoulder MR arthrography of the posterior labrocapsular complex in overhead throwers with pathologic internal impingement and internal rotation deficit. Skeletal Radiol. 36(6):495-502, 2007
                                        17. Burkhart SS: Internal impingement of the shoulder. Instr Course Lect. 55:29-34, 2006
                                        18. Laudner KG et al: Scapular dysfunction in throwers with pathologic internal impingement. J Orthop Sports Phys Ther. 36(7):485-94, 2006
                                        19. Myers JB et al: Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med. 34(3):385-91, 2006
                                        20. Giaroli EL et al: MRI of internal impingement of the shoulder. AJR Am J Roentgenol. 185(4):925-9, 2005
                                        21. Kaplan LD et al: Internal impingement: findings on magnetic resonance imaging and arthroscopic evaluation. Arthroscopy. 20(7):701-4, 2004
                                        22. Meister K et al: 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). 33(8):412-5, 2004
                                        23. Tirman PF et al: Shoulder imaging in athletes. Semin Musculoskelet Radiol. 8(1):29-40, 2004
                                        24. Jazrawi LM et al: Superior labral anterior and posterior lesions and internal impingement in the overhead athlete. Instr Course Lect. 52:43-63, 2003
                                        25. Edelson G et al: Internal impingement in the shoulder. J Shoulder Elbow Surg. 9(4):308-15, 2000
                                        26. Jobe CM et al: Evaluation of Impingement Syndromes in the Overhead-Throwing Athlete. J Athl Train. 35(3):293-299, 2000
                                        27. Paley KJ et al: Arthroscopic findings in the overhand throwing athlete: evidence for posterior internal impingement of the rotator cuff. Arthroscopy. 16(1):35-40, 2000
                                        28. Halbrecht JL et al: Internal impingement of the shoulder: comparison of findings between the throwing and nonthrowing shoulders of college baseball players. Arthroscopy. 15(3):253-8, 1999
                                        29. Schickendantz MS et al: MR imaging of the thrower's shoulder. Internal impingement, latissimus dorsi/subscapularis strains, and related injuries. Magn Reson Imaging Clin N Am. 7(1):39-49, 1999
                                        30. Giombini A et al: Posterosuperior glenoid rim impingement as a cause of shoulder pain in top level waterpolo players. J Sports Med Phys Fitness. 37(4):273-8, 1997
                                        31. Tirman PF et al: Posterosuperior glenoid impingement of the shoulder: findings at MR imaging and MR arthrography with arthroscopic correlation. Radiology. 193(2):431-6, 1994
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Pathologic internal impingement, posterosuperior glenoid impingement, posterior glenoid impingement
                                                  • Definitions

                                                    • Pain with abduction and external rotation, decreased throwing velocity
                                                      • Clinical diagnosis
                                                      • Typically in overhead throwing athletes, e.g., professional baseball pitchers
                                                      • Common features
                                                        • Posterosuperior labral fraying/tear
                                                          • Severe cases: Posterior superior labrum anterior-posterior (SLAP) tear
                                                        • Articular surface partial-thickness fraying/tear of posterior rotator cuff
                                                        • Thick posterior capsule and posterior band of inferior glenohumeral ligament (PBIGL)
                                                        • Lax, stretched anterior capsule

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • MR Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Staging, Grading, & Classification

                                                                • Gross Pathologic & Surgical Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Fessa CK et al: Posterosuperior glenoid internal impingement of the shoulder in the overhead athlete: pathogenesis, clinical features and MR imaging findings. J Med Imaging Radiat Oncol. 59(2):182-7, 2015
                                                                              2. Mistry A et al: Microinstability and internal impingement of the shoulder. Semin Musculoskelet Radiol. 19(3):277-83, 2015
                                                                              3. Spiegl UJ et al: Symptomatic internal impingement of the shoulder in overhead athletes. Sports Med Arthrosc. 22(2):120-9, 2014
                                                                              4. Chambers L et al: Microinstability and internal impingement in overhead athletes. Clin Sports Med. 32(4):697-707, 2013
                                                                              5. Manske RC et al: Shoulder posterior internal impingement in the overhead athlete. Int J Sports Phys Ther. 8(2):194-204, 2013
                                                                              6. Reinold MM et al: Microinstability of the shoulder in the overhead athlete. Int J Sports Phys Ther. 8(5):601-16, 2013
                                                                              7. Chang EY et al: Superior labrum anterior and posterior lesions and microinstability. Magn Reson Imaging Clin N Am. 20(2):277-94, x-xi, 2012
                                                                              8. Mihata T et al: Excessive glenohumeral horizontal abduction as occurs during the late cocking phase of the throwing motion can be critical for internal impingement. Am J Sports Med. 38(2):369-74, 2010
                                                                              9. Muraki T et al: Effect of posteroinferior capsule tightness on contact pressure and area beneath the coracoacromial arch during pitching motion. Am J Sports Med. 38(3):600-7, 2010
                                                                              10. Tyler TF et al: Correction of posterior shoulder tightness is associated with symptom resolution in patients with internal impingement. Am J Sports Med. 38(1):114-9, 2010
                                                                              11. Drakos MC et al: Internal impingement of the shoulder in the overhead athlete. J Bone Joint Surg Am. 91(11):2719-28, 2009
                                                                              12. Heyworth BE et al: Internal impingement of the shoulder. Am J Sports Med. 37(5):1024-37, 2009
                                                                              13. Grainger AJ: Internal impingement syndromes of the shoulder. Semin Musculoskelet Radiol. 12(2):127-35, 2008
                                                                              14. Ouellette H et al: Spectrum of shoulder injuries in the baseball pitcher. Skeletal Radiol. 37(6):491-8, 2008
                                                                              15. Ouellette H et al: Imaging of the overhead throwing athlete. Semin Musculoskelet Radiol. 2005 Dec;9(4):316-33. Review. Erratum in: Semin Musculoskelet Radiol. 11(1):91, 2007
                                                                              16. Tuite MJ et al: Shoulder MR arthrography of the posterior labrocapsular complex in overhead throwers with pathologic internal impingement and internal rotation deficit. Skeletal Radiol. 36(6):495-502, 2007
                                                                              17. Burkhart SS: Internal impingement of the shoulder. Instr Course Lect. 55:29-34, 2006
                                                                              18. Laudner KG et al: Scapular dysfunction in throwers with pathologic internal impingement. J Orthop Sports Phys Ther. 36(7):485-94, 2006
                                                                              19. Myers JB et al: Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med. 34(3):385-91, 2006
                                                                              20. Giaroli EL et al: MRI of internal impingement of the shoulder. AJR Am J Roentgenol. 185(4):925-9, 2005
                                                                              21. Kaplan LD et al: Internal impingement: findings on magnetic resonance imaging and arthroscopic evaluation. Arthroscopy. 20(7):701-4, 2004
                                                                              22. Meister K et al: 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). 33(8):412-5, 2004
                                                                              23. Tirman PF et al: Shoulder imaging in athletes. Semin Musculoskelet Radiol. 8(1):29-40, 2004
                                                                              24. Jazrawi LM et al: Superior labral anterior and posterior lesions and internal impingement in the overhead athlete. Instr Course Lect. 52:43-63, 2003
                                                                              25. Edelson G et al: Internal impingement in the shoulder. J Shoulder Elbow Surg. 9(4):308-15, 2000
                                                                              26. Jobe CM et al: Evaluation of Impingement Syndromes in the Overhead-Throwing Athlete. J Athl Train. 35(3):293-299, 2000
                                                                              27. Paley KJ et al: Arthroscopic findings in the overhand throwing athlete: evidence for posterior internal impingement of the rotator cuff. Arthroscopy. 16(1):35-40, 2000
                                                                              28. Halbrecht JL et al: Internal impingement of the shoulder: comparison of findings between the throwing and nonthrowing shoulders of college baseball players. Arthroscopy. 15(3):253-8, 1999
                                                                              29. Schickendantz MS et al: MR imaging of the thrower's shoulder. Internal impingement, latissimus dorsi/subscapularis strains, and related injuries. Magn Reson Imaging Clin N Am. 7(1):39-49, 1999
                                                                              30. Giombini A et al: Posterosuperior glenoid rim impingement as a cause of shoulder pain in top level waterpolo players. J Sports Med Phys Fitness. 37(4):273-8, 1997
                                                                              31. Tirman PF et al: Posterosuperior glenoid impingement of the shoulder: findings at MR imaging and MR arthrography with arthroscopic correlation. Radiology. 193(2):431-6, 1994