Matthew J. Siskosky and Neal S. ElAttrache
Internal impingement is a condition that can cause significant disability to the elite throwing athlete. Unlike classical impingement, internal impingement is thought to occur when the undersurface of the rotator cuff and greater tuberosity come in contact with the posterosuperior glenoid and labrum during the late cocking and early acceleration phase of throwing, when the arm is in the abducted and maximally externally rotated position. Although several theories have been proposed as to the exact mechanism of this condition, all theories lead to similar pathology. This includes rotator cuff pathology, typically partial undersuface tears, and posterosuperior labral pathology. Ultimately, the throwerâ€™s mechanics and core body fitness are of utmost importance. Treatment of internal impingement is initially nonoperative, with special emphasis on core strength, stability, and flexibility, in addition to optimization of throwing mechanics. If surgical intervention is indicated, we prefer to eliminate pain generators within the shoulder, repair structural damage if necessary, and minimize the potential for postoperative motion loss. Techniques for superior labral repair, intratendinous rotator cuff repair, and partial articular-sided rotator cuff repair are reviewed.
Operative Techniques in Sports Medicine, 2007, 15 (3),