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Internal Impingement (Throwers Shoulder)


The Injury
Throwing athletes, tennis players, volleyball players and other over shoulder athletes often suffer from shoulder pain. New studies suggest that a common cause of this pain may be due to a newly described entity called internal impingement. Dr. Halbrecht published a study on baseball players in 1999 which further confirms this concept. (View Study PDF 1,626KB)

Internal Impingement is the internal pinching of the underside of the rotator cuff tendon against the glenoid or socket joint of the shoulder. This pinching occurs when the arm is placed all the way back into the throwing position. Over time, this pinching can lead to tearing of the tendon and shoulder pain.

Symptoms & Diagnosis
The diagnosis is often difficult to make, and usually requires evaluation by a shoulder expert. The patient usually complains of posterior pain (back side of the shoulder), which is aggravated when the arm is placed into the throwing position. There is usually no associated instability or significant weakness. Examination by a physician will reveal a positive relocation test. MRI (Magnetic Resonance Imaging) can be useful if performed with dye enhancement with the arm in the throwing position. Final confirmation of the diagnosis is often made only at the time of surgery.

Treatment Options
Most athletes will respond to rehabilitation exercises to strengthen the rotator cuff and the scapula. In persistent cases, arthroscopic surgery can be very helpful in confirming the diagnosis and debriding away the torn portion of the rotator cuff tendon. Recovery is usually remarkably quick following this particular surgery, with return to throwing sports in several weeks.

Surgery is performed as an outpatient. All dressings and the sling are removed after one day, and physical therapy is begun immediately.

Excellent results can be achieved with arthroscopic management, with the great majority of athletes returning to their pre-injury level of sports participation.


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