Diagnosis and Management of Internal Shoulder Impingement


Internal impingement of the shoulder refers to mechanical abutment of the supraspinatus and infraspinatus muscles against the posterosuperior glenoid rim when the arm is abducted and externally rotated. A variety of pathologic findings associated with internal shoulder impingement make diagnosis challenging. These include tears of the posterosuperior labrum and articular side of the rotator cuff, osteochondral damage of the humeral head and glenoid, cyst formation within the greater tuberosity, and stretching of the anteroinferior capsulolabral complex. More recently glenohumeral internal rotation deficit (GIRD) has been described as the essential condition leading to increased external rotation and resultant internal impingement of the shoulder. The mainstay of treatment is a focused, comprehensive rehabilitation program; surgery is occasionally indicated.

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