Internal Rotation Shoulder Impingement

Medically reviewed by:

An OrthoNeuro Orthopedic Shoulder Surgeon

Shoulder joint pain can be very uncomfortable and can make the activities you love, including sports, very difficult. Thankfully, our board-certified specialists at OrthoNeuro can examine you and properly diagnose your pain.You may be feeling the effects of internal shoulder impingement. Schedule an appointment at one of the conveniently located offices throughout Greater Columbus today!

What Is Internal Shoulder Impingement?

Internal shoulder impingement is a condition in which there is repetitive contact between the posterior undersurface of the rotator cuff and the posterior-superior aspect of the glenoid.

Internal shoulder impingement is caused by repetitive impingement of your rotator cuff muscles. These muscles are located between your humeral head (the long bone of your arm) and the glenoid of the scapula. Your rotator cuff stabilizes your shoulder and centers your humeral head within your glenoid.

Over time, this repetitive impingement of the shoulder may result in the possible fraying (or partial tear) of your rotator cuff muscles. In addition to damaging your rotator cuff, your superior labrum can also be damaged, leading to superior labrum anterior to posterior (SLAP) lesions.

How Does Internal Shoulder Impingement Occur?

Internal shoulder impingement occurs when your shoulder is in maximum abduction and external rotation, which commonly occurs in overhead athletes during the late cocking and early acceleration phases of throwing. Athletes with repetitive overhead throwing motions (for example, baseball players) are particularly at risk.

Additionally, glenohumeral joint instability, restricted range of motion, and scapular dysfunction can also have an impact on internal impingement.

Symptoms of Internal Shoulder Impingement

If you are experiencing internal shoulder impingement, you may have the following symptoms:

Loss of strength in your rotator cuff
Diffuse pain that extends over the posterior aspect of your shoulder
Pain worsens when participating in sports or activities requiring throwing motions (especially during the late cocking phase) or other vigorous movement patterns

How Is Internal Shoulder Impingement Diagnosed?

Initially, your specialist will review your medical history and thoroughly evaluate your injury. Your physical examination may include:

Performing active and passive range of motion tests to determine whether there is excessive external rotation and a decreased internal rotation
Pain with palpation along your rotator cuff.

You will also be asked about any pain and additional symptoms you may be experiencing. An MRI may be used to assess any internal impingement complications and accurately diagnose internal impingement.

Treatment Options for Internal Impingement

Your specialist will first try to treat internal impingement by using conservative methods. These conservative methods include:

Rest and/or possible cessation of activities (particularly throwing)
Nonsteroidal anti-inflammatory medications
Ice
Physical therapy
Posterior capsule stretching
Corticosteroid injections

If there is little to no response to these conservative methods, your specialist may recommend surgical treatment. Surgical intervention may also be required if you have:

A partial tear in your rotator cuff
Shoulder dislocation
Bennett lesions
SLAP lesions

Surgical treatment is usually done arthroscopically, and there are a variety of procedures that your specialist can choose from to specifically reduce your shoulder pain. These shoulder arthroscopy procedures include:

Subacromial decompression
Debridement of the rotator cuff
Arthroscopic rotator cuff repair
Labral repair
Posterior capsular release

Once your specialist makes your diagnosis, and if it is determined that surgery will be required, they will discuss which procedure would be best for you.

Possible Complications That Can Be Associated With Surgery for Internal Impingement Shoulder

As is the case with all surgical procedures, complications may occur. Specifically, when it comes to surgery for internal impingement, these complications may include:

A delayed return to overhead activities if your healing is prolonged
Axillary nerve injury
The possible development of full-thickness rotator cuff tears if only debridement of a partial tear is performed

If you suspect that you are experiencing the effects of internal impingement, schedule an appointment at one of our OrthoNeuro locations throughout Columbus, OH today! Our specialists look forward to helping you relieve your pain.

Special thanks to Abigail Moffit, OMS II for writing the original piece entitled “The Posterior Shoulder Pain Of The Fastball: Internal Impingement Of The Shoulder.”