Internal Impingement AKA Posterior Internal Impingement (PII)

Описание: Dr Ozello's Sports Medicine Report: Internal Impingement AKA Posterior Internal Impingement (PII)



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Internal Impingement (AKA Posterior Internal Impingement) (PII)
Occurs at the posterior/lateral articular side of the cuff as it abuts the posterior/superior glenoid rim & labrum when the shoulder is in maximum abduction & external rotation.

One of the most common pathologic processes seen in overhead throwing athletes is posterior shoulder pain resulting from internal impingement.
“Internal impingement” is a term used to describe a constellation of symptoms which result from the greater tuberosity of the humerus & the articular surface of the rotator cuff abutting the posterosuperior glenoid when the shoulder is in an abducted & externally rotated position. (ABER position).

Internal impingement: Pain occurs due to compression of the supraspinatus & infraspinatus tendons by the posteriorly rotated greater tuberosity of the humeral head against the posterior/superior portions of the glenoid.
This occurs when the humeral shaft moves posteriorly beyond the plane of the body of the scapula during the cocking position of throwing.
The movement of the humerus posterior to the plane of the body is commonly called hyperangulation.



Pathophysiology is multifactorial, involving physiologic shoulder remodeling, posterior capsular contracture & scapular dyskinesis.
Patient most likely to present with Internal Impingement is a young, active, overhead athlete.
Common in overhead-throwing athletes such as baseball pitchers & javelin throwers.

Clinical classification of internal impingement
1) Early: Shoulder stiffness & need for prolonged warm–up, no pain with ADLs.
2) Intermediate: Pain localized to the posterior shoulder in the late cocking phase, no pain with ADLs.
3) Advanced: Similar symptoms to Stage II, but refractory to a period of adequate rest & rehabilitation.
Decline in performance in all stages.

Overhead throwing athletes with internal impingement frequently have weakness of scapular retractors as compared to scapular protractors, this predisposes them to internal impingement pathology.
Scapular dyskinesis has been reported in up to 100% of patients with internal impingement.

Classic Exam Finding
Increased external rotation
Decreased internal rotation
Scapular dyskinesis.
Scapula may have a prominent inferior medial border.
Throwing shoulder may be inferior compared to non-throwing shoulder.
Upper cross syndrome.

Therapy for internal impingement is focused on correction of aberrant shoulder range of motion & scapular dyskinesis.
Special attention should be paid to correction through “sleeper stretch” which allows posterior capsular stretching.
Scapular stabilization exercises should be recommended. As the throwing motion involves the entire body through the kinetic chain, core strengthening & lower body strengthening must also be stressed.
Proper throwing mechanics should be enforced, especially for younger athletes.


Dr Donald A Ozello DC of Championship Chiropractic in Las Vegas, NV
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