This case report describes two professional baseball pitchers with posterior-superior shoulder pain in the cocking phase of throwing. It introduces "internal impingement" as a new site of rotator cuff injury distinct from classic subacromial impingement. The authors frame this pathology within Jobe's instability continuum for the overhead athlete.
When a thrower complains of posterior-superior shoulder pain during the cocking phase, think internal impingement rather than classic subacromial impingement. The distinction matters because the pathology is on the articular side and is driven by increased glenohumeral motion, not by the coracoacromial arch. A subacromial injection or acromioplasty will not fix it.
Use the relocation test as your bedside marker, and remember the arm must be in maximal external rotation, often well past 90°, to reproduce the pain. The two cases teach a decision framework along Jobe's instability continuum: excess rotation alone responds to dynamic stabilization rehab, while frank anterior translation with laxity may require capsulolabral reconstruction.
The key rehab pearl is to strengthen the cuff and scapular rotators while never stretching the anterior-inferior capsule, since that would worsen the underlying instability.
This case report describes two professional baseball pitchers with posterior-superior shoulder pain in the cocking phase of throwing. It introduces "internal impingement" as a new site of rotator cuff injury distinct from classic subacromial impingement. The authors frame this pathology within Jobe's instability continuum for the overhead athlete.
When a thrower complains of posterior-superior shoulder pain during the cocking phase, think internal impingement rather than classic subacromial impingement. The distinction matters because the pathology is on the articular side and is driven by increased glenohumeral motion, not by the coracoacromial arch. A subacromial injection or acromioplasty will not fix it.
Use the relocation test as your bedside marker, and remember the arm must be in maximal external rotation, often well past 90°, to reproduce the pain. The two cases teach a decision framework along Jobe's instability continuum: excess rotation alone responds to dynamic stabilization rehab, while frank anterior translation with laxity may require capsulolabral reconstruction.
The key rehab pearl is to strengthen the cuff and scapular rotators while never stretching the anterior-inferior capsule, since that would worsen the underlying instability.