Narrative review of internal impingement of the shoulder — a condition of excessive greater tuberosity contact with the posterosuperior glenoid in abduction/external rotation — covering pathomechanics, physical examination, imaging, and a diagnostic/therapeutic algorithm for overhead athletes.
When a young overhead athlete presents with posterior shoulder pain, use the posterior impingement sign and relocation test to raise suspicion for internal impingement, then pursue MRI for articular-sided cuff tears and posterosuperior labral lesions — but remember that similar findings appear in asymptomatic throwers, so clinical correlation is essential.
Start with aggressive posterior capsular stretching (sleeper stretches) targeting GIRD before considering surgery, and at arthroscopy, systematically assess all five at-risk structures (posterosuperior labrum, articular cuff, greater tuberosity, IGHL complex, posterosuperior glenoid) because isolated pathology is the exception, not the rule.
Narrative review of internal impingement of the shoulder — a condition of excessive greater tuberosity contact with the posterosuperior glenoid in abduction/external rotation — covering pathomechanics, physical examination, imaging, and a diagnostic/therapeutic algorithm for overhead athletes.
When a young overhead athlete presents with posterior shoulder pain, use the posterior impingement sign and relocation test to raise suspicion for internal impingement, then pursue MRI for articular-sided cuff tears and posterosuperior labral lesions — but remember that similar findings appear in asymptomatic throwers, so clinical correlation is essential.
Start with aggressive posterior capsular stretching (sleeper stretches) targeting GIRD before considering surgery, and at arthroscopy, systematically assess all five at-risk structures (posterosuperior labrum, articular cuff, greater tuberosity, IGHL complex, posterosuperior glenoid) because isolated pathology is the exception, not the rule.