This 1995 case series by Jobe defines the expanded injury spectrum of posterior superior glenoid impingement. Eleven patients with confirmed abduction-external rotation shoulder injuries are analyzed to show which structures are at risk and how often multiple structures are injured together. The paper establishes that this mechanism is not limited to overhead athletes and that multi-structure injury is the norm.
When you see an articular-side partial rotator cuff tear in a young or active patient, the instinct to perform acromioplasty is wrong. Jobe's paper establishes that the lesion originates inside the joint from glenohumeral hyperangulation, not from the acromion above.
The clinical decision rule is this: identify one of the five at-risk structures (labrum, rotator cuff articular surface, inferior glenohumeral ligament, greater tuberosity, superior glenoid bone) and you must evaluate all four others before finalizing your surgical plan.
The relocation test is your best physical exam tool. Pain relieved by posterior humeral head pressure at 90° abduction-external rotation points to internal impingement. Apprehension at the same position points to anterior instability — though a concurrent SLAP lesion can blur this picture entirely, as patient 10 in this series illustrates.
Treatment targets the mechanism first: cuff and scapular rotator strengthening to limit hyperangulation. When that fails, anterior capsulolabral repair addresses the root cause. Debridement of the labrum or cuff in isolation, without controlling the mechanism, will not hold.
This 1995 case series by Jobe defines the expanded injury spectrum of posterior superior glenoid impingement. Eleven patients with confirmed abduction-external rotation shoulder injuries are analyzed to show which structures are at risk and how often multiple structures are injured together. The paper establishes that this mechanism is not limited to overhead athletes and that multi-structure injury is the norm.
When you see an articular-side partial rotator cuff tear in a young or active patient, the instinct to perform acromioplasty is wrong. Jobe's paper establishes that the lesion originates inside the joint from glenohumeral hyperangulation, not from the acromion above.
The clinical decision rule is this: identify one of the five at-risk structures (labrum, rotator cuff articular surface, inferior glenohumeral ligament, greater tuberosity, superior glenoid bone) and you must evaluate all four others before finalizing your surgical plan.
The relocation test is your best physical exam tool. Pain relieved by posterior humeral head pressure at 90° abduction-external rotation points to internal impingement. Apprehension at the same position points to anterior instability — though a concurrent SLAP lesion can blur this picture entirely, as patient 10 in this series illustrates.
Treatment targets the mechanism first: cuff and scapular rotator strengthening to limit hyperangulation. When that fails, anterior capsulolabral repair addresses the root cause. Debridement of the labrum or cuff in isolation, without controlling the mechanism, will not hold.