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Shoulder: Internal Impingement Syndrome

     - the hyperextension phase of throwing may be the most important component of internal impingement;
- in the late cocking position (abduction, external rotation, extension) may cause the postero-superior edge of the glenoid labrum to become caught between the humeral head and rotator cuff (surface of the infraspinatus and posterior fibers of supraspinatus tendon);
-  posterior glenoid impacts the articular surface of the infraspinatus and posterior fibers of the supraspinatus tendon;
- w/ anterior instability, there will be anterior translation of the humeral head on the glenoid which accentuates impingement of the rotator cuff against the posterosuperior glenoid rim;
      - exam findings:
              - tenderness over the coracoid has been attributed to a contracture of the pectoralis minor tendon secondary to scapular malposition.
 - MRI findingsposterolateral humeral head edema, posterior labram fraying, partial rotator cuff tear;
- treatment:
- capsular stretching and dynamic strengthening of the rotator cuff musculature
- arthroscopic findings may reveal an isolated posterior cuff tear (or undersurface fraying) and fraying of the posterior labrum , and increased anterior capsular volume;
- w/ posterior impingment and recurrent anterior instability, anterior reconstruction (either open reconstruction or arthroscopic anterior reconstruction) may be indicated;