May 8, 2020

What is internal impingement?

Shoulder | Sports Injury

Constant throwing or arm rotation can put a lot of stress on the most mobile joint in your body: your shoulder. “The Thrower’s Shoulder” refers to an internal impingement. This injury is caused in the “cocking” phase of throwing, when a pitcher is bringing his or her arm back before the swing. Sometimes, the tendons in your rotator cuff get pinched between your labrum and humeral head which could lead to a rotator cuff tendon tear if it’s not treated.

Anatomy of the Shoulder

Two joints make up the shoulder. Your acromioclavicular joint connects your shoulder blade (scapula) to your collarbone (clavicle). This joint allows you to raise your arm above your head. Your glenohumeral joint is a ball and socket joint. It connects the top of your upper arm, your humeral head (ball), to part of the scapula called the glenoid (socket). It gives you the ability to rotate your shoulder in a circle and move it up and out from your body.

Soft tissue like ligaments, cartilage and tendons surround your glenohumeral joint. They help cushion the joint’s movement and keep the large humeral head in the shallow socket cavity. 

Your rotator cuff is a group of tendons and muscles surrounding the top of the humerus to keep the head in place and allow your arm to rotate. 

The deltoid muscle is the largest and strongest muscle in your shoulder. Tendons attach it to the clavicle and humerus, and it provides you the strength to lift your arm.

Your bicep tendon connects the muscle on the front of your forearm to the top of your shoulder socket and allows your forearm to rotate and your elbow to bend.

What does shoulder impingement feel like?

An internal impingement affects a very important group of tendons, your rotator cuff, sitting on top of your shoulder’s ball and socket joint to protect it. 

  • Tenderness in the front of the shoulder
  • Pain when throwing overhead
  • Tenderness around your scapula
  • Inflammation/irritation of affected tendons
  • Shoulder instability
  • Shoulder weakness

Symptoms usually begin at the time of the injury, but it can worsen over time if it isn’t treated and turn into a rotator cuff tear.

What causes internal impingement?

Thrower’s shoulder is caused by what it sounds like: It is an injury caused by overusing the tendons in your shoulder, usually from a throwing or another overhead activity, like tennis, baseball or swimming. It’s mainly seen in young athletes.

When you overuse your shoulder, the tendons become inflamed and “catch” on your shoulder bone. Although this usually affects your rotator cuff, it can also affect your labrum.

How do I know if I have damaged my rotator cuff?

To determine whether you have a rotator cuff injury from throwing, your physician will ask you for a complete medical history, have you describe your symptoms and conduct a physical examination. An X-ray or MRI may be necessary to confirm the diagnosis and determine if there are other problems.

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How is internal impingement treated?

Treatment will start with nonsurgical rehabilitation, along with rest. Most shoulder impingements respond well to physical therapy. If you don’t see any change in your inflammation or pain levels, your physician may suggest surgery.

  • Rest
  • NSAIDS and steroid injections
  • Strengthening program through physical therapy
  • Surgery 

The surgery you may undergo will widen the space around your rotator cuff and allow your rotator cuff space to move without catching on the bone.

How do you fix a shoulder impingement?

An internal impingement will take three to six months to completely heal. Normal activities can usually resume within a month as long as your physician says it’s ok. To prevent further overuse injuries, make sure you aren’t overdoing it. During recovery, you shouldn’t do any exercises involving your shoulder or any overhead movements.

How do I prevent shoulder impingement?

Preventing a shoulder impingement is as simple as being well conditioned, practicing proper technique and giving yourself time to rest. It’s very important to follow guidelines set by coaches, trainers and organizations so you don’t get an overuse injury.

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By OrthoIndy

Founded over 50 years ago, OrthoIndy is one of the most highly respected orthopedic practices in the Midwest. With over 70 physicians providing care to central Indiana residents from more than 10 convenient locations, OrthoIndy provides leading-edge bone, joint, spine and muscle care.

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