Internal impingement

This predominantly occurs in athletes where throwing is the main part of the sport. The under side of the rotator cuff tendons are 'impinged' against the glenoid labrum - this tends to cause pain at the front of the shoulder joint. 

With repeated injury the tendon of the rotator cuff muscle will become worn and a partial articular sided tear can develop.  If the head is 'levered' downwards by the internal impingment secondary damage to the labrum can occur.



What is the non surgical treatmentTreatment?

Rest: Patients must avoid activities which agrevate the symptoms.

NSAIDS and steroid injection: These help to reduce the inflamation of the tissues. 

Strengthening exercises: Aimed at the rotator cuff muscles and other muscles of the shoulder and upper back. (Strengthening exercises)

Sports / Job specific training: Analysis can identify poor technique which can be improved apon.

 What is the surgical option when conservative measures fail?

Surgery: If rehab fails to provide satisfactory results then surgery is indicated. This is aimed at repairing rotator cuff damage or labral damage. If the rotator cuff is badly damaged, then early repair must be considered. Controlled 'rebalancing' of the capsule may also be performed.

(see video of labral repair and partial cuff repair)