During throwing motion the athlete puts enormous stress on both the dynamic and the static stabilisers of the shoulder. Repetitive forces cause adaptive soft tissue and bone changes that initially improve performance but ultimately may lead to shoulder pathologies. Although a broad range of theories have been suggested for the pathophysiology of internal impingement, the reasons are obviously multifactorial. This review aims to critically analyse the current literature and to summarise clinically important information. The cardinal lesions of internal impingement, articular-sided rotator cuff tears and posterosuperior labral lesions, have been shown to occur in association with a number of other findings, most importantly glenohumeral internal rotation deficit and SICK scapula syndrome, but also with posterior humeral head lesions, posterior glenoid bony injury and, rarely, with Bankart and inferior glenohumeral ligament lesions. Extensive biomechanical and clinical research is necessary before a complete understanding and reconciliation of the varying theories of the pathomechanisms of injury can be developed.

https://www.uhasselt.be/Documents/UHasselt/initiatieven/2012/schouderklachten/1-Overzichtsartikel-All%20in%20one/1-A8-Shoulder-Kirchhoff-Posterosuperior_and_anterosuperior_impingement-IO-2010.pdf

Posterosuperior and anterosuperior impingement of the shoulder in overhead athletes—evolving concepts

Background Subacromial impingement syndrome, with pain and limited motion, is a common disease encountered daily in clinics. This study determined the efficacy of subacromial injections of corticosteroids and local anesthesia for treatment of painful subacromial impingement syndrome. Methods A total of 238 shoulders in 209 patients, with regular follow-up, were enrolled in this study. Mean patient age was 51 years (range 31-72 years). Each patient complained of shoulder pain with progressive motion limitation present for more than one month, which was not relieved by various nonsurgical treatments. The mean duration of symptoms before injection was five months (range 1-12 months). Each patient had a positive Neer impingement sign, Hawkins impingement sign, painful tendon sign, limited range of motion and did not show clinical evidence of a rotator cuff tear. Each patient was administered an injection of 1 ml of 2% Xylocaine and 1 ml of Rinderon suspension. A second injection was administered one week later for patients without obvious improvement. Following injections, patients were instructed to perform a home rehabilitation program for four weeks. Follow-up examinations were scheduled for one, two and four weeks, and three, six, nine and 12 months after injection. Outcome measures included the Constant-Murley score and shoulder range of motion. Results At follow-up four weeks after the first injection, 216 shoulders (91%) had satisfactory improvement in amount of pain and range of motion: mean improvements in the active range of motion of forward elevation, abduction, internal rotation and external rotation were 56 degrees, 48 degrees, 18 degrees and 22 degrees, respectively. However, at the first year follow-up, the satisfaction rate was slightly down at 88%, and 19 shoulders (8%; 16 patients) had recurrent pain and motion limitation after an average of 5.4 months (range 3-12 months). Each of these patients received another injection. Surgery was recommended for 22 shoulders (9%; 18 patients) that did not have satisfactory improvement. Of these patients, eight shoulders (seven patients) had a partial tear of the rotator cuff and 10 shoulders (eight patients) had complete rotator cuff tears. Conclusion Subacromial injection of corticosteroids and local anesthesia is an effective therapy for the treatment of symptomatic subacromial pathology, such as impingement pain, tendonitis and bursitis. The injection can substantially reduce pain and increase range of motion of the shoulder. If there is no improvement following injections, a rotator cuff tear should be suspected.

Subacromial injections of corticosteroids and xylocaine for painful subacromial impingement syndrome.

The throwing athlete puts enormous stress on both the dynamic and the static stabilizers of the shoulder during the throwing motion. These repetitive forces cause adaptive soft tissue and bone changes that initially improve the performance but ultimately may lead to shoulder pathologies, especially during the motion of throwing. Although a range of theories have been suggested for the pathophysiologic development of internal impingement, the causes are obviously of multifactorial nature. The cardinal lesions of internal impingement, articular-sided rotator cuff tears, and posterosuperior labral lesions, have been shown to occur not only in association with a number of other findings, most importantly GIRD and SICK scapula syndrome, but also with posterior humeral head lesions, posterior glenoid bony injury, and rather rarely with Bankart and IGHL lesions. Extensive biomechanical and clinical research is necessary before a complete understanding and reconciliation of the varying theories of the pathomechanics of injury can be developed.

/pdf/posterosuperior-and-anterosuperior-impingement-in-overhead-39sytydzzh.pdf

Posterosuperior and Anterosuperior Impingement in Overhead Athletes

/pdf/anterosuperior-and-posterosuperior-impingement-syndrome-of-3bpwzhc7.pdf

Anterosuperior and posterosuperior impingement syndrome of the shoulder in overhead athletes

Magnetic resonance imaging (MRI) has become a powerful diagnostic tool for the evaluation of the painful shoulder in general and of the diseased rotator cuff in particular. MRI evaluates cuff disease in terms of tendon morphology and pathologic signal alterations within diseased cuff tendons. Additionally, MRI displays important pathoanatomic changes of the coracoacromial arch which are predisposing factors for the development of shoulder impingement syndrome and cuff disease. The accuracy of MRI in diagnosing small rotator cuff tears and in assessing the integrity of the labral-ligamentous complex is improved by the intraarticular injection of a suitable contrast agent. In the preoperative assessment of patients with cuff disease, MR arthrography enhances the staging of the disease and allows a more confident exclusion of concomitant lesions of the shoulder joint.

Magnetic resonance tomography in disorders of the rotator cuff

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Magnetic resonance tomography in disorders of the rotator cuff