Internal Impingement

Throwing athletes or athletes typically involved in overhead sports like badminton, lawn tennis, squash & baseball typically have a repetitive trauma to the capsule of the joint. The activity involves an impact injury during the deceleration phase of the throw/shot which damages the posterior part of capsule. Due to healing after the injury, scarring takes place which tightens the posterior capsule. This eventually leads to an altered kinematics during throw.

During a violent throw this might also lead to a ‘peel-back’ effect on the attachment of biceps tendon attached o the capsulolabral complex. This is probably the reason for a SLAP tear in throwing athletes.

If diagnosed in early phases, simple stretching and rehabilitation programme can help re-join sporting activity. In cases requiring violent throwing activity, this might lead to a severe change in kinematics of the joint which might lead to eitopathogenesis of a Thrower’s shoulder. Typical patients are young with symptoms pertaining to capsular tightness.

Following exercises may be of help in most patients with early disease. Cases with SLAP leisons and or chronic disease are less likely to become better with exercises alone.

Typical symptoms include a loss of internal rotation, hyper external rotation along with a severe pain in posterior aspect of shoulder after the throw which resolves within a few minutes of throw.

The mainstay remains physiotherpay and rehabilitation but might warrant a surgery to release the tight capsule arthroscopically or repair a torn biceps tendon.

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