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Internal impingement is one of the primary causes of enduring shoulder pain in overhead athletes like baseball players, volleyball players, and tennis players. Overhead athletes often place distinctive and substantial stress through the shoulder at the limits of the arc of the motion. With time, this repeating stress results in skeletal and soft tissue alterations; additionally, there is a change in the pathology of their shoulder girdle.

One of the common causes of shoulder pain in such athletes is the pain that results from internal impingement. It’s a term that describes a group of symptoms that occurs because of the compression of the soft tissues and the bony structures present in the shoulder. In simple terms, it’s a shoulder injury due to frequent overhead motions, leading to instability and pain.

Cause of internal impingement

Our shoulder joint is a ball and socket joint that facilitates varied motions such as abduction, extension, rotation, and flexion. During these motions, the labrum and the rotator cuff muscles assist in stabilizing the shoulder joint. But in overhead athletes, the shoulder experiences a lot of stress and force, causing damage to the rotator cuff and the labrum. During overhead activities, the labrum and the rotator cuff are compressed between the glenoid fossa and the humerus during overhead activities, which leads to internal impingement.

Symptoms of internal impingement

The primary symptom of internal impingement is pain which becomes worse with overhead activities like throwing. Pain occurs mainly because of the irritation and inflammation of the impinged tendons, called tendonitis. Another structure affected is the bursa, a fat pad in the shoulder that allows the muscles and the tendons to slide over bones. When this is inflamed, it’s called bursitis. Another symptom is shoulder instability due to the damage occurring in the labrum. Moreover, injury in the rotator cuff causes weakness in shoulder motion, mainly abduction, and rotation. Some other symptoms include a clicking sensation in the shoulder and loss of strength in the shoulder joint.

How is internal impingement diagnosed?

Diagnosis of internal impingement in overhead athletes is diagnosed through clinical examination. One particular test, like MR arthrogram, is helpful, which is a special kind of MRI scan, where the dye is put into the joint space to see if there are any tears in the labrum. Fluids present around tendons and in the shoulder joint also show impingement. An ultrasound scan also helps in diagnosing internal impingement.

Treatment of internal impingement

Treatment is mainly divided into five different phases:

Rest

Taking enough rest helps the inflammation and irritation in tendons, bursa, and joints to subside.

NSAIDS

NSAIDS like ibuprofen helps decrease inflammation, and in some cases, a steroid injection is given to reduce joint inflammation.

Physical therapies

This helps strengthen the rotator cuff and shoulder muscles, enhance movements and rectify biomechanical problems that might be causing injury.

Surgery

Surgery is recommended when the above treatments fail to give the required results, which helps repair all damages that have occurred to the rotator cuff or the labral. Rebalancing of the joint capsule is also done during surgery.

How to prevent internal impingement in overhead athletes?

Prevention mainly includes proper training and methods, along with sufficient rest. Athletes must work with the trainer to use the appropriate form and techniques while making overhead motions. They should enhance the intensity of their workouts gradually to avoid injuries. Resting is also essential for the shoulder joint to recover from stress and strains.

Conclusion

Internal impingement is an ordinary condition observed in overhead athletes resulting in shoulder instabilities and pain. Proper treatment takes about three to six months for complete healing. Some of the severe cases take about one year to heal. But one can return to normal activities within two to four weeks. Regularly checking with the doctor to recover fast and avoid further damage is essential.

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