Arthroscopic Findings in the Overhand Throwing Athlete: Evidence for Posterior Internal Impingement of the Rotator Cuff

Paley, Kevin J.; Jobe, Frank W.; Pink, Marilyn; Kvitne, Ronald S.; ElAttrache, Neal S.

doi:10.1016/s0749-8063(00)90125-7

Cited by 252 publications

(163 citation statements)

References 14 publications

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“…29 Retraction during the late-cocking phase of pitching is also considered to minimize impingement and subsequent fraying of the posterior rotator cuff muscles between the posterior glenoid rim and the humerus, a phenomenon referred to as posterior or internal impingement. 32,52,60 Therefore, the retraction exercises may be recommended to baseball players, as well as to other overhead throwing athletes, to potentially facilitate the scapular movement necessary to perform their sports activity.…”

Section: Discussion Tmentioning

confidence: 99%

Three-Dimensional Scapular and Clavicular Kinematics and Scapular Muscle Activity During Retraction Exercises

Oyama

Myers²,

Wassinger

et al. 2010

Journal of Orthopaedic & Sports Physical Therapy

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Sakiko oyama, MS, ATC1 • Joseph B. Myers, PhD, ATC2 Craig a. Wassinger, PT, PhD3 • sCott M. Lephart, PhD, ATC 4 p roper movement of the scapula and clavicle is essential in minimizing stress applied to tissues surrounding the glenohumeral joint during overhead movements. 15,29,32,36,39,40,56,61 Scapular/clavicular movement maintains line of pull and length-tension relationship of the rotator cuff muscles throughout humeral range of motion. 31,33,39,64 This enables the rotator cuff muscles to produce joint compression while minimizing translation of the Three-Dimensional Scapular and Clavicular Kinematics and Scapular Muscle Activity During Retraction Exercises t stUDy Design: Controlled laboratory study.t oBJeCtiVes: To describe and compare scapular and clavicular kinematics and muscle activity during 6 retraction exercises in young healthy adults (mean  SD age, 23.2  2.4 years).

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Section: Discussion Tmentioning

confidence: 99%

Three-Dimensional Scapular and Clavicular Kinematics and Scapular Muscle Activity During Retraction Exercises

Oyama

Myers²,

Wassinger

et al. 2010

Journal of Orthopaedic & Sports Physical Therapy

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“…3,7,9,15,22,28,34 However, very little data are currently available that empirically describe scapular alterations among these athletes. The results of this study indicate that throwers diagnosed with pathological internal impingement demonstrate statistically significant increases in SC elevation and scapular posterior tilt position compared to throwers without internal impingement.…”

Section: Discussionmentioning

confidence: 99%

“…While it is believed that contact between the humeral head and the posterior-superior glenoid labrum is a normal physiological occurrence, the biomechanics of the throwing motion are believed to intensify this contact and its effect on the involved anatomical structures. 3,5,7,9,15,22,28,34 Thus, pathological internal impingement of the supraspinatus and infraspinatus can result. Using arthroscopy, clinicians have identified undersurface lesions on the posterior aspect of the supraspinatus and anterior portion of the infraspinatus tendons, and fraying of the posteriorsuperior glenoid labrum in overhead athletes.…”

Section: P Revious Research Hasmentioning

confidence: 99%

Scapular Dysfunction in Throwers with Pathologic Internal Impingement

Laudner

Myers

Pasquale

et al. 2006

J Orthop Sports Phys Ther

195

153

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Study Design: Case control group study. Objectives: To compare scapular position and orientation between baseball players with and without pathologic internal impingement. Background: Scapular dysfunction has been implicated as a contributor to throwing-related pathologic internal impingement of the shoulder due to its role in increasing the contact between the greater tuberosity and posterior-superior glenoid, thereby impinging the posterior rotator cuff tendon(s) and labrum. However, to date, no definitive data demonstrate this scapular dysfunction in throwing athletes. The purpose of this study was to assess, in a controlled laboratory environment, whether scapular position and orientation would be different in throwing athletes diagnosed with pathologic internal impingement than in a control group of throwing athletes. Methods and Measures: Eleven throwing athletes diagnosed with pathologic internal impingement, using both clinical examination and a magnetic resonance arthrogram, were demographically matched with a control group of 11 throwers with no history of upper extremity injury. An electromagnetic tracking device was used to measure scapular internal/external rotation, anterior/ posterior tilt, upward/downward rotation, sternoclavicular protraction/retraction, and elevation/ depression during humeral elevation within the scapular plane. Comparisons were made between groups with analysis of variance models (PϽ.05). Results:The individuals in the pathologic internal impingement group demonstrated statistically significant increased sternoclavicular elevation when elevating their humerus from 30°to 120°( P = .002) and from 60°to 120°(P = .003), compared to the control group. Furthermore, these patients also had increased posterior scapular tilt position (P = .016). No statistically significant differences were present in any other scapular variables measured. Conclusions: Based on the results of this study, throwing athletes diagnosed with pathologic internal impingement present with statistically significant increases in sternoclavicular elevation and scapular posterior tilt position during humeral elevation in the scapular plane.

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“…Cuff-glenoid contact has been observed with the arm in abduction and external rotation (called ''internal impingement'') and with the arm in forward flexion (called ''flexion contact'') [7,18,38]. Cuff-glenoid contact with the arm in abduction and external rotation or with the arm in flexion has been documented in cadaver [36], MRI [16], and clinical studies involving arthroscopy [18,30,35].…”

Section: Introductionmentioning

confidence: 99%

Does a Positive Neer Impingement Sign Reflect Rotator Cuff Contact with the Acromion?

Jia

Pannirselvam

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background One possible cause of shoulder pain is rotator cuff contact with the superior glenoid (cuff-glenoid contact) with the arm in flexion, as occurs during a Neer impingement sign. It has been assumed that the pain with a Neer impingement sign on physical examination of the shoulder was secondary to the rotator cuff making contact with the anterior and lateral acromion. Questions/purposes We determined if the arm position where pain occurs with a Neer impingement sign would correlate with the position where the rotator cuff made contact with the superior glenoid, as determined by arthroscopic evaluation. Patients and Methods We prospectively studied 398 consecutive patients with a positive Neer impingement sign during office examination and used a handheld goniometer to measure (in degrees of flexion) the arm position in which impingement pain occurred. During subsequent arthroscopy, the arm was moved into a similar position, and we measured the arm's position in flexion at the point the rotator cuff made contact with the superior glenoid using a handheld goniometer. We compared the degrees of flexion at which pain occurred preoperatively and at which there was cuff-glenoid contact.

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Arthroscopic Findings in the Overhand Throwing Athlete: Evidence for Posterior Internal Impingement of the Rotator Cuff

Cited by 252 publications

References 14 publications

Three-Dimensional Scapular and Clavicular Kinematics and Scapular Muscle Activity During Retraction Exercises

Three-Dimensional Scapular and Clavicular Kinematics and Scapular Muscle Activity During Retraction Exercises

Scapular Dysfunction in Throwers with Pathologic Internal Impingement

Does a Positive Neer Impingement Sign Reflect Rotator Cuff Contact with the Acromion?

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