Posterior superior glenoid impingement: Expanded spectrum

Jobe, Christopher M.

doi:10.1016/0749-8063(95)90128-0

Cited by 353 publications

(102 citation statements)

References 4 publications

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“…Although varying degrees of internal impingement occur in all shoulders, repetitive throwing may lead to tightening of the posteroinferior capsule, posterosuperior migration of humeral head on glenoid, and subsequent impingement of the humerus on the articular side of the rotator cuff and posterosuperior labrum in the abducted and externally rotated position. 46 There has been disagreement and controversy on whether anterior laxity contributed to worsening 17 or lessening 14 of internal impingement.…”

Section: Discussionmentioning

confidence: 99%

Return to Sport Following Shoulder Surgery in the Elite Pitcher

et al. 2013

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T he shoulder is an integral part of the kinetic chain in the throwing motion. 22 Elite pitchers throw a baseball in excess of 95 mph, with the generation of over 7250 degrees of motion in internal rotation per second. 13 The kinematics of the throwing motion progresses through several distinct phases, with potential functional and/or pathologic adjustments occurring at each stage. 23 Although the entire throwing motion takes less than 2 seconds, repetitive microtrauma over the course of a career may lead to several osseous and/or soft tissue adaptations of the thrower's shoulder (Table 1). 4,5,9,12,14,18,25,43,47,[49][50][51] The resultant changes demonstrate significant differences from the general population, baseball Study Selection: Levels I-IV evidence were eligible for inclusion if performance-based (eg, RTS) and/or clinical outcomebased reporting of outcomes were reported following surgical treatment of shoulder pathology in elite pitchers (major or minor league or collegiate).Data Extraction: Subject, shoulder, and pre-and postoperative performance-based variables of interest were extracted. All shoulder surgery types were potentially inclusive (eg, open, arthroscopic, rotator cuff, labrum, biceps, acromioclavicular joint, fracture). Study methodological quality was analyzed using the Modified Coleman Methodology Score (MCMS).Results: Six studies were analyzed (287 elite male pitchers [mean age, 27 years] who underwent shoulder surgery, with 99% on the dominant, throwing shoulder). MCMS was 38 (poor). Most pitchers were professional, with a mean career length of 6.58 years and postoperative clinical follow-up of 3.62 years. In 5 of 6 studies, multiple diagnoses were addressed concomitantly at surgery. Rate of RTS was 68% at mean 12 months following surgery. Twenty-two percent of Major League Baseball (MLB) pitchers never RTS in MLB. Overall performance did improve following surgery; however, this did not improve to pre-injury levels. Conclusion:In this systematic review, the rate of return to elite baseball pitching following surgery was established. Performance tended to decrease prior to surgery and gradually improve postoperatively, though not reaching pre-injury levels of pitching.Level of Evidence: IV (systematic review of studies level I-IV evidence), therapeutic.

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Section: Discussionmentioning

confidence: 99%

Return to Sport Following Shoulder Surgery in the Elite Pitcher

et al. 2013

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“…The arc of motion in a high-level throwing athlete is shifted posteriorly to allow for increased external rotation at the cost of decreased internal rotation by allowing increased clearance of the greater tuberosity over the glenoid during rotation[2-4,21,23,25]. Increased external rotation is achieved by a number of shoulder adaptations that develop over time including increased retroversion of the humeral head and glenoid, and increased anterior capsular laxity[1,2,4,5,17,32]. …”

Section: Pathophysiology and Biomechanicsmentioning

confidence: 99%

“…Jobe et al[12,32,35] originally described “subtle instability”, or microinstability, to define the acquired laxity and anterior translation of the humeral head that occurs with the arm in a maximally abducted and externally rotated position. At what point this laxity becomes pathologic is another matter of debate.…”

Section: Pathophysiology and Biomechanicsmentioning

confidence: 99%

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Evaluation and treatment of internal impingement of the shoulder in overhead athletes

Corpus¹,

Camp²,

Dines³

et al. 2016

WJO

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One of the most common pathologic processes seen in overhead throwing athletes is posterior shoulder pain resulting from internal impingement. “Internal impingement” is a term used to describe a constellation of symptoms which result from the greater tuberosity of the humerus and the articular surface of the rotator cuff abutting the posterosuperior glenoid when the shoulder is in an abducted and externally rotated position. The pathophysiology in symptomatic internal impingement is multifactorial, involving physiologic shoulder remodeling, posterior capsular contracture, and scapular dyskinesis. Throwers with internal impingement may complain of shoulder stiffness or the need for a prolonged warm-up, decline in performance, or posterior shoulder pain. On physical examination, patients will demonstrate limited internal rotation and posterior shoulder pain with a posterior impingement test. Common imaging findings include the classic “Bennett lesion” on radiographs, as well as articular-sided partial rotator cuff tears and concomitant SLAP lesions. Mainstays of treatment include intense non-operative management focusing on rest and stretching protocols focusing on the posterior capsule. Operative management is variable depending on the exact pathology, but largely consists of rotator cuff debridement. Outcomes of operative treatment have been mixed, therefore intense non-operative treatment should remain the focus of treatment.

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“…At the same time, studies of glenohumeral kinetics demonstrate up to 40% anterior joint This article is part of the Topical Collection on Injuries in Overhead Athletes translation during the late cocking phase and 80% body weight distraction on pitch delivery which may be additional contributory factors [26]. The resultant forces on the rotator cuff peak during follow through and deceleration and can lead to repetitive microtrauma on the relatively avascular tendon insertions, resulting in either articular-sided tears due to internal impingement or tensile failure due to overload of the rotator cuff itself [27][28][29][30][31][32]. Internal impingement, first described by Walch, results when the posterior undersurface of the supraspinatus tendon impinges on the greater tuberosity insertion on the posterosuperior glenoid rim and typically occurs in overhead athletes in the late cocking and early acceleration phases of throwing ( Fig.…”

Section: Etiologymentioning

confidence: 99%

Treatment of Partial Thickness Rotator Cuff Tears in Overhead Athletes

Liu

Garcia

Gowd

et al. 2018

Curr Rev Musculoskelet Med

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Purpose of Review To review the etiology, classification, presentation, evaluation, treatment strategy, and outcomes in overhead athletes with partial thickness rotator cuff tears. Recent Findings Despite advances in surgical repair techniques, return to play following surgical repair of partial rotator cuff tears remains modest at best. Summary Overhead athletes may be particularly prone to rotator cuff pathology due to the supraphysiological strains within the tendon during the throwing motion, as well as mechanical stress with contact between the undersurface of the rotator cuff and the glenoid. The true prevalence of partial tears may be underestimated given the high incidence of asymptomatic tears. Both dynamic ultrasound and enhanced contrast MRI have improved our understanding of this pathology. For most overhead athletes, nonoperative management is the most common course. Despite advances in imaging, diagnosis, and surgical techniques, our ability to return these patients to their elite level is modest at best when nonoperative management fails and surgical treatment is performed. If a surgical route is needed, debridement alone is the most frequent procedure given concerns of over constraint and poor return to play with surgical repair of the partial thickness rotator cuff tear.

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Posterior superior glenoid impingement: Expanded spectrum

Cited by 353 publications

References 4 publications

Return to Sport Following Shoulder Surgery in the Elite Pitcher

Return to Sport Following Shoulder Surgery in the Elite Pitcher

Evaluation and treatment of internal impingement of the shoulder in overhead athletes

Treatment of Partial Thickness Rotator Cuff Tears in Overhead Athletes

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