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Knee Surg Sports Traumatol Arthrosc (2010) 18:16881693 DOI 10.1007/s00167-010-1232-z
SHOULDER
Anterior-superior internal impingement of the shoulder: an evidence-based review
Raffaele Garofalo Jon Karlsson Ulf Nordenson
Eugenio Cesari Marco Conti Alessandro Castagna
Received: 6 April 2010 / Accepted: 20 July 2010 / Published online: 11 August 2010 Springer-Verlag 2010
AbstractPurpose Internal impingement syndrome is a painful shoulder condition related to the impingement of the soft tissue, including the rotator cuff, joint capsule and the long head of the biceps tendon and glenoid labrum. Two types of internal impingement syndrome can be differentiated: posterior-superior impingement and anterior-superior impingement (ASI). The aetiology of ASI in particular is not clear. The purpose of this paper is to discuss the different aetiological theories relating to ASI, try to clarify the clinical, radiological and arthroscopic ndings and, nally, suggesting treatment for this complex shoulder syndrome. Methods The article is based on own research and clinical experience, as well as a non-systematic search in the PubMed database.
Results The aetiology of ASI appears to be related to the pulley lesion and instability of the long head of the biceps tendon. It can be caused by trauma or degenerative factors, which produces anterior shoulder pain in middle-aged patients, particularly when performing overhead activities. Conclusion The ASI is probably more frequent than previously reported. There is no evidence to prove the
efcacy of a specic rehabilitative protocol, and the gold standard of surgical management has to be ascertained. However, in patients with a pulley lesion, there is some evidence that early surgical management, when minor soft injury lesions are present, produces better clinical outcomes.
Keywords Internal Non-outlet Impingement Rotator
cuff Pulley Instability Anterior-superior
Introduction
Classic shoulder impingement, as described by Neer, is caused by the extrinsic compression of the subacromial bursa, the long head of the biceps tendon and the rotator cuff by the coraco-acromial arch. In recent years, the internal impingement phenomenon has been described as a clinical entity responsible for shoulder pain and discomfort [8].
The internal or non-outlet impingement syndrome is the result of an impingement between the rotator cuff and joint capsule on the glenoid, rotator cuff and glenoid rim itself or between the glenoid and humerus, where the glenoid contact may involve attached soft tissue (i.e. the labrum, anterior...