What is Internal Impingement?
Internal impingement is characterized by posterior shoulder pain when the athlete places the humerus in extreme external rotation and abduction as in the cocking phase of pitching or throwing. Impingement in this position occurs between the supraspinatus and or infraspinatus and the glenoid rim.
Secondary to the repetitive overhead activities can form a Thrower’s exostosis of the shoulder, which is also called a Bennett lesion of the shoulder, refers to the calcification in the posterior band of the inferior glenohumeral ligament, which is one of the ligaments that connect the upper arm bone to the shoulder socket.
Symptoms of Internal Impingement or Thrower’s Exostosis of the Shoulder
Thrower’s exostosis of the shoulder may result in the following signs and symptoms:
- Posterior shoulder discomfort during the follow-through phase of the throwing cycle
- Radiating pain down the posterior upper arm
- Loss of strength in the shoulder and arm
- Scapula pain when using the arm overhead
- Snapping or popping sensation in the shoulder
Diagnosis of Thrower’s Exostosis of the Shoulder
A diagnosis of thrower’s exostosis of the shoulder is based on your symptoms, physical examination and imaging tests such as:
- MRI scan
- X ray
- CT scan
Management of Thrower’s Exostosis of the Shoulder
Treatment options for thrower’s exostosis of the shoulder will vary based on the severity of the condition. It may include the following options:
Medications
- Oral NonSteroidal Anti-Inflammatory medications
- Steroid injections to reduce inflammation
- Physical therapy
- Avoiding activities that exacerbate the condition
Surgery
If conventional methods failed to treat thrower’s exostosis of the shoulder or it is associated with other complications, then your doctor might suggest surgical intervention which may be performed arthroscopically. The goal of surgery is to remove the bony outgrowth and any associated damaged tissues in order to improve range of motion and reduce pain.
Postoperative Care and Recovery
After the surgery, the small surgical wounds take a few days to heal and the surgical dressing is replaced by simple Band-Aids. The recovery time depends on the type and extent of problem for which the procedure was performed. Pain medications are prescribed to keep you comfortable. The arm of the affected shoulder is placed in a sling for a short period as recommended by your doctor. Physical therapy is advised to improve shoulder mobility and strength after the surgery.
Risks and Complications
Complications are the same as with any surgery which include infection, bleeding, damage to nearby nerves or blood vessels, or delayed healing after the surgery. In certain cases, stiffness of the shoulder joint may occur after the surgery. It is important to participate actively in your physical therapy to prevent this from occurring.