Subacromial Impingement Syndrome vs Internal Impingement

What's the Difference? Subacromial Impingement Syndrome (AKA Shoulder Impingement Syndrome and External Impingement) vs Internal Impingement (AKA Posterior Impingement Syndrome)
Scapular Dyskinesis • Scapular Dyskinesis
Subacromial Impingement Syndrome • Subacromial Impingemen...
Internal Impingement • Internal Impingement A...
Subacromial Impingement Syndrome (AKA Shoulder Impingement Syndrome and External Impingement). Encompasses etiologies of external compressive sources (the acromion) leading to subacromial bursitis and bursal-sided injuries to the rotator cuff.
Painful and often long lasting, condition affecting function and quality of life. Reduction of subacromial space. Impingement of supraspinatus tendon in subacromial space.
Usually caused by a strength imbalance in shoulder. Anterior shoulder muscles overpower posterior shoulder muscles. Leading to scapular instability, poor scapular posture and poor scapular motion.
Pinching pain in posterior superior lateral shoulder blade.
Aggravating by reaching overhead.
Scapular Dyskinesis is a major contributing factor.
Internal Impingement (AKA Posterior Internal Impingement) (PII) occurs at the posterior/lateral articular side of the cuff as it abuts the posterior/superior glenoid rim and labrum when the shoulder is in maximum abduction and external rotation (Late Cocking Phase).
Pain occurs due to compression of the supraspinatus and infraspinatus tendons by the posteriorly rotated greater tuberosity of the humeral head against the posterior/superior portions of the glenoid.
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 & the articular surface of the rotator cuff abutting the posterosuperior glenoid when the shoulder is in an abducted & externally rotated position. (ABER position).
Pathophysiology is multifactorial, involving physiologic shoulder remodeling, posterior capsular contracture and scapular dyskinesis.
Patient most likely to present with Internal Impingement is a young, active, overhead athlete.such as baseball pitchers and javelin throwers.
Clinical classification of internal impingement
1) Early: Shoulder stiffness and need for prolonged warm-up, no pain with ADLs.
2) Intermediate: Pain localized to the posterior shoulder in the late cocking phase, no pain with ADLs.
3) Advanced: Similar symptoms to Stage II, but refractory to a period of adequate rest and rehabilitation.
Decline in performance in all stages.
Scapular Dyskinesis: Alteration in normal resting position of scapula or alteration in normal dynamic scapular motion.
Scapular Dyskinesis may be caused or be the cause of shoulder pathology.
Any change in scapular positioning directly influences muscle strength and stability of shoulder complex.
Three Types
1) Posterior displacement from posterior thorax of inferior medial angle.
2) Posterior displacement from posterior thorax of entire medial border of scapula.
3) Early scapular elevation or excessive/insufficient scapular upward rotation during dynamic motion.
Distal and Proximal causative factors.
Distal Factors: Joint internal imbalance such as labral tears, GH instability, acromioclavicular separation.
Proximal Factors: Weakness of scapular muscles, especially lower trapezius.
***Disclaimer: Viewing this video does not take the place of seeing a medical professional, working with a nutritional professional, working with a fitness professional and receiving proper training in the medical profession. Please visit a medical professional for evaluation, diagnosis and treatment. Please work with a nutritional profession to develop individualized nutrition strategies. Please work with a fitness professional to learn proper exercise technique and to develop a proper training program. Never perform an exercise that elicits or intensifies symptoms. If an exercise elicits or intensifies symptoms, stop immediately and use a viable substitute. Always perform all exercises through a symptom free range of motion. Begin your training at your current health, fitness and strength levels. Increase intensity in small gradual calculated increments. Please use nutritional strategies that are designed to work for your individual needs.
Dr Donald A Ozello DC of Championship Chiropractic in Las Vegas, NV
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