Internal impingement: concurrent superior labral and rotator cuff injuries

Internal impingement is a general term usually applied to the pathologic combination of a superior labral anterior-posterior injury and a partial thickness rotator cuff injury that is commonly seen in the disabled throwing shoulder. Clinical presentation varies but involves a combination of internal derangement (popping, clicking, catching, sliding) and rotator cuff weakness. Evaluation should be precise to delineate all components of the injury. Treatment must be directed toward both of the components and any other coexisting pathology. Labral repair should aim at restoring all aspects of the roles of the labrum. Rotator cuff treatment should take into account the need for optimal rotation and may not include complete take down and repair. Pitfalls in diagnosing and treating internal impingement should be known and avoided. Comprehensive rehabilitation emphasizing kinetic chain principles and full ranges of motion should be used.