TY - JOUR T1 - Posterior superior internal impingement: an evidence-based review JF - British Journal of Sports Medicine JO - Br J Sports Med SP - 382 LP - 388 DO - 10.1136/bjsm.2009.059261 VL - 44 IS - 5 AU - Alessandro Castagna AU - Raffaele Garofalo AU - Eugenio Cesari AU - Nikolaos Markopoulos AU - Mario Borroni AU - Marco Conti Y1 - 2010/04/01 UR - http://bjsm.bmj.com/content/44/5/382.abstract N2 - Over the last decade, the concept of internal impingement has continued to evolve, and the frequency with which this condition is recognised continues to increase. This syndrome should be clearly differentiated from the classical (external) impingement that is thought to be caused by compression of the subacromial bursa, long head of the biceps tendon and rotator cuff (RC) by the coraco-acromial arch. Internal (posterosuperior) impingement syndrome is typified by a painful shoulder due to impingement of the soft tissue, including the RC, joint capsule and the posterosuperior part of the glenoid. The aetiology of this syndrome is unclear, but hypotheses include anterior shoulder instability or micro-instability, contracture of the posterior capsule, reduced humeral retroversion and scapular dyskinesis. Non-operative therapy represents the first line of treatment for this syndrome and includes the management of pain, stretching of the posterior capsule and a muscle strengthening programme. Surgical treatment should only be considered when conservative management fails. A number of different surgical procedures have been proposed, but the results are variable. The success rate is generally improved when the subtle instability, associated with internal impingement, is also addressed. ER -