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Anterior internal impingement: An arthroscopic observation
1Department of Orthopaedic Surgery, The Hospital for Joint Diseases, New York, New York, USA.
Summary
Anterior internal impingement, not subacromial impingement, causes pain in patients with rotator cuff tears. This finding improves diagnosis and treatment for shoulder pain.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Shoulder Arthroscopy
Background:
- Subacromial impingement is the traditional explanation for shoulder impingement pain.
- This study investigates an alternative cause in patients with rotator cuff tears.
Observation:
- Arthroscopic visualization revealed anterior internal impingement in all 10 patients with partial-thickness rotator cuff tears.
- Abnormal rotator cuff tissue contacted the anterosuperior labrum during specific maneuvers.
- Subacromial impingement or bursitis was absent in these cases.
Findings:
- Anterior internal impingement was identified as the source of pain in patients with partial rotator cuff tears.
- Preoperative MRI was only 20% accurate in diagnosing these tears.
Implications:
- Recognizing anterior internal impingement is crucial for accurate diagnosis and treatment of shoulder pain.
- This understanding can prevent unnecessary surgeries like acromioplasty in young patients.
- Improved patient selection for surgical procedures can be achieved.