Review Question - QID 699

Internal impingement is when the posterior rotator cuff pinches against the poster-superior labrum. It is implicated in the development of articular sided rotator cuffs and SLAP tears. This patient has a glenohumeral internal rotation deficit (GIRD) which is felt to contribute to this pathology. Treatment is directed at posterior capsule and rotator cuff stretching. This if often performed with the sleeper stretch, which is shown in the illustration below. The paper by Burkhart et al reviews the pathoanatomy of the throwing shoulder and notes that the use of a prophylactic posterior-inferior stretching program has been shown to decrease both GIRD and subsequent throwing injuries. The reference by Tehranzadeh reported the MRI finding of thickening of the posterior band of the inferior glenohumeral ligament on a small series of throwers with GIRD.