Internal impingement of the shoulder

Case contributed by Dr Andrew Dixon


Posterior shoulder pain in a high-level tennis player.

Patient Data

Age: 35
Gender: Male

There are a combination of findings suggestive of internal shoulder impingement consisting of cysts within the humeral head underlying the superior fibres of infraspinatus, undersurface fraying of the superior fibres of infraspinatus, tendinosis and intrasubstance delamination involving the posterior fibres of supraspinatus, and significant fraying of the posterosuperior glenoid labrum.  

There is mild thickening of the inferior glenohumeral ligament and anterior joint capsule.  Mild subcoracoid and rotator interval oedema is evident. Normal appearance of the coracoacromial ligament.  Thickening / increased fluid within the subacromial / subdeltoid bursa. Early superficial chondral wear of the inferior portions of the glenohumeral joint.  Mild degenerative hypertrophy of the AC joint with mild capsular hypertrophy and adjacent marrow oedema.

Annotated image

Constellation of findings in keeping with internal shoulder impingement. Posterior fibre supraspinatus tendinosis with intrasubstance delamination and overlying bursal fluid (black arrow). Humeral head cysts underlying the superior insertional fibres of infraspinatus which demonstrate undersurface fraying (white). Significant fraying of the posterosuperior glenoid labrum (grey arrow). 

Case Discussion

Features of internal impingement of the shoulder with humeral head cysts underlying infraspinatus, superior fibre infraspinatus and posterior fibre supraspinatus tendinosis and posterosuperior labral fraying. Subacromial bursal thickening and increased fluid indicating co-existing subacromial bursitis.

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Case information

rID: 24454
Published: 17th Aug 2013
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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