Evaluation and treatment of internal impingement of the shoulder in overhead athletes

Table 1 Keys to diagnosing internal impingement

History	Shoulder stiffness
	Need for prolonged warm-up
	Decline in performance (loss of velocity of control)
	Posterior shoulder pain in late cocking phase
Physical exam	Posterior glenohumeral joint line tenderness
	Increased external rotation, decreased internal rotation
	Scapular dyskinesis
	Positive anterior relocation test
	Positive posterior impingement sign
Imaging	Bennett lesion (exostosis of posteroinferior glenoid rim)
	Sclerosis of greater tuberosity, posterior humeral head cysts, rounding of posterior glenoid rim
	Posterosuperior labral tears
	Partial-thickness articular-sided rotator cuff tears (supraspinatus, infraspinatus)