Posterior Impingement Test | Internal Impingement

A very common pathology in overhead-throwing athletes is posterior shoulder pain resulting from internal impingement. “Internal impingement” is a term used to describe a constellation of symptoms that result from the greater tuberosity of the humerus and the articular surface of the rotator cuff abutting the posterosuperior glenoid when the shoulder is in an abducted and externally rotated position. The pathophysiology of symptomatic internal impingement is multifactorial, involving physiologic shoulder remodeling, posterior capsular contracture, and scapular dyskinesis.

Meister et al. (2004) evaluated the internal impingement test and found a sensitivity of 76% and a specificity of 85%. Although the diagnostic accuracy is moderate, the study contained several methodological flaws. For this reason, we give this test a weak clinical value until further diagnostic studies have been carried out.

To conduct the test, have the patient in supine position.
Then bring the patient’s shoulder into 90-110 degrees of abduction, 10-15 degrees of extension, and maximal external rotation.

The test is positive if the patient complains of deep posterior pain.
A positive test was correlated with undersurface tearing of the rotator cuff and/or posterior labrum in athletes with gradual onset of posterior shoulder pain during overhand athletics.

Be aware, that tests that were designed for the formerly called “external impingement” group can create a false positive test outcome in case of internal impingement as well.  Leschinger et al. (2017) reported that mechanical contact of the supraspinatus with the posterosuperior glenoid was present during the Neer test, while the Hawkins-Kennedy Test might be provocative in case of anterosuperior internal impingement.

Common tests for subacromial pain syndrome (SAPS), which you might want to check out are:

• Hawkins-Kennedy Test
• Painful Arc Sign

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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References

Meister, K., Buckley, B., & Batts, J. (2004). The posterior impingement sign: diagnosis of rotator cuff and posterior labral tears secondary to internal impingement in overhand athletes. American Journal of Orthopedics (Belle Mead, NJ), 33(8), 412-415.

Corpus, K. T., Camp, C. L., Dines, D. M., Altchek, D. W., & Dines, J. S. (2016). Evaluation and treatment of internal impingement of the shoulder in overhead athletes. World Journal of Orthopedics, 7(12), 776.

Leschinger, T., Wallraff, C., Müller, D., Hackenbroch, M., Bovenschulte, H., & Siewe, J. (2017). Internal impingement of the shoulder: a risk of false positive test outcomes in external impingement tests?. BioMed Research International, 2017.