Posterior Impingement Sign Test

What is internal shoulder impingement?

Internal shoulder impingement is a condition that typically affects athletes, particularly those involved in sports with overhead arm movements such as baseball, tennis, and swimming. It occurs when the rotator cuff tendons and the posterior labrum are pinched between the head of the posterior capsule of the humerus and the glenoid rim. This repetitive impingement can lead to fraying or partial tearing of the rotator cuff tendons, as well as labral tears, resulting in symptoms like posterior shoulder pain, stiffness, and weakness.

Symptoms

Symptomatic internal impingement manifests through various symptoms that can affect an individual's daily activities and athletic performance. Commonly, individuals experience deep posterior pain in the shoulder, which intensifies with overhead activities or throwing motions. This condition often leads to reduced strength in the affected shoulder, making it challenging to perform routine tasks or engage in sports. Since it results in greater tuberosity during abduction and external rotation, it may also lead to inflammation and potentially partial rotator cuff tears.

Additionally, those suffering from internal impingement may experience posterior shoulder tightness, making it difficult to fully rotate their shoulder or extend their arm above their head. A sensation of looseness or instability in the shoulder joint  is also frequently reported, further complicating movement and exacerbating discomfort.

Causes

Internal shoulder impingement and shoulder problems are primarily caused by repetitive overhead activities that place significant stress on the shoulder joint. Common causes of internal impingement and shoulder injuries include:

• Repetitive motions, especially in sports that involve throwing or overhead activities, can lead to wear and tear on the shoulder.
• Incorrect technique in sports or physical activities can contribute to improper shoulder movement and subsequent impingement.
• Shoulder stiffness, tightness, or weakness can alter joint mechanics and increase the risk of impingement.
• Variations in the shoulder's anatomy, such as bone spurs or abnormal bone shapes, can contribute to impingement.

What is the Posterior Impingement Sign Test?

The Posterior Impingement Sign Test is a diagnostic tool used to identify the presence of posterior shoulder pain resulting from impingement. This test benefits athletes who experience pain in the shoulder's posterior aspect during overhead activities. The test helps to pinpoint whether the posterior shoulder pain resulting in symptoms is due to impingement of the posterior rotator cuff, tendons, and the superior labrum against the glenoid rim and humeral head.

During the test, the patient lies supine with the arm extended and the shoulder positioned in various degrees of abduction and external rotation. The examiner applies pressure to the posterior shoulder, and a positive test is indicated by reproducing the degrees of abduction of the patient's pain in the posterior shoulder. This test assists healthcare providers in diagnosing posterior shoulder impingement and formulating an appropriate treatment plan.

How to use our Posterior Impingement Sign Test template

Our Posterior Impingement Sign Test template is designed to assist healthcare professionals in accurately assessing and documenting cases of posterior shoulder impingement. Follow these steps to utilize the template effectively during patient examinations.

Step 1: Access the template

First, download the free printable template PDF via the Carepatron app or by clicking the link on this page. If you open it on the app, you can tailor it to your needs and share it with other Carepatron users.

Step 2: Prepare the template and the patient

Start by filling in the patient’s details. After filling in the details, take the time to explain the procedure and the purpose of the test to your patient.

Step 3: Position the patient and conduct the test

Position the patient supine on the examination table and follow the detailed steps in the template to perform the test. Document the results accordingly.

Benefits of conducting this test

Conducting the Posterior Impingement Sign Test offers several advantages for healthcare professionals, enhancing diagnostic accuracy in diagnosing and treating internal shoulder impingement.

Accurate diagnosis

The Posterior Impingement Sign Test provides a reliable method to identify internal shoulder impingement, helping healthcare professionals make accurate diagnoses. This diagnostic accuracy ensures that patients receive the appropriate treatment, improving their chances of recovery.

Tailored treatment plans

With precise diagnostic information, healthcare professionals can develop more personalized treatment plans. This test helps understand the impingement's specific nature and severity, allowing customized interventions that address the patient's unique condition.

Improved patient outcomes

The Posterior Impingement Sign Test allows healthcare providers to monitor shoulder recovery progress and adjust treatments as necessary. This ongoing assessment helps track the effectiveness of interventions, ultimately leading to better patient outcomes and enhanced recovery rates.

Common treatments for internal shoulder impingement

Internal shoulder impingement can be managed through a variety of treatments aimed at reducing shoulder pain and improving shoulder function:

• Physical therapy: Focused on strengthening the shoulder muscles, improving flexibility, and correcting posture to alleviate impingement symptoms. One example is posterior capsular stretching, which is used to loosen the posterior capsule.
• Anti-inflammatory medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) help reduce pain and inflammation.
• Corticosteroid injections: Administered to reduce severe inflammation and provide pain relief.
• Activity modification: Advising patients to avoid activities that exacerbate symptoms and incorporating ergonomic adjustments.
• Surgery: In severe cases, surgical intervention may be required to correct structural issues contributing to impingement. Interventions may include arthroscopic interventions, capsular procedures, and even obstruction removal.