Correction of posterior shoulder tightness is associated with symptom resolution in patients with internal impingement

Interesting study on internal impingement.  However, no baseball players in this study, which make up a good bulk of the internal impingement patients.  

Purpose:  
Determine if improvement in GIRD and/or decreased PST after a course of physical therapy are associated with a resolution of symptoms in patients with internal impingement.  They hypothesized that symptom resolution would be associated with internal impingement.  

Methods:  
Cohort Study.  22 patients (11 men, 11 women).  Age 41+/- 13 years.  Dx of internal impingement determined by:  + relocation test, + posterior impingement sign, posterior GHJ line tenderness, MRI= posterosuperior glenoid labrum lesion

Measurements:  
- Posterior shoulder tightness (PST)
- GIRD
- ER ROM
- Simple shoulder test

Intervention:  
-  In the clinic 3x/week for tx
-  HEP
-  Manual mobilization and stretching of posterior shoulder
-  Grade IV posterior glides in scapular plan and max GHJ IR, AAROM cross-chest adduction, sleep stretch, scapular stabilization and strengthening exercises

Results:
-  12 patients (55%) had COMPLETE resolution of symptoms
-  10 patients (45%) had some RESIDUAL symptoms
-  GIRD, PST and loss of ER ROM all significantly improved after the period of PT
-  Average improvement in PST was 27 deg
-  Average improvement in GIRD was 26 deg

Key Points:
-  Prior to treatment, PST was associated with lower Simple shoulder test scores
-  Improvement in PST was greater in patients who had complete resolution of symptoms vs patients with residual symptoms
-  Improvements in GIRD and loss of ER ROM were unrelated to outcome

Things to consider:  
-  Patients who had complete resolution of symptoms tended to have greater PST before treatment
-  No baseball players included in study
-  5 patients had non-dominant arm involved
-  Complete resolution of symptoms= 12 on Simple shoulder test

Tyler, TF et al.  Correction of posterior shoulder tightness is associated with symptom resolution in patients with internal impingement. American Journal of Sports Medicine 2010. 38(1); 114-119

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