POSTERIOR SUPERIOR IMPINGEMENT OF THE SHOULDER IN OVERHEAD ATHLETES: OUTCOME OF ARTHROSCOPIC TREATMENT

Abstract

Introduction. Posterior superior glenoid impingement as a cause of partial rotator cuff lesions and posterior superior labral tears in overhead athletes was first described in the early 90’s by Walch and Jobe.

Material and methods. From January 1994 to January 2002, 71 patients were treated (48 men and 23 women). The majority were overhead athletes: handball (39), ketcher sports (12), volleyball (8), others (12). Indications for surgery were shoulder pain with athletic activity and a failed trial of conservative treatment. Mean age was 26 (range, 17–41) years. Mean duration of symptoms was 31 (range, 7–120) months. Following diagnostic arthroscopy–excluding anterior inferior ligament lesions and other significant intaarticular pathology–the partial rotator cuff lesions and posterior superior labral tears were debrided arthroscopically. During postoperative rehabilitation emphasis was placed on strengthening rotator cuff muscles, restoring normal scapulohumeral rhythm and avoiding stretching of the anterior static glenohumeral stabilizers.

Results. In 97% of cases a partial rotator cuff were found, and 90% had significant posterior–superior labral lesions. There were also 6 SLAP type II lesions that were repaired. Sixty four out of 71 patients were available for a follow up of minimum 2 years: 61% were able to return to preinjury activity level without any shoulder symptoms and 22% were not able to return to their desired sport. Overall satisfaction rate was 84%. The average time for return to sports participation was 9 (range, 4–12) months. Thirty six out of 46 patients had a telephone interview in a second minimum 5 years follow up. Fifty two percent (52%) were still active overhead athletes and 48% had stopped athletic activity (half of them because of shoulder problems). Six patients had secondary operations: 4 a capsular shift procedure and 2 a subacromial decompression.

Conclusion. In patients with symptomatic posterior superior impingement arthroscopic debridement followed by careful rehabilitation is an acceptable treatment. There is some tendency for the symptoms to recur over time.