Comprehensive evaluation and treatment of the shoulder in the throwing athlete.

Subacromial impingement is typically diagnosed in the older throwing athlete who has a stable shoulder. Often these overhand athletes will have a loss of internal rotation that may be refractory to stretching. Some have postulated bony adaptive changes in the thrower leading to internal rotation loss.1,2 These patients have a painful arc, positive impingement maneuvers, and respond affirmatively to a subacromial injection. Radiographs usually show some form of an acquired or congenitally prominent anterior acromion that predisposes to outlet stenosis. Some may also exhibit lateral downsloping of the acromion. Many of these patients will improve with anti-inflammatory medication combined with a well-supervised physical therapy program focusing not only on cuff rehabilitation, but also on scapular dynamics. There is no conclusive data supporting acromioclavicular (AC) joint spurring as a cause of subacromial impingement.