External impingement consists of bursa-sided rotator cuff irritation that results from any process that decreases the space between the rotator cuff and the acromion. These processes can be static or dynamic. Bursitis, tendinitis, and acromial spurring are all conditions that statically decrease the space available for the rotator cuff. When the rotator cuff muscles are fatigued, precise rotator cuff control can be lost, and the humerus can become compressed against the glenoid. As a result, the humeral head migrates superiorly during glenohumeral elevation, which dynamically decreases the space available between the rotator cuff and the acromion.19
In internal impingement, rotator cuff fatigue lead to a cumulative effect of repetitive microtrauma to the anterior capsule and labrum, which results in stretching of these structures and consequent anterior translation of the humeral head. This anterior translation causes the undersurface of the posterior rotator cuff to be brought against the postero-superior surface of the glenoid and labrum, which causes fraying and tearing.19
Dry needling acupuncture therapy is very effective in preventing and treating this injury. The treatment should include the symptomatic area and associated soft tissues. For local injuries, treatment of the musculoskeletal system is always beneficial.
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