Glenohumeral Internal Rotation Deficit Research Articles

Glenohumeral Internal Rotation Deficit and Injuries: A Systematic Review and Meta-analysis.

Background:There is an association between throwing activity and glenohumeral internal rotation deficit (GIRD). An 18° to 20° deficit has been adopted as the standard definition of pathological GIRD, but specific findings as to how GIRD relates to an injury are inconsistent.Purpose:To systematically review the literature to clarify the definition of GIRD diagnosis for adolescent and adult overhead athletes and to examine the association between GIRD and an increased risk of injuries in these athletes.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of the literature was performed. Observational studies comparing glenohumeral internal rotation range of motion (ROM) in injured and uninjured overhead athletes were included for the meta-analysis. Studies of adolescent and adult athletes were analyzed separately. ROM was compared for the injured and uninjured groups, and a weighted mean GIRD was estimated. To account for potential heterogeneity across studies, both fixed- and random-effects models were used to calculate a standardized mean difference (SMD).Results:Nine studies of level 3 or 4 evidence were included. From these, 12 study groups (4 adolescent, 8 adult) comprising 819 overhead athletes (226 injured, 593 uninjured) were included in the meta-analysis. The estimated SMD in GIRD between the injured and uninjured groups was 0.46 (95% CI, 0.15-0.77; P < .01) for the overall sample. The between-group effect was larger for adults (SMD, 0.60 [95% CI, 0.18 to 1.02]; P < .01) than adolescents (SMD, 0.20 [95% CI, –0.24 to 0.63]; P = .13). The weighted mean GIRD for the injured and uninjured groups was 13.8° ± 5.6° and 9.6° ± 3.0°, respectively, which also differed by age group. Moderate study heterogeneity was observed (I 2 = 69.0%).Conclusion:Based on this systematic review, the current definition of pathological GIRD may be too conservative, and a distinct definition may be required for adolescent and adult athletes. While the results indicate a link between internal rotation deficits and upper extremity injuries in the overhead athlete, higher quality prospective research is needed to clarify the role that GIRD plays in future injuries to overhead athletes of various ages.

Posterior shoulder tightness, joint position sense,and shoulder strength in subjects with and without glenohumeral internal rotation deficit

Posterior shoulder tightness, joint position sense,and shoulder strength in subjects with and without glenohumeral internal rotation deficit

Can Shoulder Muscle Activity Be Evaluated With Ultrasound Shear Wave Elastography?

Quantitative assessment of rotator cuff muscle activity is important in the treatment of shoulder disorders. However, the known methods for assessing rotator cuff muscle activity thus far have been inaccurate, invasive, and inconvenient. (1) Does the activity of the deltoid, supraspinatus, and infraspinatus muscles measured using ultrasound shear wave elastography have a linear correlation with muscle activity assessed using generally used methods, including isokinetic dynamometry and electromyography? (2) Does the activity of the deltoid, supraspinatus, and infraspinatus muscles measured using shear wave elastography show good intraobserver and interobserver reliability? Twelve volunteers participated in intrasession reliability experiments. They were asked to perform isometric abduction, external rotation, and scaption contractions (defined as elevation of the arm within the plane of the scapula with neutral arm rotation) gradually increased from 0% to 75% of maximal voluntary contraction. The joint torque, electromyographic activity, and shear elastic modulus were synchronously measured in the middeltoid, supraspinatus, and infraspinatus muscles. The validity of the elastic modulus value was assessed using regression analysis between normalized torque and electromyographic root mean square values. For intraobserver and interobserver reliability measurements, repeated experiments were performed with the same protocol. The shear elastic modulus and normalized joint torque with isokinetic dynamometry showed a linear relationship in all muscles (deltoid, supraspinatus, and infraspinatus) and each of the ultrasonography planes (longitudinal and transverse) (mean R > 0.8 and p < 0.001 for all measurements). For the supraspinatus muscle, the mean slope of the relationship between shear elastic modulus in the longitudinal plane and the normalized joint torque during scaption contraction was 1.28 ± 0.39 kPa/%MVC (mean R = 0.93 ± 0.21, p < 0.001). Furthermore, similar results were obtained in relation to electromyography root mean square values (mean R > 0.8 and p < 0.001 in all measurements). For the supraspinatus muscle, the mean slope of the relationship between shear elastic modulus in the longitudinal plane and electromyographic (EMG) root mean square was 0.96 ± 0.27 kPa/%EMG (mean R = 0.91 ± 0.08, p < 0.001). The intraobserver and interobserver reliabilities were excellent in all positions (abduction, external rotation, and scaption) and in both the longitudinal and transverse ultrasonography planes (all intraclass correlation coefficients are > 0.85). Shoulder muscle activity can be noninvasively evaluated with ultrasound shear wave elastography. Clinician and scientists should consider the application of this technique in cases in which evaluation of shoulder muscle activity is required. The next step after this study will be to check the shear elastic modulus of rotator cuff muscle in patients with rotator cuff tear. We plan to evaluate the correlation between shear elastic modulus and joint torque according to tear size and fatty infiltration status of rotator cuff muscle. Shear wave electrography can be used to measure various tissue elasticities in both static and dynamic modes. It may be a useful tool to evaluate pre- and postoperative rotator cuff muscle activity in a relatively simple manner. Shoulder function after reverse total shoulder arthroplasty associated with deltoid muscle activity also may be evaluated. Changes in tissue tightness in shoulder disorders caused by increase soft tissue stiffness (ie, adhesive capsulitis and glenohumeral internal rotation deficit) can be evaluated.

Risk Factors for Elbow and Shoulder Injuries in Adolescent Baseball Players: A Systematic Review

Background: The incidence of shoulder and elbow injuries among adolescent baseball players is on the rise. These injuries may lead to surgery or retirement at a young age. Purpose: To identify independent risk factors for elbow and shoulder injuries in adolescent baseball players. A secondary aim was to determine whether the literature supports the Major League Baseball and USA Baseball Pitch Smart guidelines. Study Design: Systematic review. Methods: A systematic review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines utilizing MEDLINE, SPORTDiscus, and Web of Science. Because of study heterogeneity, a quantitative synthesis was not performed. A qualitative review was performed on 19 independent risk factors for elbow and shoulder injuries in adolescent baseball players. Level of evidence was assigned per the Oxford Centre for Evidence-Based Medicine Working Group, and risk of bias was graded per the Newcastle-Ottawa Scale. Results: Twenty-two articles met criteria for inclusion. Of the 19 independent variables that were analyzed, age, height, playing for multiple teams, pitch velocity, and arm fatigue were found to be independent risk factors for throwing arm injuries. Pitches per game appears to be a risk factor for shoulder injuries. Seven independent variables (innings pitched per game, showcase participation, games per year, training days per week, pitch type, shoulder external rotation, and shoulder total range of motion) do not appear to be significant risk factors. The data were inconclusive for the remaining 6 variables (weight, months of pitching per year, innings or pitches per year, catching, shoulder horizontal adduction, and glenohumeral internal rotation deficit). Conclusion: The results from this study demonstrate that age, height, playing for multiple teams, pitch velocity, and arm fatigue are clear risk factors for throwing arm injuries in adolescent baseball players. Pitches per game appears to be a risk factor for shoulder injuries. Other variables are either inconclusive or do not appear to be specific risk factors for injuries.

Glenohumeral internal rotation deficit in throwing athletes: current perspectives

Glenohumeral internal rotation deficit (GIRD) is an adaptive process in which the throwing shoulder experiences a loss of internal rotation (IR). GIRD has most commonly been defined by a loss of >20° of IR compared to the contralateral shoulder. Total rotational motion of the shoulder is the sum of internal and external rotation and may be more important than the absolute value of IR loss. Pathologic GIRD has been defined as a loss of IR combined with a loss of total rotational motion. The leading pathologic process in GIRD is posterior capsular and rotator-cuff tightness, due to the repetitive cocking that occurs with the overhead throwing motion. GIRD has been associated with numerous pathologic conditions, including posterior superior labral tears, partial articular-sided rotator-cuff tears, and superior labral anterior-to-posterior tears. The mainstay of treatment for patients with GIRD is posterior capsular stretching and strengthening to improve scapular mechanics. In patients who fail nonoperative therapy, shoulder arthroscopy can be performed. Arthroscopic surgery in the high-level throwing athlete should be to restore them to their functional baseline with the minimum amount of intervention possible.

Assessment of upper extremity stability, GIRD (Glenohumeral internal rotation deficit)/GERG (Glenohumeral external rotation gain) ratio and strength of internal rotators (IR) and external rotators (ER) in badminton players

Racquet sports have gained increasing popularity in Asia. In the current study performed on 25 district level male badminton players aging between 18-25 years assessment of GIRD/GERG ratio, strength of internal, external rotators and of upper extremity stability was done on the dominant and non-dominant side. On statistical analysis using paired t-test.The internal and external rotators were stronger on dominant side when compared to the non-dominant side. The internal rotators were stronger than the external rotators on both dominant and non-dominant side. The external rotation range of motion was more than the internal range of motion on the dominant and non-dominant side. GIRD/GERG ratio was significant in badminton players (p>0.0001). Correlational statistics using Spearman’s test showed that the strength of the dominant side external rotators correlated with the CKCUEST.The strength of the non-dominant side external rotators, both side internal rotators and GIRD/GERG ratio did not have any significant correlation with the CKCUEST.

A COMPARATIVE STUDY OF PASSIVE SHOULDER ROTATION RANGE OF MOTION, ISOMETRIC ROTATION STRENGTH AND SERVE SPEED BETWEEN ELITE TENNIS PLAYERS WITH AND WITHOUT HISTORY OF SHOULDER PAIN

Glenohumeral internal rotation deficit and external rotation strength have been associated with the development of shoulder pain in overhead athletes. To examine the bilateral passive shoulder rotational range of motion (ROM), the isometric rotational strength and unilateral serve speed in elite tennis players with and without shoulder pain history (PH and NPH, respectively) and compare between dominant and non-dominant limbs and between groups. Cohort study. Fifty-eight elite tennis players were distributed into the PH group (n = 20) and the NPH group (n = 38). Serve velocity, dominant and non-dominant passive shoulder external and internal rotation (ER and IR) ROM, total arc of motion (TAM: the sum of IR and ER ROM), ER and IR isometric strength, bilateral deficits and ER/IR strength ratio were measured in both groups. Questionnaires were administered in order to classify characteristics of shoulder pain. The dominant shoulder showed significantly reduced IR ROM and TAM, and increased ER ROM compared to the non-dominant shoulder in both groups. Isometric ER strength and ER/IR strength ratio were significantly lower in the dominant shoulder in the PH group when compared with the NPH group. No significant differences between groups were found for serve speed. These data show specific adaptations in the IR, TAM and ER ROM in the dominant shoulder in both groups. Isometric ER muscle weakness and ER/IR strength ratio deficit appear to be associated with history of shoulder injuries in elite tennis players. It would be advisable for clinicians to use the present information to design injury prevention programs. 2.

Shoulder Injuries in the Overhead-Throwing Athlete: Epidemiology, Mechanisms of Injury, and Imaging Findings.

The unparalleled velocity achieved by overhead throwers subjects the shoulder to extreme forces, resulting in both adaptive changes and pathologic findings that can be detected at imaging. A key biomechanical principle of throwing is achieving maximum external rotation, which initially leads to adaptive changes that may result in a pathologic cascade of injuries. In addition to the well-established concepts of glenohumeral internal rotation deficit and internal impingement, osseous and soft-tissue injuries of the shoulder unique to overhead athletes are illustrated. The epidemiology and biomechanics of throwing injuries are reviewed, and examples from the authors' institutional experience with competitive, collegiate, and professional baseball players are provided to demonstrate the constellation of unique imaging findings seen in overhead throwing athletes. Given the widespread popularity of baseball, and other sports relying on overhead throwing motions at all playing levels from recreational to professional, it is important for radiologists in various practice settings to be familiar with the special mechanisms, locations, and types of shoulder injuries seen in the overhead throwing population. © RSNA, 2018.

Glenohumeral Internal Rotation Deficit and Risk of Upper Extremity Injury in Overhead Athletes: A Meta-Analysis and Systematic Review.

Context:Current perception dictates that glenohumeral internal rotation deficit (GIRD) is a chronic adaptation that leads to an increased risk of pathologic conditions in the dominant shoulder or elbow of overhead athletes.Objective:To determine whether adaptations in glenohumeral range of motion in overhead athletes lead to injuries of the upper extremity, specifically in the shoulder or elbow.Data Sources:An electronic database search was performed using Medline, Embase, and SportDiscus from 1950 to 2016. The following keywords were used: GIRD, glenohumeral internal rotation deficit, glenohumeral deficit, shoulder, sport, injury, shoulder joint, baseball, football, racquet sports, volleyball, javelin, cricket, athletic injuries, handball, lacrosse, water polo, hammer throw, and throwing injury.Study Selection:Seventeen studies met the inclusion criteria for this systematic review. Of those 17 studies, 10 included specific range of motion measurements required for inclusion in the meta-analysis.Study Design:Systematic review and meta-analysis.Level of Evidence:Level 4.Data Extraction:Data on demographics and methodology as well as shoulder range of motion in various planes were collected when possible. The primary outcome of interest was upper extremity injury, specifically shoulder or elbow injury.Results:The systematic review included 2195 athletes (1889 males, 306 females) with a mean age of 20.8 years. Shoulders with GIRD favored an upper extremity injury, with a mean difference of 3.11° (95% CI, –0.13° to 6.36°; P = 0.06). Shoulder total range of motion suggested increased motion (mean difference, 2.97°) correlated with no injury (P = 0.11), and less total motion (mean difference, 1.95°) favored injury (P = 0.14). External rotational gain also favored injury, with a mean difference of 1.93° (P = 0.07).Conclusion:The pooled results of this systematic review and meta-analysis did not reach statistical significance for any shoulder motion measurement and its correlation to shoulder or elbow injury. Results, though not reaching significance, favored injury in overhead athletes with GIRD, as well as rotational loss and external rotational gain.

Prevalence of Glenohumeral Internal Rotation Deficit and its Association with Scapular Dyskinesia and Rotator Cuff Strength Ratio in Collegiate Athletes Playing Overhead Sports

Introduction: Glenohumeral Internal Rotation Deficit (GIRD) indicates a 15° or greater loss of internal rotation of the throwing shoulder compared with the non-dominant shoulder.Aim: To estimate the prevalence of GIRD in collegiate overhead sports player and determine whether GIRD is associated with scapular dyskinesia and rotator cuff strength ratio. Materials and Methods: The present study was a Cross-sectional study. A total of 127 collegiate athletes were assessed for passive range of motion, external to internal rotation strength ratio (ER/IR ratio) and scapular dyskinesia for the throwing and non-throwing shoulder. Internal and external rotation of shoulder was measured using an inclinometer with the subject in prone and arm abducted to 90°. Scapular dyskinesia was measured using Lateral Scapula Slide test (LSST) and external to internal rotator strength was measured using a held hand isometric dynamometer. Chi-square test was used to find the association between GIRD and scapular dyskinesia and rotator cuff strength ratio.Results: Prevalence of GIRD (n=37) was found to be 29.1%. GIRD was not found to be associated with Scapular dyskinesia (p=0.237) and ER/IR strength ratio (p=0.411).Conclusion: Prevalence of GIRD in collegiate athletes playing overhead sports was found to be 29.1% and there was no association of GIRD with scapular dyskinesia, rotator cuff strength ratio.

Effects of glenohumeral internal rotation deficit on baseball pitching among pitchers of different ages

Previous studies have reported that glenohumeral internal rotation deficit (GIRD) may increase the risk of shoulder injury. However, the effects of GIRD on baseball pitching among pitchers of different age groups are still unclear. The study participants were 24 high school and 24 university pitchers. For each age group, the pitchers were evenly divided into a GIRD group and a normal group. The pitching motion of each participant was captured using a motion analysis system at a sampling frequency of 300 Hz. The kinematics and kinetics of the throwing shoulder and trunk were quantified, and statistical differences between the groups were examined by 2-sample t tests. For both age groups, significant differences were observed in shoulder external rotations of the GIRD and normal groups. Compared with the university pitchers in the normal group, the university pitchers with GIRD exhibited a greater shoulder loading and did more internal rotation work in the acceleration phase. The high school pitchers with GIRD showed a larger trunk tilt and less trunk rotation than the university pitchers with GIRD. However, the university pitchers with GIRD exhibited a larger shoulder posterior force and horizontal adduction torque than the high school pitchers with GIRD. Pitchers with GIRD do change their pitching motions, and the greater resulting shoulder joint loading predisposes them to a greater risk of shoulder injury, especially among university pitchers.

The Effect of Glenohumeral Internal Rotation Deficit Rehabilitation Training on Exercise Performance &amp; Body Shape Displacement in High-School Baseball Pitchers

The Effect of Glenohumeral Internal Rotation Deficit Rehabilitation Training on Exercise Performance &amp; Body Shape Displacement in High-School Baseball Pitchers

Glenohumeral internal rotation deficit in table tennis players

ABSTRACTTable tennis requires rapid and extreme movements that may result in shoulder adaptations, such as glenohumeral internal rotation deficit, which is a risk factor for several injuries. This study compared range of motion of internal and external rotation and total rotation motion of glenohumeral joint between dominant and non-dominant shoulders of table tennis players. This is a cross-sectional observational study. Twenty healthy male table tennis players that were enrolled in an official table tennis league took part in this study (mean age: 22.9 ± 12.9 years, time of sports practice: 6.2 ± 7.12 years). Measurements of passive glenohumeral external rotation and internal rotation were taken with the individuals in the supine and sidelying positions. Total rotation motion was calculated by summing external and internal rotations. The dominant side showed decreased internal rotation when compared to non-dominant side in both supine (mean difference: 14.9°, p = 0.02) and sidelying positions (mean difference: 16.3°, p = 0.01). No significant difference (p > 0.05) was found for external rotation and total rotation motion between dominant and non-dominant shoulders. The findings indicate that table tennis players exhibit glenohumeral internal rotation deficit of dominant shoulder.

Decreased Shoulder External Rotation and Flexion Are Greater Predictors of Injury Than Internal Rotation Deficits: Analysis of 132 Pitcher-Seasons in Professional Baseball

The primary aims of this work were to (1) describe normal range of motion (ROM) profiles for elite pitchers, (2)describe the characteristics of shoulder and elbow injuries in professional pitchers over a 6-year period in one Major League Baseball organization, and (3) identify ROM measures that were independently associated with a future shoulder or elbow injury. Over 6 seasons (2010-2015), a preseason assessment was performed on all pitchers invited to Major League Baseball Spring Training for a single organization. ROM measures included shoulder flexion, horizontal adduction, external rotation (ER), internal rotation, as well as elbow flexion and extension, were measured for both the dominant and nondominant arm, and total range of motion and deficits were calculated. All noncontact shoulder and elbow injuries were identified. Using multivariate binomial logistic regression analysis to control for age, height, weight, and all other ROM measures, the factors associated with an increased risk of subsequent shoulder or elbow injury were identified. A total of 53 shoulder (n= 25) and elbow (n= 28) injuries occurred during 132 pitcher seasons (n=81 pitchers). The most significant categorical risk factor associated with increased elbow injury rates was the presence of a shoulder flexion deficit >5° (odds ratio [OR] 2.83; P= .042). For continuous variables, the risk of elbow injury increased by 7% for each degree of increased shoulder ER deficit (OR 1.07; P= .030) and 9% for each degree of decreasedshoulder flexion (OR 1.09; P= .017). None of the measures significantly correlated with shoulder injuries. Preseason shoulder ER and flexion deficits are independent risk factors for the development of elbow injuries during the upcoming season. Although prior work has supported the importance of reducing glenohumeral internal rotation deficits in pitchers, this study demonstrates that deficits in shoulder ER and flexion are more significant predictors of subsequent elbow injury. Level III, retrospective comparative study.

Decreased Shoulder External Rotation and Flexion are Greater Predictors of Injury than Internal Rotation Deficits: Analysis of 132 Pitcher-Seasons in Professional Baseball

Objectives:There is a strong desire to identify modifiable risk factors for shoulder and elbow injuries in pitchers, that when corrected, have the potential to reduce injury burden. Although much attention has been paid to Glenohumeral Internal Rotation Deficits (GIRD), less is known about the value of other range of motion (ROM) deficits. Therefore, the purpose of this work was to determine the impact and predictive capacity of shoulder and elbow ROM on shoulder and elbow injuries in professional baseball pitchers.Methods:Over the course of 6 seasons (2010 to 2015), a comprehensive, preseason assessment of ROM was performed on all pitchers (n=132 pitcher-seasons) invited to Major League Baseball (MLB) Spring Training Camp for a single MLB organization. Total range of motion (TROM) and deficits were also calculated. All non-traumatic shoulder and elbow injuries that resulted in at least one day out of play were identified. Using multivariate binomial logistic regression analysis to control for age, height, weight, and all other ROM measures, the factors associated with an increased risk of subsequent shoulder or elbow injury were identified.Results:53 shoulder (n=25) and elbow (n=28) injuries occurred during 132 pitcher-seasons. The most significant categorical risk factors associated with increased elbow injury rates included the presence of a shoulder ER deficit > 5° (OR 2.40; p=0.069) and shoulder flexion deficit > 5° (OR 2.83; p=0.042). For continuous variables, the most important factors included increasing shoulder ER deficit (OR 1.07, p=0.030), decreased shoulder flexion (OR 1.09, p=0.017), increased IR deficit (OR 1.04, p=0.068), weight (OR 1.10, p=0.012), and decreased shoulder ER (OR 1.06; p=0.076).Conclusion:A number of preseason ROM parameters are independent risk factors for the development of shoulder and elbow injuries during the upcoming season. This is particularly true for shoulder ER and flexion deficits. Although prior work has supported the importance of reducing GIRD in professional pitchers, this study demonstrates that deficits in shoulder ER and flexion are more significant predictors of subsequent injury.

Acute effects of self-myofascial release and stretching in overhead athletes with GIRD

ObjectiveTo examine the acute effects of self-myofascial release (SMR), static stretching (SS), and the combination of self-myofascial release and static stretching (SMR + SS) on glenohumeral internal rotation range of motion (GH IR ROM) in overhead athletes with glenohumeral internal rotation deficit (GIRD). ParticipantsTwelve asymptomatic adult male amateur softball position players exhibiting GIRD. ResultsAll three methods significantly improved GH IR ROM. Post hoc testing revealed that SS alone and SMR + SS improved GH IR ROM significantly more than SMR alone. However, there were no significant differences in GH IR ROM between SS alone and SMR + SS. ConclusionsIf an athlete has a limited time to perform a warm-up (e.g., 3–4 min), SS alone is recommended to improve GH IR ROM. However, if the athlete has more time available to warm up (e.g., 7–8 min), combining SMR + SS may result in a greater increase in GH IR ROM.

Paper #53 - Reproducibility and validity of goniometric iPhone applications for shoulder range measurements in elite throwers

Introduction: Shoulder ROM assessment is important in diagnosing conditions such as glenohumeral internal rotation deficits (GIRD) and adhesive capsulitis that are commonly found in throwing athletes and can lead to serious injury. The purpose of this study was to evaluate the utility of current iPhone applications to measure passive shoulder range of motion (ROM) in baseball pitchers compared to the traditional goniometer. Methods: Two trained measurers collected forward flexion, internal rotation and external rotation measurements on both throwing and non-throwing shoulders in 10 elite pitchers using a goniometer and three new iPhone apps (GetMyROM, Joint Goniometry, Clinometer) used to measure joint range of motion. Measurements were taken with throwers in supine position using an iPhone 5s and a Baseline 360° goniometer. Participants performed a standard warm-up procedure before having shoulder measurements taken by one measurer and then repeated by another measurer following a 10-minute rest break. Order of measurements, shoulder measured, measurement device and measurer were randomized. Measurements were compared between the three iPhone apps and the goniometer using paired t-tests. Results: Significant differences ranging from 1.6° to 5.5° were found when measuring internal rotation with Joint Goniometer and Clinometer apps. Joint goniometer measurements for forward flexion showed a significant difference of 3.1° in throwing shoulders only. No significant differences (P > .05) were found between the iphone apps and goniometer when measuring external rotation in both shoulders. Discussion: Overall, differences between the iphone applications and the goniometer were small (<6°) and non-significant. However, it is important to be aware of measurement differences between the iPhone and the goniometer when comparing measurements. These results suggest that iphone based applications provide a valid alternative to the goniometer when measuring shoulder range of motion. The iPhone applications are an accurate and easy to use modality that may be more accessible to the entire athletic community given the high prevalence of iPhones when compared to the traditional goniometer. Minimal training is needed to use the iPhone applications, which are designed with a user-friendly interface and built-in tutorials. Therefore, iPhone based ROM measurement may allow for more widely accepted ROM measurement protocols to aid in diagnosing and preventing injuries in throwing athletes.

Care of Shoulder Pain in the Overhead Athlete.

Shoulder complaints are common in the overhead athlete. Understanding the biomechanics of throwing and swimming requires understanding the importance of maintaining the glenohumeral relationship of the shoulder. Capsular laxity, humeral retrotorsion, glenoid retroversion, glenohumeral internal rotation deficit, and scapular dyskinesis can all contribute to shoulder dysfunction and pain. Injuries are more likely during peak height velocity, especially when coupled with overuse, previous injuries not adequately treated, or change in the demands on the shoulder such as a new technique, bigger field, or longer race. Working with physical therapists, athletic trainers, and coaches to identify and treat the etiology of the shoulder dysfunction will help pediatricians return the athlete to activity and prevent future injury. [Pediatr Ann. 2017;46(3):e112-e119.].

Are professional handball players at risk for developing a glenohumeral internal rotation deficit in their dominant arm?

ABSTRACTObjectives: Overhead athletes, such as baseball players, have been shown to have adaptive changes in the shoulder range of motion (ROM) of their dominant arm. Professional handball players are a unique subtype of overhead athletes with very different demands from baseball players. The aim of this study was to determine if professional handball players demonstrate differences in shoulder ROM between their dominant and non-dominant arm and try to relate them with new variables.Methods: Fifty professional male handball players were included and completed a questionnaire regarding age at which they started to play, number of hours they practice a week, field position and arm dominance. ROM measurements were performed including forward flexion (FF), external rotation with the shoulder in abduction (ABER) and with adducted arm (ADER) and internal rotation with shoulder in abduction (IR). Statistical analysis was performed to determine differences in ROM between the dominant and non-dominant shoulder and if there is a relationship between these differences and shoulder load or field position.Results: The dominant arm showed decreased internal rotation (47 vs. 56 degrees, p < 0.001) and increased external rotation both with the arm abducted (99 vs. 88 degrees, p < 0.001) and at the side (62 vs 57 degrees, p = 0.001). This was not correlated with shoulder load for any movement (FF, p = 0.980; ABER, p = 0.741; ADER, p = 0.803; IR, p = 0.085) but was dependent on field position with first line players showing the highest internal rotation deficit (13 degrees vs. 6–7 degrees in the other field positions, p = 0.013).Conclusion: This study showed that professional male handball players with a first line position have a significant risk for developing a glenohumeral internal rotation deficit, similar to the phenomenon seen in baseball pitchers.

Immediate effects of two types of stretching techniques on glenohumeral internal rotation deficit and posterior shoulder tightness; a crossover randomised controlled trial.

Objectives: Various stretching techniques have been proposed to prevent or improve Glenohumeral Internal Rotation Deficit (GIRD) and Posterior Shoulder Tightness (PST). Common stretching techniques include modified sleeper stretch and cross-body stretch. The current evidence is unclear which stretching technique is more effective. This study aimed to examine immediate effects of modified sleeper stretch and cross-body stretch on GIRD and PST. Methods: This study was a crossover randomised controlled trial. 12 young healthy individuals (nine men and three women, age 20.9 ± 0.3 years, body mass index 21.3 ± 1.3) were recruited. At two separate sessions, participants actively performed a randomly assigned stretching technique; modified sleeper stretch, or cross-body stretch. Range of motions (ROM) of dominant shoulder in external rotation (ER), internal rotation (IR) and horizontal adduction (HA), were assessed before and after stretching interventions. Results: Both stretching interventions led to significant immediate improvements in IR and HA (p<0.01), however not in ER. There was no significant difference between the two intervention groups in terms of ROM changes. Conclusion: Both modified sleeper stretch, and cross-body stretch might be applied effectively to treat GIRD and PST in the short term, as long as they do not provoke pain.