Rotation Deficit Research Articles

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.

Efficacy of a Prevention Program for Medial Elbow Injuries in Youth Baseball Players

Background: Youth baseball players are at high risk for elbow injuries, which can lead to future functional disability. Purpose: To evaluate the effectiveness of a prevention program to lower the risk of medial elbow injury in these athletes. Study Design: Cohort study; Level of evidence, 2. Methods: Youth baseball players, 8 to 11 years old, without a history of elbow and shoulder pain, were allocated to either the intervention (n = 136) or control (n = 169) group. The intervention consisted of 9 strengthening and 9 stretching exercises, performed during warm-up or at home, with high compliance defined as completion of the program 1 or more times per week. The following outcome variables were measured: clinical assessment of the elbow and shoulder joint, ultrasonography assessment of the elbow, and assessment of physical function (passive range of motion of the elbow, shoulder, and hip; strength of the shoulder and scapular muscles; and measurement of the thoracic kyphosis angle). The clinical and ultrasonography assessments were measured at baseline and at 3-month intervals over the 1-year follow-up. Physical function outcomes were measured at baseline and at the endpoint of the follow-up. The primary endpoint of effectiveness was the incidence of medial elbow injury. Secondary endpoints were absolute measures of physical function and change in these measures over the 1-year follow-up. Results: The incidence rate of medial elbow injury was significantly lower in the intervention group (0.8/1000 athlete-exposures) than the control group (1.7/1000 athlete-exposures) (hazard ratio, 50.8%; 95% CI, 0.292-0.882; P = .016). The program improved total range of shoulder rotation (dominant side), hip internal rotation (nondominant side), shoulder internal rotation deficit (bilaterally), lower trapezius muscle strength (dominant side), and the thoracic kyphosis angle. Improvements in the following variables of physical function were predictive of a lower rate of medial elbow injury: increased total shoulder total rotation (odds ratio [OR], 0.973; 95% CI, 0.950-0.997), increased hip internal rotation of the nondominant side (OR, 0.962; 95% CI, 0.936-0.989), and decreased thoracic kyphosis angle (OR, 1.058; 95% CI, 1.015-1.103). Conclusion: A prevention program aiming to improve physical function can prevent medial elbow injury in youth baseball players.

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

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

Piperine in combination with quercetin halt 6-OHDA induced neurodegeneration in experimental rats: Biochemical and neurochemical evidences

Parkinson’s disease (PD) is a multifactorial neurological disorder caused by selective dopaminergic neuronal loss. Quercetin (QC) in combination with piperine (bioenhancer) acts as potential antioxidant, anti-inflammatory and neuroprotective against 6-OHDA rat model of PD. Rats were injected 6-OHDA (8μg/2μl, saline) unilaterally, intranigrally once into right SNpc. Pre-treatment with QC (25 and 50mg/kg, p.o.) alone and combination of QC (25mg/kg, p.o.) with piperine (2.5mg/kg, p.o.) were given for 14days starting from 8th day of 6-OHDA infusion. Post lesions were confirmed by rotational behavior with amphetamine (2.5mg/kg, i.p.) and motor coordination was assessed by narrow beam walk, open field and rotarod apparatus on the weekly basis. On 22nd day, animals were sacrificed and striatum homogenates were used for biochemical (LPO, GSH, Nitrite), neuroinflammatory (TNF-α, IL-1 β and IL-6) and neurotransmitter (dopamine, norepinephrine, serotonin, GABA, glutamate) analysis. Rats pre-treated with QC alone and in combination with piperine have significantly attenuated the 6-OHDA induced rotational behavior and motor deficits. Further, these drugs have significantly improved antioxidant potential, decreased striatal proinflammatory cytokines level as well as restored neurotransmitters level. The neuroprotective enhancement of QC along with piperine is attributed through antioxidant, anti-inflammatory and preventing neurotransmitter alteration mechanisms.

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.

The association between infantile postural asymmetry and unsettled behaviour in babies.

Questions remain regarding the construct validity of the infantile postural asymmetry scale. No association between unsettled infant behaviour and infantile postural asymmetry was found in 12- to 16-week-old infants. The influence of sex on the interaction between infantile postural asymmetry and infant behaviour needs further examination. An association between unsettled infant behaviour and infantile postural asymmetry is still unproven. What is known: • Unsettled infant behaviour has a considerable impact on many family situations. • Identifying a definitive cause has been a source of much examination and research. Many different hypotheses have been suggested yet much is still unknown. What is new: • The association between unsettled infant behaviour and infantile postural asymmetry is still unproven. • The need to validate a reliable tool to measure infantile postural asymmetry, with particular focus on cervical spine rotation deficit, is indicated.

Antegrade intramedullary Kirschner-wire fixation of displaced metacarpal shaft fractures

PurposeThe objective of this study was to analyze complications and patient-related functional outcome after antegrade intramedullary Kirschner-wire fixation of metacarpal shaft fractures.MethodsAll consecutive patients treated from January 2010 until December 2015 were retrospectively analyzed using patient logs and radiographic images. Indications for operative fixation were angulation > 40°, shortening > 2 mm, or rotational deficit. Complications were registered from the patient logs. Functional outcome was assessed with the Patient-rated wrist/hand evaluation (PRWHE) and Disabilities of the Arm, Shoulder, and Hand score (DASH) questionnaire both ranging from 1 to 100 after a minimum follow-up of 6 months.ResultsDuring the study period, 34 fractures of 27 patients could be included. Mean outpatient follow-up was 11 weeks (range 4–24 weeks). The mean interval for functional assessment was 30 months (range 8–62 months) and 19 patients (70%) responded to the questionnaires. During outpatient follow-up, all fractures proceeded to union with no signs of secondary fracture dislocation or implant migration. One re-fracture after a new adequate trauma was seen and one patient underwent tenolysis due to persistent pain and impaired function. In 26 cases (81%), the K-wires were removed of which 23 (68%) were planned removals. Functional outcome was excellent with mean PRWHE and DASH scores of 7 and 5 points, respectively.ConclusionsIf surgical treatment for metacarpal shaft fractures is considered, we recommend antegrade intramedullary K-wire fixation. This technique results in low complication rates and excellent functional outcome.

Effectiveness of a specific manual approach to the suboccipital region in patients with chronic mechanical neck pain and rotation deficit in the upper cervical spine: study protocol for a randomized controlled trial

BackgroundMechanical neck pain is a highly prevalent problem in primary healthcare settings. Many of these patients have restricted mobility of the cervical spine. Several manual techniques have been recommended for restoring cervical mobility, but their effectiveness in these patients is unknown. The aim of the present study is to compare the effectiveness of two types of specific techniques of the upper neck region: the pressure maintained suboccipital inhibition technique (PMSIT) and the translatory dorsal glide mobilization (TDGM) C0-C1 technique, as adjuncts to a protocolized physiotherapy treatment of the neck region in subjects with chronic mechanical neck pain and rotation deficit in the upper cervical spine.MethodsA randomized, prospective, double-blind (patient and evaluator) clinical trial. The participants (n = 78) will be randomly distributed into three groups. The Control Group will receive a protocolized treatment for 3 weeks, the Mobilization Group will receive the same protocolized treatment and 6 sessions (2 per week) of the TDGM C0-C1 technique, and the Pressure Group will receive the same protocolized treatment and 6 sessions (2 per week) of the PMSIT technique. The intensity of pain (VAS), neck disability (NDI), the cervical range of motion (CROM), headache intensity (HIT-6) and the rating of clinical change (GROC scale) will be measured. The measurements will be performed at baseline, post-treatment and 3 months after the end of treatment, by the same physiotherapist blinded to the group assigned to the subject.DiscussionWe believe that an approach including manual treatment to upper cervical dysfunction will be more effective in these patients. Furthermore, the PMSIT technique acts mostly on the musculature, while the TDGM technique acts on the joint. We expect to clarify which component is more effective in improving the upper cervical mobility.Trial registrationClinicalTrials.gov NCT02832232. Registered on July 13th, 2016.

Pectoralis Minor Contracture in Throwing Shoulders of Asymptomatic Adolescent Baseball Players.

Background:Although scapular malpositioning is commonly associated with rotational deficits and risk of injury, modifiable causes of such malpositioning in overhead athletes are not well described.Purpose/Hypothesis:The purpose of this study was to examine the scapulothoracic profile of adolescent baseball players, specifically, pectoralis minor (PM) length. We hypothesized that PM would be shorter in throwing shoulders compared with nonthrowing shoulders.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Forty-nine healthy adolescent baseball players underwent clinical screening of PM lengths in throwing and nonthrowing shoulders by means of previously described, validated techniques. PM measurements were conducted while players were supine with arms at rest, sitting with arms at rest, and sitting with shoulders in maximal external rotation; measurements were made with a digital caliper and by assessment of table-to-acromion distance. Static scapular position and range of motion measurements were recorded. Demographic information and playing history were documented.Results:All players were male, they had a mean ± SD age of 16.2 ± 1.16 years, and they predominantly threw right-handed (83.7%). Sixty-nine percent of players were pitchers, 61.2% had played baseball for 9 or more months per year, and 67.3% had played in excess of 30 games in the previous year. Significant differences were noted during side-to-side comparisons within participants. Absolute PM length was significantly shorter in throwing compared with nonthrowing shoulders when measured with players sitting with arms at rest (by 3.7 ± 11.8 mm) and with their shoulders in maximal external rotation (by 4.8 ± 15.1 mm) (P < .004 for both). The PM index was significantly reduced in throwing compared with nonthrowing shoulders while players were supine with arms at rest (P = .007), sitting with arms at rest (P = .006), and sitting with shoulders in maximal external rotation (P < .001). Mean table-to-acromion distance was increased 7.7 ± 1.26 mm in throwing versus nonthrowing arms (P < .001). The scapular index was significantly reduced in throwing compared with nonthrowing shoulders (P < .005).Conclusion:Asymptomatic adolescent baseball players have significant differences in PM length and static scapular measurements in throwing compared with nonthrowing shoulders. The clinical significance requires further investigation, but emphasis on PM stretching routines is encouraged.

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.

Ha-Eri Chari procedure for recurrent anterior dislocation of shoulder

Background: To evaluate the functional outcome following Ha-Eri Chari procedure as treatment for recurrent anterior dislocation of shoulder. Materials and methods: This study is a prospective study. 20 patients aged 20 to 44, who underwent Ha-Eri chari procedure from 2014 to 2016 for recurrent anterior dislocation of the right (n=14) and left (n=6) shoulders were included in this study. The mean number of dislocations was 20. The patients were evaluated every 12 weeks during the first year and every 6 months thereafter. The mean follow-up period was 12 months. Outcome was evaluated using the Burkhead and Rockwood criteria. Results: Outcome was excellent in 16 patients, good in 4. None had poor outcome. The mean external rotation deficit at 00 and 900 of abduction improved. No patient had evidence of loosening, infection, re dislocation, migration of coracoid screw or glenohumeral arthritis. Conclusion: Ha-Eri Chari procedure is a viable and simple treatment for recurrent anterior shoulder dislocation. This procedure is relatively simple and can be performed by all orthopaedic surgeons without the need of specialised arthroscopic instruments.

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.

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.

Congenital muscular torticollis: Use of gaze angle and translational deformity in assessment of facial asymmetry.

Background:Assessment of facial asymmetry is challenging in torticollis deformity. Neck tilt in toroticollis is associated with deviation of horizontal ocular gaze and translation of neck from the midline. These deviations can be assessed clinically and can be used as surrogate marker for facial asymmetry.Materials and Methods:Thirty five children with congenital muscular torticollis (CMT) were classified into three grades of severity based on the new clinical score. The parameters included in the scoring system included rotational deficit, side flexion deficit, gaze angle (GA), and translational deformity (TD). Seven children had Grade I (mild), 18 had Grade II (moderate), and 10 had Grade III (severe) CMT. There were 21 girls and 14 boys with a mean age of 8.46 years (range 3–16 years). Twenty two children underwent a bipolar release, and 13 had unipolar surgery. Facial asymmetry (FA) signs were noted and based on GA and TD; all children had a deviation from the neutral angles (GA of 90° and 0 mm translation from the midsterna plumb line were considered neutral angle). The final outcome was based on the modified Cheng and Tang Score.Results:The mean GA in Grade I, II, and III improved from 81.71 to 90, 72.77 to 89.16, and 66.60 to 88, respectively (Chi-square P < 0.0001). The TD improved from 15 mm to 0 mm, 25.83 mm to 3.05 mm, and 36.6 mm to 6 mm in Grade I, II, and III, respectively (Chi-square P < 0.05). The rotational and side flexion deficits also improved across all grades of severity but were not statistically significant (P < 0.911 and P < 0.04). Twenty four children had an excellent outcome with complete correction of their GA and TD. Four children with Grade II CMT and seven children with Grade III who had a residual translation of 5 mm or more and GA less than neutral horizontal had a good outcome. No child had problems with scar cosmesis or prominent lateral bands, and there was no recurrence of deformity at a mean followup of 28 months (range 24–32 months).Conclusion:The GA and TD can be used to assess FA in torticollis management and significant improvement can be expected even in severe cases.

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.].

Rotational glenohumeral adaptations are associated with shoulder pathology in professional male handball players.

Glenohumeral range of motion adaptations may affect throwing athletes and contribute to shoulder injury. The purpose of this study was to evaluate shoulder rotation deficits among elite professional handball players and its correlation to the presence of shoulder pain and morphological changes. Eighty-seven elite professional handball players and 41 healthy non-athlete volunteers participated in the study. Evaluations included measurement of range of internal and external rotation, total arch of motion, identification of shoulder pain and ultrasound scan for diagnosis of rotator cuff tears and internal impingement. Glenohumeral rotational deficits (>20-25°) were found among 11 players group (13%). The throwing shoulders in the players group showed a decrease in internal rotation and an increase in external rotation with significantly larger ranges among players compared to the non-athlete group. Internal rotation deficit >20° was associated with higher incidence of shoulder pain among players. Both internal rotation deficits (>25°) and total arch of motion deficit (>20°) co-existed with higher incidence of internal impingement. Shoulder pain was common (36/97-41%) and was associated with decreased external rotation and total arch of motion. Internal impingement (found in 13/87-15%) correlated with decreased rotation ranges and a greater deficit in total arch of motion, whereas higher gain in external rotation correlated with a partial rotator cuff tear (found in 12/87-14%). Shoulder pathologies and problems commonly affected the group of handball players. Greater glenohumeral rotational deficits in throwing shoulders of handball players correlate with shoulder pain and internal impingement, while increased external rotation with partial rotator cuff tears. Such deficits affect 13% of the athlete population. Major clinical relevance of the study is to monitor handball players' shoulders both clinically and by proper imaging. Evaluation of range of rotation seems to identify shoulders at risk of the pathology. Cross-Sectional study with control group, Level II.

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.

Glenohumeral Internal Rotation Deficit (GIRD) in Asymptomatic Collegiate Cricket Bowlers and Badminton Players

Glenohumeral Internal Rotation Deficit (GIRD) in Asymptomatic Collegiate Cricket Bowlers and Badminton Players

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.