Glenohumeral internal rotation deficit in throwing athletes: current perspectives

Abstract

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.

Sports Imaging of Team Handball Injuries

“…During the cocking phase, the humeral head moves posteriorly on the glenoid, the torso rotates forward, and forces on the anterior shoulder joint and rotator cuff activity increase. 13 The anterior joint capsule gets stretched, and internal impingement can occur. While the shoulder joint is in maximal external rotation, pectoralis major, latissimus dorsi, and subscapularis muscle activities initiate the acceleration phase to rotate the humerus internally.…”

Effect of Fascial Manipulation on Glenohumeral Internal Rotation Deficit in Overhead Athletes - A Randomized Controlled Trial

“…Overhead throwing athletes (OTA) tend to have restricted Internal rotation Range of Motion (IRROM) leading to Glenohumeral Internal Rotation Deficit (GIRD). Anatomical GIRD results in the loss of IRROM, along with an equivalent increase in ERROM due to increased humeral retro-version (HR) (1,2,3,6). The increased HR allows higher shoulder External Rotation Range of Motion (ERROM) during the cocking phase, thereby assisting the shoulder in reaching high rotational velocities.…”

“…The substantial increase in the thickness of the posterior capsule may occur due to repetitive strain injuries that occur over a period of repeated overhead throwing movements. This leads to the formation of reactive scar tissue over the posterior capsule and shoulder musculature thereby resulting in GIRD (3,4,5). Pathologic GIRD occurs when there is a deficit in the Total Arc of Rotational Motion (TARM) where the IRROM loss is more than the ERROM gain.…”

“…Since there is a plausible association between the UCL adaptations and GIRD and the progressive adaptations of GIRD in OTA, it is vital to improve GIRD to reduce the risk of shoulder and elbow injuries in OTA (8). Joint mobilization, shoulder capsular release using balls, and stretching of the posterior capsule are the conventional treatment strategies used in the management for GIRD (3,6). These traditional treatment methods focus only on the rigid posterior capsular structure.…”

Glenohumeral internal rotation deficit in non-pitcher overhead athletic athletes: case series analysis of ten athletes

“…This disorder is defined as loss of 20° of internal rotation compared to the contralateral shoulder and occur during the late cocking and early acceleration phase. This process has been thought as an adaptive process of the shoulder to compensate for the repeated stresses exerted during a throwing motion [ [1] , [2] , [3] ]. This condition mostly appeared and described in details in athletes with overhead activities i.e.…”