Biomechanical Analysis of Glenohumeral Internal Rotation Deficit in a Cadaveric Model

2010 ◽  
Author(s):  
Akash Gupta ◽  
Jeffrey Gates ◽  
Michelle H. McGarry ◽  
James E. Tibone ◽  
Thay Q. Lee
Keyword(s):  
Internal Rotation ◽  
Clinical Decision Making ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Clinical Decision ◽  
Biomechanical Analysis ◽  
Glenohumeral Internal Rotation Deficit ◽  
Posterior Translation ◽  
Throwers Shoulder ◽  
Cadaveric Model

Overhead throwing athletes have been shown to develop adaptive changes in humeral rotation to allow for higher throwing velocities. This manifests as an increase in humeral external rotation and a decrease in internal rotation, which is called glenohumeral internal rotation deficit (GIRD). The percentage of GIRD that significantly affects glenohumeral joint kinematics is not known. The objective of the study was to create a throwers shoulder model with fixed percentages of GIRD to determine at which point kinematic changes start occurring. The results showed that there was a significant decrease in posterior translation starting at 10% GIRD. With inferior translational loads, significantly less inferior translation starts occurring at 20% GIRD. The humeral head apex position at maximum external rotation moves superiorly, posteriorly and laterally, with significant changes in the superior direction occurring with 10% GIRD onwards. Overall, significant kinematic changes begin at 10% GIRD and this should be taken into account for clinical decision-making as to when intervention is necessary.

scholarly journals Internal Rotation and Scapular Position Differences: A Comparison of Collegiate and High School Baseball Players

2010 ◽  
Vol 45 (1) ◽  
pp. 44-50 ◽  
Author(s):  
Stephen J. Thomas ◽  
Kathleen A. Swanik ◽  
Charles B. Swanik ◽  
John D. Kelly
Keyword(s):  
High School ◽  
Internal Rotation ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Scapular Dyskinesis ◽  
Position Change ◽  
Baseball Players ◽  
Glenohumeral Internal Rotation Deficit ◽  
Rotator Cuff Injuries ◽  
Collegiate Baseball

Abstract Context: Conditions such as labral and rotator cuff injuries have been linked with decreases in glenohumeral internal-rotation and increases in external-rotation motion. Also, decreased glenohumeral internal rotation is strongly associated with scapular dyskinesis. Objective: To compare healthy collegiate and high school baseball players' glenohumeral joint range of motion and scapular position. Design: Cross-sectional study. Setting: Institutional research laboratory. Patients or Other Participants: Thirty-one male National Collegiate Athletic Association Division I collegiate (age  =  20.23 ± 1.17 years, height  =  186.24 ± 5.73 cm, mass  =  92.01 ± 7.68 kg) and 21 male high school baseball players (age  =  16.57 ± 0.76 years, height  =  180.58 ± 6.01 cm, mass  =  79.09 ± 11.51 kg). Main Outcome Measure(s): Glenohumeral internal and external rotation and scapular upward rotation were measured with a digital inclinometer. Scapular protraction was measured with a vernier caliper. All variables except scapular upward rotation were calculated as the difference between the dominant and nondominant sides. Results: Collegiate baseball players had more glenohumeral internal-rotation deficit (4.80°, P  =  .028) and total motion deficit (5.73°, P  =  .009) and less glenohumeral external-rotation gain (3.00°, P  =  .028) than high school players. Collegiate baseball players had less scapular upward rotation than high school players at the 90° (4.12°, P  =  .015, versus 3.00°, P  =  .025) and 120° (4.00°, P  =  .007, versus 3.40°, P  =  .005) positions. The scapular protraction difference was greater in collegiate baseball players than in high school players in the hands-on-hips and 90° positions (0.77 cm, P  =  .021, and 1.4 cm, P  =  .001). Conclusions: When comparing high school with collegiate baseball players, these data suggest that glenohumeral internal-rotation deficit and scapular position change as the level of competition increases.

GIRD syndrome in male handball and volleyball players: Is the decrease of total range of motion the turning point to pathology?

2021 ◽  
pp. 1-8
Author(s):  
Jonas Schmalzl ◽  
Helen Walter ◽  
Wolfram Rothfischer ◽  
Sören Blaich ◽  
Christian Gerhardt ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Turning Point ◽  
External Rotation ◽  
Constant Score ◽  
High Rate ◽  
Overhead Athletes ◽  
Glenohumeral Internal Rotation Deficit ◽  
Total Range ◽  
Volleyball Players

BACKGROUND: Adaptations in glenohumeral range of motion may affect overhead athletes and lead to shoulder pathologies. OBJECTIVE: The purpose of this study was to evaluate glenohumeral internal rotation deficit (GIRD) and postero-superior impingement among male handball and volleyball players and the relationship between these pathologies and training level (amateur vs. professional), position (attack vs. no attack), experience (> 5 years vs. < 5 years) and sports. METHODS: Sixty-seven handball players and 67 volleyball players with a mean age of 25 [± 5] years were included. The range of motion including external and internal rotation in 90∘ abduction of the dominant and non-dominant shoulder was measured of each examined athlete. Visual analogue scale, disabilities of the shoulder and hand score, constant score and subjective shoulder value were recorded. The athletes were examined for postero-superior impingement and abduction force was measured with an isokinetic dynamometer. RESULTS: Internal rotation was significantly lower and external rotation was significantly greater in the dominant arm for both sports. 72% presented with GIRD. GIRD was more prevalent in athletes active for > 5 years (odds ratio (OR) 3), in those training > 3 times per week (OR 1.4) and in handball players (OR 2.7). 24% presented with postero-superior impingement. Players active for > 5 years (OR 1.22), professionals (OR 1.14), volleyball players (OR 1.19), offensive players (OR 2.2) and athletes with GIRD > 10∘ (OR 1.5) showed a higher prevalence of postero-superior impingement. CONCLUSION: GIRD is a common phenomenon in handball and volleyball players. Offensive players are frequently suffering from postero-superior impingement. GIRD > 10∘ leads in nearly 75% of the athletes to a decrease of total range of motion and a high rate of postero-superior impingement. Thus, a decreased range of motion seems to be the turning point from adaptation to pathology. Therefore, regular controls of range of motion and countermeasures by means of stretching the posterior shoulder joint should be integrated in the training content.

scholarly journals Characterization of Ankle Kinematics and Constraint Following Ligament Rupture in a Cadaveric Model

2019 ◽  
Vol 141 (11) ◽  
Author(s):  
Bardiya Akhbari ◽  
Matthew H. Dickinson ◽  
Ednah G. Louie ◽  
Sami Shalhoub ◽  
Lorin P. Maletsky
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Training Data ◽  
Ankle Injuries ◽  
Ankle Sprains ◽  
Ligament Rupture ◽  
Ankle Kinematics ◽  
Posterior Translation ◽  
Ankle Mobility ◽  
And Inversion

Ankle sprains are a common injury that may need reconstruction and extensive physical therapy. The purpose of this study was to provide a description of the biomechanics of the ankle joint complex (AJC) after anterior talofibular (ATFL) and calcaneofibular (CFL) ligament rupture to better understand severe ankle injuries. The envelope of motion of ten cadaveric ankles was examined by manual manipulations that served as training data for a radial basis function used to interpolate ankle mobility at flexion angles under load and torque combinations. Moreover, ankle kinematics were examined, while tendons were loaded to identify how their performance is altered by ligament rupture. The increased force required to plantarflex the ankle following ligament rupture was measured by calculating the load through the Achilles. Following ATFL injury, the largest changes were internal rotation (5 deg) in deep plantarflexion and anterior translation (1.5 mm) in early plantarflexion. The combined ATFL and CFL rupture changed the internal/external rotation (3 deg), anterior/posterior translation (1 mm), and inversion (5 deg) throughout flexion relative to the isolated ATFL rupture. Moreover, the Achilles' load increased by 24% after the rupture of ligaments indicating a reduction in its efficiency. This study suggests that if patients demonstrate primarily an increased laxity in internal rotation, the damage has solely occurred to the ATFL; however, if the constraint is reduced across multiple motions, there is likely damage to both ligaments. Higher loads in the Achilles suggest that it is overloaded after the injury; hence, targeting the calf muscles in rehabilitation exercises may reduce patients' pain.

Measurement of Glenohumeral Internal Rotation in Asymptomatic Tennis Players and Swimmers

2009 ◽  
Vol 37 (5) ◽  
pp. 1017-1023 ◽  
Author(s):  
Renato Rangel Torres ◽  
João Luiz Ellera Gomes
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Control Group ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Tennis Players ◽  
Glenohumeral Internal Rotation Deficit ◽  
Significant Difference ◽  
Overhead Sports ◽  
The Difference

Background Glenohumeral internal rotation deficit, often diagnosed in players of overhead sports, has been associated with the development of secondary shoulder lesions. Hypothesis Asymptomatic players of different overhead sports will exhibit variable degrees of glenohumeral internal rotation deficit. Study Design Cross-sectional study; Level of evidence, 3. Methods Fifty-four asymptomatic male volunteers (108 shoulders) divided into 3 groups (tennis players, swimmers, control group) underwent measurements of glenohumeral internal and external rotation using clinical examination with scapular stabilization. Measurements of dominant and nondominant shoulders were compared within and between groups. Glenohumeral internal rotation deficit (GIRD) was defined as the difference in internal rotation between the nondominant and dominant shoulders. Results In tennis players, mean GIRD was 23.9° ± 8.4° (P < .001); in swimmers, 12° ± 6.8° (P < .001); and in the control group, 4.9° ± 7.4° (P = .035). Dominant shoulders showed significant difference between all groups, and the difference in internal rotation of the dominant shoulder between the group of tennis players in comparison with the control group (27.6°, P < .001) was greater than the difference in internal rotation of the dominant shoulder found in the group of swimmers compared with the control group (17.9°, P < .001). Between tennis players and swimmers, the difference in internal rotation of the dominant shoulder was 9.7° (P = .002). Conclusion Dominant limbs showed less glenohumeral internal rotation than the nondominant limbs in all groups, with the deficit in the group of tennis players about twice the deficit found for swimmers. Mean difference between limbs in the control group was less than 5°, which is within normal parameters according to most studies. There were statistically significant differences between all groups when dominant shoulders were compared with each other, differences that were not compensated by external rotation gain. Tennis players had the least range of motion, followed by swimmers.

Three-Dimensional Scapular Kinematics during the Throwing Motion

2008 ◽  
Vol 24 (1) ◽  
pp. 24-34 ◽  
Author(s):  
Kristin E. Meyer ◽  
Erin E. Saether ◽  
Emily K. Soiney ◽  
Meegan S. Shebeck ◽  
Keith L. Paddock ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Angular Position ◽  
Three Dimensional ◽  
Low Velocity ◽  
Dynamic Activity ◽  
Motion Data ◽  
Asymptomatic Subjects ◽  
Scapular Motion

Proper scapular motion is crucial for normal shoulder mechanics. Scapular motion affects glenohumeral joint function during throwing, yet little is known about this dynamic activity. Asymptomatic subjects (10 male and 10 female), ages 21 to 45, were analyzed. Electromagnetic surface sensors on the sternum, acromion, and humerus were used to collect 3-D motion data during three trials of low-velocity throwing. Scapular angular position data were described for five predetermined events throughout the throw corresponding with classic descriptions of throwing phases, and trial-to-trial reliability was determined. ANOVA compared scapular angles across events. Subjects demonstrated good to excellent reliability between trials of the throw (ICC 0.74–0.98). The scapula demonstrated a pattern of external rotation, upward rotation (peak of approx. 40°), and posterior tilting during the initial phases of the throw, progressing into internal rotation after maximum humeral horizontal abduction. During the arm acceleration phase, the scapula moved toward greater internal rotation and began anteriorly tilting. At maximum humeral internal rotation, the scapula ended in internal rotation (55°), upward rotation (20°), and anterior tilting (3°).

scholarly journals Four-Dimensional Computed Tomography Evaluation of Shoulder Joint Motion in Collegiate Baseball Pitchers

2021 ◽  
Author(s):  
Daisuke Momma ◽  
Alejandro A Espinoza Orías ◽  
Tohru Irie ◽  
Tomoyo Irie ◽  
Eiji Kondo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Internal Rotation ◽  
Contact Area ◽  
Humeral Head ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Ct Scanning ◽  
4D Ct ◽  
Collegiate Baseball ◽  
Baseball Pitchers

Abstract The purpose of this study is to evaluate the glenohumeral contact area, center of glenohumeral contact area, and center of humeral head during simulated pitching motion in collegiate baseball pitchers using four-dimensional computed tomography (4D CT). We obtained 4D CT data from the dominant and non-dominant shoulders of eight collegiate baseball pitchers during the cocking motion. CT image data of each joint were reconstructed using a 3D reconstruction software package. The glenohumeral contact area, center of glenohumeral contact area, center of humeral head, and oblateness of humeral head were calculated from 3D bone models using customized software. The center of glenohumeral contact area translated significantly from anterior to posterior during maximum external rotation to maximum internal rotation. The center of humeral head translated from posterior to anterior during maximum external rotation to maximum internal rotation. There was a high negative correlation between anterior translation of the center of glenohumeral contact area and center of humeral head, and a positive correlation between the translation and the oblateness. 4D CT analyses demonstrated that the center of humeral head translated in the opposite direction to that of the center of glenohumeral contact area during external rotation to internal rotation in abduction in the dominant and non-dominant shoulders. This diametric translation can be explained by the oblateness of the humeral head. 4D CT scanning and the software for bone surface modeling of the glenohumeral joint enabled quantitative assessment of glenohumeral micromotion and identified humeral head oblateness as the cause of diametric change.

scholarly journals Effect of Glenohumeral Internal Rotation Deficit on Shoulder in Baseball Pitchers during Fastball Pitching

2020 ◽  
Vol 17 (21) ◽  
pp. 8211
Author(s):  
Hwai-Ting Lin ◽  
Yu-Chuan Lin ◽  
You-Li Chou ◽  
Hung-Chien Wu ◽  
Rong-Tyai Wang ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Motion Analysis ◽  
External Rotation ◽  
Three Dimensional ◽  
Limited Information ◽  
Shoulder Injury ◽  
Acceleration Phase ◽  
Glenohumeral Internal Rotation Deficit ◽  
Baseball Pitchers ◽  
Analysis System

Previous studies have reported that pitchers with glenohumeral internal rotation deficit (GIRD) may increase the risk of shoulder injury. However, limited information is available regarding the specific effects of GIRD in baseball pitching. The purpose of this study was to investigate whether baseball pitchers with GIRD change their pitching mechanism. Fifteen baseball pitchers with GIRD and 15 pitchers without GIRD were recruited from university or senior high-school teams. A three-dimensional motion analysis system (Eagle System, Motion Analysis Corporation, Santa Rosa, CA, USA) was used to capture the pitching motion while performing fastball pitches. The kinematics and kinetics of the throwing shoulder and trunk were analyzed based on motion captured data. The Mann–Whitney U test was used to test the differences of the analyzed parameters between two groups. At the instant of ball release, the GIRD group showed lower shoulder external rotation and trunk rotation, and larger shoulder horizontal adduction. In addition, the GIRD group exhibited a significantly larger shoulder inferior force in the cocking and acceleration phase, and a significantly larger internal rotation torque in the acceleration phase. The present results suggested that pitchers with GIRD need stretch training to enlarge joint range of motion, and to improve trunk strength and flexibility to alleviate potential problems associated with pitching in GIRD pitchers.

scholarly journals Acute effect of posterior deltoid static stretching on Glenohumeral Internal Rotation Deficit in elite swimmers after competition. A randomized trial

2018 ◽  
Vol 6 (6_suppl3) ◽  
pp. 2325967118S0004
Author(s):  
M Solana-Tramunt ◽  
R Lopez-Vidriero ◽  
E Lopez-Vidriero
Keyword(s):  
Internal Rotation ◽  
Repeated Measures ◽  
Sagittal Plane ◽  
External Rotation ◽  
National Level ◽  
Control Group ◽  
Overhead Athletes ◽  
Repeated Measures Design ◽  
Glenohumeral Internal Rotation Deficit ◽  
Experimental Group

Objectives: The aim of this study was to determine whether a static stretch of posterior deltoid could reduce the glenohumeral internal rotation deficit (GIRD) and the total arc of movement deficit (TAMD) in professional swimmers after competition. Methods: Participants: A total of 74 professional swimmers aged from 16-33 years volunteered to participated in the study. Their competition experience were more than 2 years at national level. All the subjects were informed in written and verbal form and signed their informed consent before being assessed. Design and procedures: A randomized repeated measures design was used to assess the glenohumeral rotation in 3 moments: prior to the race, just after finishing their trial and after performing a static passive stretch of posterior deltoid muscles of 90-sec. In randomized order the computer selected 20 subjects as a control group (CG) who didn’t perform the stretching. The experimental group (EG) included 54 swimmers. The glenohumeral internal and external rotation (IR and ER) were recorded by a video camera (IPhone 6 S, version 10.1), in sagittal plane, with the center of the screen at shoulder high. Subjects were laying on supine position over a massage table, with the glenohumeral joint at 90° of abduction, the elbow at 90° of flexion, and the researcher controlling the scapula movements by pushing the shoulder over coracoid apophasis. The App Thechnique (Ubersense ©) was used to measure the glenohumeral rotation degrees between the vertical line (controlled by a plumb) and the forearm segment. Results: The multifactorial ANOVA showed that there were significant differences on GIRD and TAMD between the experimental and the control group performing the stretching F(2,70)=49.150, P=0.000, η2p=0.992. The experimental group reduced the GIRD a16.2% and the TAMD a 6.7%. The dominant IR mean values changed significantly from 66.3±12.5 to 79.2±10.4 degrees for EG ( P=0.00) and non-significantly for CG, from 74.6±12.7 to 77.6±13.9 degrees ( P=0.11). The dominant TAM means changed significantly in EG from 173.2±16.8 to 192.0±17.0 degrees ( P=0.00) and non- significantly for CG 181.5±21.7 to 188.2±23.3 degrees ( P=0.12). Conclusion: To apply a static passive stretching on posterior deltoid during 90-sec reduced GIRD and the TAMD in professional swimmers after competition, which suggest a reduced risk of shoulder injury in these overhead athletes.

The Effect of Femoral Malrotation in Offset Templating for Total Hip Arthroplasty: A Cadaveric Study and Curvilinear Analysis

2021 ◽  
Author(s):  
H. Del Schutte ◽  
Sergio M. Navarro ◽  
Hashim Shaikh ◽  
William R. Barfield ◽  
Jeffrey Conrad ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Internal Rotation ◽  
Hip Arthroplasty ◽  
Proximal Femur ◽  
External Rotation ◽  
Femoral Rotation ◽  
Level Of Evidence ◽  
Total Hip ◽  
Femoral Malrotation ◽  
Cadaveric Model

AbstractTechniques allow assessment of preoperative offset in hip arthroplasty. This study assessed femoral rotation in preoperative offset templating using a cadaveric model. Ten femurs were imaged at degrees of rotation. Offset was measured. A generalizable equation predicting change in offset was derived with a curvilinear model. Statistically significant differences at rotational positions were found. For 30 degrees of internal rotation, 2.1 mm change in adjusted mean offset existed; for 30 degrees of external rotation, 8.4 mm change existed. Improved awareness of malrotation of the proximal femur and templating adjustments may improve total hip arthroplasty outcomes. This study reflects level of evidence III.

Computed tomographic evaluation of femoral and tibial conformation in English Staffordshire Bull Terriers with and without congenital medial patellar luxation

2017 ◽  
Vol 30 (03) ◽  
pp. 191-199 ◽  
Author(s):  
Katja Voss ◽  
Mark Newman
Keyword(s):  
Computed Tomography ◽  
Clinical Decision Making ◽  
External Rotation ◽  
Femoral Condyle ◽  
Clinical Decision ◽  
Femoral Anteversion ◽  
Femoral Diaphysis ◽  
Control Group ◽  
Anteversion Angle ◽  
Tibial Valgus

SummaryObjective: To compare hindlimb conformation of English Staffordshire Bull Terriers with and without medial patellar luxation using computed tomography.Methods: Hindlimb computed tomography (CT) was performed on six English Staffordshire Bull Terriers with grade II or III medial patellar luxation, and six without medial patellar luxation. Inclination angle, femoral condyle trochanteric angle, anteversion angle (AA), distal anteversion angle (DAA), proximal anteversion angle (PAA), femoral varus angle (FVA), tibial valgus angle (TVA), and tibial torsion angle (TTA) were measured. Student’s T-test was conducted to compare normal limbs to limbs with medial patellar luxation, all limbs of dogs with medial patellar luxation to limbs of the control group, and medial patellar luxation affected limbs (normal limbs of unilaterally affected dogs excluded) to the control group. P-values less than 0.05 were considered significant.Results: Two dogs with medial patellar luxation were only affected unilaterally. Limbs of English Staffordshire Bull Terriers with medial patellar luxation had significantly diminished AA and DAA, in addition to decreased TVA. These differences were similar regardless of how the unaffected limbs from affected dogs were treated in our analysis.Discussion and conclusion: Medial patellar luxation in this population of English Staffordshire Bull Terriers was characterized by a decrease in femoral anteversion, external rotation of the femoral diaphysis, and decreased tibial valgus. These findings may help inform clinical decision making when performing osteotomy for treatment of medial patellar luxation in this breed.

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