The Contribution of Posterior Capsule Hypertrophy to Soft Tissue Glenohumeral Internal Rotation Deficit in Healthy Pitchers

2022 ◽  
pp. 036354652110625
Author(s):  
Ryan W. Paul ◽  
Scott Sheridan ◽  
Katherine E. Reuther ◽  
John D. Kelly ◽  
Stephen J. Thomas
Keyword(s):  
Soft Tissue ◽  
Internal Rotation ◽  
Positive Relationship ◽  
External Rotation ◽  
Pearson Correlation ◽  
Posterior Capsule ◽  
Glenohumeral Internal Rotation Deficit ◽  
Humeral Retroversion ◽  
Pearson Correlations ◽  
Bilateral Difference

Background: The relationship between posterior capsule adaptations and soft tissue glenohumeral internal rotation deficit (GIRD) in healthy pitchers remains unclear. Purpose/Hypothesis: This study aimed to identify if posterior capsule thickness (PCT) was associated with soft tissue GIRD in healthy pitchers. We hypothesized that there would be a positive relationship between soft tissue GIRD and PCT in the dominant arm, no relationship between soft tissue GIRD and PCT in the nondominant arm, and a strong positive relationship between soft tissue GIRD and the bilateral difference in PCT (posterior capsule hypertrophy [PCH]). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 45 healthy collegiate and professional pitchers were included. Glenohumeral internal rotation and external rotation range of motion, humeral retroversion, and PCT were measured bilaterally. PCT was determined for unilateral posterior capsule measurements, and PCH of the throwing shoulder was calculated as the bilateral difference in PCT. Soft tissue GIRD was calculated as the sum of clinical GIRD and the bilateral difference in humeral retroversion. Pearson correlation coefficients were determined to evaluate the relationships between dominant arm PCT, nondominant arm PCT, and PCH and soft tissue GIRD. Results: Pearson correlations showed that both dominant arm PCT ( R = −0.13; P = .378) and nondominant arm PCT ( R = 0.21; P = .165) were not related to soft tissue GIRD. However, Pearson correlations did show that the amount of PCH was moderately related to soft tissue GIRD ( R = 0.40; P = .007). Therefore, as the posterior capsule hypertrophied, soft tissue GIRD moderately increased. Conclusion: Increased PCH was associated with an increase in soft tissue GIRD in healthy pitchers. If PCT measurements are feasible, clinicians should consider performing bilateral ultrasound assessments to isolate posterior capsule adaptations (ie, PCH). This will allow clinicians to identify pitchers with potentially maladaptive structural adaptations and optimize management strategies throughout the season to counteract them.

Effect of Posterior Capsule Tightness and Humeral Retroversion on 5 Glenohumeral Joint Range of Motion Measurements: A Cadaveric Study

2019 ◽  
Vol 47 (6) ◽  
pp. 1434-1440 ◽  
Author(s):  
Dayana P. Rosa ◽  
Paula R. Camargo ◽  
John D. Borstad
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Posterior Capsule ◽  
Joint Range Of Motion ◽  
Motion Measurements ◽  
Humeral Retroversion ◽  
Clinical Measurements ◽  
Joint Range

Background: Altered glenohumeral joint range of motion can be caused by increased humeral retroversion (HR) and/or posterior capsule tightness (PCT). To make informed clinical decisions, it is vital to understand how HR and PCT alterations, individually and in combination, affect joint range of motion measurements. Purpose: To evaluate the effect of experimental tissue alterations on clinical range of motion measures. Study Design: Controlled laboratory study. Methods: Five clinical measurements were quantified in 8 fresh-frozen cadavers under 4 experimentally created conditions: baseline (no alterations), HR condition (20° increase in HR by transecting the bone), PCT condition (20% decrease in length via thermal energy), and PCT + HR combined. Clinical measurements included bicipital forearm angle, low flexion, glenohumeral internal and external rotation, and horizontal adduction. All measurements were taken by the same blinded tester. Separate 1-factor repeated measures analyses of variance were used to evaluate the effect of the alterations on each clinical measurement. Results: There was a significant main effect of condition for bicipital forearm angle ( P = .02, F = 4.03), low flexion ( P = .02, F = 3.86), internal rotation ( P = .03, F = 3.65), and external rotation ( P < .001, F = 15.15) but not for horizontal adduction ( P = .29, F = 1.33). The HR condition resulted in a decreased bicipital forearm angle of 16.1° and 15.8° as compared with the PCT and PCT + HR conditions, respectively. When compared with baseline, the PCT + HR condition decreased the low flexion test by 13.5°, and the HR condition decreased internal rotation range of motion by 14.2°. All conditions increased external rotation when compared with baseline. Conclusion: Greater measurement changes were noted in both HR conditions, suggesting that bony alterations influence motion to a greater extent than posterior capsule alterations. Clinical Relevance: Clinicians should be aware that humeral retroversion will influence the measurement of posterior shoulder tightness.

Chronic Adaptations of the Posterior Rotator Cuff in Professional Pitchers

2021 ◽  
pp. 036354652098868
Author(s):  
Stephen J. Thomas ◽  
Justin Cobb ◽  
Scott Sheridan ◽  
Joseph Rauch ◽  
Ryan W. Paul
Keyword(s):  
Soft Tissue ◽  
Rotator Cuff ◽  
Internal Rotation ◽  
External Rotation ◽  
Negative Relationship ◽  
Muscle Thickness ◽  
Pennation Angle ◽  
Muscle Architecture ◽  
Infraspinatus Muscle ◽  
Teres Minor

Background: Because of the large forces and high frequency of throwing, the upper extremity experiences repetitive stresses that lead to acute and chronic adaptations. While the importance of pennation angle and muscle thickness as predictors of muscle force production has been shown in other populations and other joints, there has been little research done that examines these variables in the shoulders of baseball players. Purpose: (1) To examine the chronic effect pitching has on the rotator cuff muscle architecture (pennation angle and muscle thickness) in healthy professional baseball pitchers, and (2) to examine the correlation between muscle architecture and clinical measures of strength and range of motion (ROM). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Twenty-eight healthy professional pitchers were recruited during the 2019 spring training. Internal rotation (IR) and external rotation (ER) strength were measured with a handheld dynamometer and IR and ER ROM were measured with an inclinometer. A diagnostic ultrasound machine was utilized to capture images of humeral retroversion, as well as the pennation angle and muscle thickness of the infraspinatus and teres minor muscles. ImageJ software was used to quantify the pennation angle and muscle thickness. Results: There were no significant differences between the dominant and nondominant arms for ER or IR strength. Also, no pennation angle and muscle thickness differences were found between the dominant and nondominant arms. A weak positive relationship between infraspinatus muscle thickness (superficial and total) and ER strength ( P = .016, R = 0.287 and P = .009, R = 0.316) and a moderate negative relationship between soft tissue glenohumeral internal rotation deficit (GIRD) and the bilateral difference of the teres minor deep pennation angle ( R = −0.477, P = .008) were observed. No other significant relationships were noted. Conclusion: Our results are contrary to current literature as we expected to see a stronger dominant arm, with a larger pennation angle and greater muscle thickness. Interestingly, we found that ER strength was positively related to only the thickness of the infraspinatus muscle, and that soft tissue GIRD was positively related to only the side-to-side adaptation of the pennation angle within the deep portion of the teres minor. This suggests that when posterior shoulder tightness occurs, specifically the architecture of the teres minor muscle is involved. However, the organization to which these players belonged has a very extensive training protocol throughout the year that emphasizes bilateral training during a large majority of the exercises. Therefore, the results may not be generalizable to all professional players.

scholarly journals Soft Tissue Mobilization and Stretching for Shoulder in CrossFitters: A Randomized Pilot Study

2021 ◽  
Vol 18 (2) ◽  
pp. 575
Author(s):  
Marcos Jusdado-García ◽  
Rubén Cuesta-Barriuso
Keyword(s):  
Soft Tissue ◽  
Internal Rotation ◽  
Repeated Measures ◽  
Control Group ◽  
Average Weight ◽  
Average Height ◽  
Shoulder Injury ◽  
Glenohumeral Internal Rotation Deficit ◽  
Posterior Shoulder ◽  
Soft Tissue Mobilization

Background. The shoulder in CrossFit should have a balance between mobility and stability. Glenohumeral internal rotation deficit and posterior shoulder stiffness are risk factors for overhead shoulder injury. Objective. To determine the effectiveness of instrument-assisted soft tissue mobilization and horizontal adduction stretch in CrossFit practitioners’ shoulders. Methods: Twenty-one regular CrossFitters were allocated to experimental (stretching with isometric contraction and instrument-assisted soft tissue mobilization) or control groups (instrument-assisted soft tissue mobilization). Each session lasted 5 min, 2 days a week, over a period of 4 weeks. Shoulder internal rotation and horizontal adduction (digital inclinometer), as well as posterior shoulder stretch perception (Park scale), were evaluated. Shapiro–Wilk test was used to analyze the distribution of the sample. Parametric Student’s t-test was used to obtain the intragroup differences. The inter- and intra-rater differences were calculated using a repeated measures analysis of variance (ANOVA). Results. Average age was 30.81 years (SD: 5.35), with an average height of 178 (SD: 7.93) cm and average weight of 82.69 (SD: 10.82) kg. Changes were found in the experimental group following intervention (p < 0.05), and when comparing baseline and follow-up assessments (p < 0.05) in all variables. Significant differences were found in the control group following intervention (p < 0.05), in right horizontal adduction and left internal rotation. When comparing the perception of internal rotation and horizontal adduction in both groups, significant differences were found. Conclusions. Instrument-assisted soft tissue mobilization can improve shoulder horizontal adduction and internal rotation. An instrument-assisted soft tissue mobilization technique yields the same results alone as those achieved in combination with post-isometric stretch with shoulder adduction.

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 Relationship between propulsive force of the arm, body composition and isokinetic muscle strength indicators in surfers

2018 ◽  
Vol 20 (3) ◽  
pp. 342-351
Author(s):  
Sidarta Oliveira Geber ◽  
Bruno Remígio Cavalcante ◽  
Antonio Henrique Germano-Soares ◽  
Raysa Catarina Cavalcante Figueiredo Montes ◽  
Arthur Henrique Oliveira Silva ◽  
...  
Keyword(s):  
Body Composition ◽  
Internal Rotation ◽  
Fat Mass ◽  
Muscle Function ◽  
External Rotation ◽  
Pearson Correlation ◽  
Peak Torque ◽  
Total Work ◽  
Propulsive Force ◽  
Teres Major

This study aimed to evaluate the potential relationship between body composition (percentage of fat mass (FM %), fat mass and lean mass), muscle function (e.g., muscles; deltoid side and front, pectoralis major and teres major) and the propulsive force of the arm (PFA). Sixteen competitive surfers (29.1 ± 7.3 years; 1.72 ± 0.06 m; 74.2 ± 1.4 kg) were assessed for height, body mass, body composition (dual-energy-DXA), muscle function and PFA. Pearson correlation analyses were used to verify the relationship between all variables. An inverse correlations were found between PFA and isokinetic parameters to 60o/s: external rotation (peak torque: r = -0.71; p = 0.014; total work: r = -0.75; p = 0.007; power: r = -0.72; p = 0.011) and internal rotation (peak torque: r = -0.61; p = 0.045; total work: r = -0.73; p = 0.010; power: r = -0.61; p = 0.045) and 300o/s: external rotation (peak torque: r = -0.79; p = 0.003; total work: r = -0.84; p<0,001; power: r = -0.81; p = 0.002) and internal rotation (peak torque: r = -0.69; p = 0.017; total work: r = -0.72; p = 0.011; power: r = -0.69; p = 0.017). There was no significant correlation between body composition components and PFA (p>0.05). Although correlations do not imply cause and effect, PFA is not correlated with body composition in surfers and these relationships are inversely related to the parameters of muscle function.

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.

Management strategies for shoulder reconstruction in obstetric brachial plexus injury with special reference to loss of internal rotation after surgery

2012 ◽  
Vol 37 (8) ◽  
pp. 772-779 ◽  
Author(s):  
M. Sibinski ◽  
T. E. J. Hems ◽  
D. A. Sherlock
Keyword(s):  
Soft Tissue ◽  
Brachial Plexus ◽  
Internal Rotation ◽  
External Rotation ◽  
Management Strategies ◽  
Shoulder Function ◽  
Obstetric Brachial Plexus ◽  
Teres Major ◽  
Shoulder Reconstruction

We assessed the outcomes in 24 of 25 children (mean age 3 years) who had soft-tissue shoulder reconstruction procedures for obstetric brachial plexus injuries. All had latissimus dorsi and teres major transfers to strengthen external rotation combined with subscapularis lengthening, reduction of posterior dislocation or subluxation, and humeral osteotomy, if necessary. At a mean follow-up of 3.8 years, the mean Mallet score improved from 12.3 preoperatively to 17.4 postoperatively, active external rotation improved from 21° to 32°, and passive external rotation improved from 26° to 67°. The shoulder remained in joint in all patients. Active internal rotation deteriorated in nine shoulders, two requiring secondary internal rotation osteotomy. Combined soft tissue rebalancing and bony procedures gives reliable shoulder function improvement. Care is required regarding the effect on internal rotation.

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.

Descriptive Profile of Hip Rotation Range of Motion in Elite Tennis Players and Professional Baseball Pitchers

2007 ◽  
Vol 35 (8) ◽  
pp. 1371-1376 ◽  
Author(s):  
Todd S. Ellenbecker ◽  
Gail A. Ellenbecker ◽  
E. Paul Roetert ◽  
Rogerio Teixeira Silva ◽  
Greg Keuter ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Hip Joint ◽  
External Rotation ◽  
Professional Baseball ◽  
Tennis Players ◽  
Active Range Of Motion ◽  
Baseball Pitchers ◽  
Hip Rotation ◽  
Bilateral Difference

Background Repetitive loading to the hip joint in athletes has been reported as a factor in the development of degenerative joint disease and intra-articular injury. Little information is available on the bilateral symmetry of hip rotational measures in unilaterally dominant upper extremity athletes. Hypothesis Side-to-side differences in hip joint range of motion may be present because of asymmetrical loading in the lower extremities of elite tennis players and professional baseball pitchers. Study Design Cohort (cross-sectional) study (prevalence); Level of evidence, 1. Methods Descriptive measures of hip internal and external rotation active range of motion were taken in the prone position of 64 male and 83 female elite tennis players and 101 male professional baseball pitchers using digital photos and computerized angle calculation software. Bilateral differences in active range of motion between the dominant and nondominant hip were compared using paired t tests and Bonferroni correction for hip internal, external, and total rotation range of motion. A Pearson correlation test was used to test the relationship between years of competition and hip rotation active range of motion. Results No significant bilateral difference (P > .005) was measured for mean hip internal or external rotation for the elite tennis players or the professional baseball pitchers. An analysis of the number of subjects in each group with a bilateral difference in hip rotation greater than 10° identified 17% of the professional baseball pitchers with internal rotation differences and 42% with external rotation differences. Differences in the elite male tennis players occurred in only 15% of the players for internal rotation and 9% in external rotation. Female subjects had differences in 8% and 12% of the players for internal and external rotation, respectively. Statistical differences were found between the mean total arc of hip range of internal and external rotation in the elite tennis players with the dominant side being greater by a clinically insignificant mean value of 2.5°. Significantly less (P < .005) dominant hip internal rotation and less dominant and nondominant hip total rotation range of motion were found in the professional baseball pitchers compared with the elite male tennis players. Conclusion This study established typical range of motion patterns and identified bilaterally symmetric hip active range of motion rotation values in elite tennis players and professional baseball pitchers. Asymmetric hip joint rotational active range of motion encountered during clinical examination and screening may indicate abnormalities and would indicate the application of flexibility training, rehabilitation, and further evaluation.

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.

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