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

Author(s):  
Jonas Schmalzl ◽  
Helen Walter ◽  
Wolfram Rothfischer ◽  
Sören Blaich ◽  
Christian Gerhardt ◽  
...  

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.

2014 ◽  
Vol 49 (4) ◽  
pp. 507-513 ◽  
Author(s):  
Elizabeth E. Hibberd ◽  
Sakiko Oyama ◽  
Justin Tatman ◽  
Joseph B. Myers

Context: Biomechanically, the motions used by baseball and softball pitchers differ greatly; however, the throwing motions of position players in both sports are strikingly similar. Although the adaptations to the dominant limb from overhead throwing have been well documented in baseball athletes, these adaptations have not been clearly identified in softball players. This information is important in order to develop and implement injury-prevention programs specific to decreasing the risk of upper extremity injury in softball athletes. Objective: To compare range-of-motion and humeral-retrotorsion characteristics of collegiate baseball and softball position players and of baseball and softball players to sex-matched controls. Design: Cross-sectional study. Setting: Research laboratories and athletic training rooms at the University of North Carolina at Chapel Hill. Patients or Other Participants: Fifty-three collegiate baseball players, 35 collegiate softball players, 25 male controls (nonoverhead athletes), and 19 female controls (nonoverhead athletes). Intervention(s): Range of motion and humeral retrotorsion were measured using a digital inclinometer and diagnostic ultrasound. Main Outcome Measure(s): Glenohumeral internal-rotation deficit, external-rotation gain, total glenohumeral range of motion, and humeral retrotorsion. Results: Baseball players had greater glenohumeral internal-rotation deficit, total–range-of-motion, and humeral-retrotorsion difference than softball players and male controls. There were no differences between glenohumeral internal-rotation deficit, total–range-of-motion, and humeral-retrotorsion difference in softball players and female controls. Conclusions: Few differences were evident between softball players and female control participants, although range-of-motion and humeral-retrotorsion adaptations were significantly different than baseball players. The throwing motions are similar between softball and baseball, but the athletes adapt to the demands of the sport differently; thus, stretching/strengthening programs designed for baseball may not be the most effective programs for softball athletes.


2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0040
Author(s):  
Caleb Gulledge ◽  
Toufic Jildeh ◽  
Joseph Tramer ◽  
Fabien Meta ◽  
Kevin Taylor ◽  
...  

Objectives: Overuse injuries in overhead athletes are becoming more prevalent, with an unclear relationship between shoulder biomechanics and medial elbow symptoms and injury. The purpose of this study was to investigate the relationship of shoulder range of motion to torque across the medial elbow in college pitchers using a validated MOTUS sensor baseball sleeve. Methods: Pitchers were recruited from three local university baseball teams. Exclusion criteria included injury or restricted activity due to pain. They were evaluated in the preseason, within two weeks before their first game of the season. Pitchers completed workload questionnaires and patient reported outcome measurement information system (PROMIS) pain interference (PI), physical function (PF), and upper extremity (UE) surveys. Shoulder range of motion and upper extremity lengths were measured bilaterally. After adequate warm-up, pitchers were fitted with a MOTUS sensor baseball sleeve (Motus Global, Massapequa, NY) and instructed to throw 5 fastballs in a standardized manner off the mound at game-speed effort. The sensor placed at the medial elbow reported elbow torque, arm speed, arm slot, and shoulder rotation for each pitch, while a radar gun measured peak ball velocity. The primary outcome was to evaluate the relationship between shoulder range of motion and increased stress across the medial elbow. Additional outcomes evaluated pitcher characteristics, demographics, and outcome scores. Outcomes were assessed via a multivariable model, which controlled for possible covariates. Results: Twenty-eight pitchers were included in the preseason analysis with an average (SD) age of 20.1 (1.3) years and playing experience of 15.3 (1.8) years, 2.5 (1.2) of those years at collegiate level. The dominant shoulder demonstrated decreased internal rotation (54.5+/-10.6 vs 65.8+/-9.1) and increased external rotation (ER, 94.1+/-10.4 vs 88.4+/-9.2) relative to the non-dominant side (p < 0.001), while total rotational range of motion (TRROM) was significantly decreased in the dominant arm (148.6+/-12.4 vs 154.1+/-10.6, p < 0.001). The average glenohumeral internal rotation deficiency (GIRD) was 11.3 (9.87) and average external rotation gain (ERG) was 5.71 (8.8). External rotation was found to be a predictor of arm stress, with an increase in 0.35 Nm of elbow torque for every degree increase in ER (beta = 0.35+/-0.06, p = 0.003); there was moderate correlation between ER and arm stress (r = .45, P<.001). Pitchers demonstrated significantly greater arm stress with the following shoulder ROM measurements: GIRD < 20 as compared to greater than 20 degrees (46.6 +/- 0.5 versus 43.5 +/- 1.1, P=.011), ERG greater than 5 as compared to < 5 degrees (47.4 +/- 0.7 versus 45.1 +/- 0.6, P=.014), and loss of total rotational ROM less than 5 as compared to > 5 degrees (46.6 +/- 0.5 versus 43.6 +/- 1.1, P=.013). Multivariate analysis demonstrated significant predictors of PROMIS PF and UE scores were arm stress, ERG, and GIRD (p<0.05), while increased PROMIS PI scores were predicted by increased ERG and GIRD (p<0.05). Conclusion: We found medial elbow stress, arm speed, arm slot, and shoulder rotation as measured by the MOTUS baseball sensor sleeve were influenced by rotational adaptations of the pitching shoulder in collegiate throwing athletes prior to their season. Likewise, arm stress and shoulder rotational adaptations were reflected as predictors of PROMIS PF, UE, and PI scores.


2018 ◽  
Vol 10 (2) ◽  
pp. 125-132 ◽  
Author(s):  
Robert A. Keller ◽  
Anthony F. De Giacomo ◽  
Julie A. Neumann ◽  
Orr Limpisvasti ◽  
James E. Tibone

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.


2018 ◽  
Vol 6 (6_suppl3) ◽  
pp. 2325967118S0004
Author(s):  
M Solana-Tramunt ◽  
R Lopez-Vidriero ◽  
E Lopez-Vidriero

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.


2020 ◽  
Vol 22 (3) ◽  
pp. 1-7
Author(s):  
Jim Schilling ◽  
Sujeiry Guzman ◽  
Chad Lewis ◽  
Jupil Ko

OBJECTIVES To compare the clinical outcome and effectiveness of Swedish massage and a traditional passive stretching program, on the shoulder of ROM in overhead athletes.PARTICIPANTS A total of 10 overhead throwing overhead male athletes (age= 23.5 ± 1.5yrs; height= 186.69 ± 6.35 cm; mass= 91.86 ± 12.48 kg).METHODS Participants were randomly assigned to either Swedish massage or a traditional passive static stretching program for 1 session of 5 minutes. Baseline and post-intervention shoulder ROM to end range in the flexed, external rotation, internal rotation, horizontal adduction and abduction positions. The Pearson chi-square test was applied to compare the differences of shoulder ROM of both therapeutic variables. Recorded outcome measures on the participants’ shoulder ROM (flexion with scapula fixed, horizontal adduction, horizontal abduction, internal rotational & external rotation) pre- & post-interventions.RESULTS Results indicate that participants in the Swedish massage therapeutic intervention group had significant improvements in their internal rotation post-treatment (M=5.20, SD= 1.304, p=.038) and the traditional passive stretching protocol group had significant improvements in shoulder external rotation post-treatment (M=11.20, SD=2.68, p=.016).CONCLUSION Swedish massage had better effects in four out of the five shoulder motions measured compared to passive static stretching. Educating overhead athletes on the potential beneficial effects of massage therapy and its role in maintaining shoulder range of motion.


2011 ◽  
Vol 46 (4) ◽  
pp. 438-444 ◽  
Author(s):  
Nihan Ozunlu ◽  
Hatice Tekeli ◽  
Gul Baltaci

Context: The stability of the scapula in relation to the entire moving upper extremity is the key in the throwing sequence. The importance of scapular positioning in volleyball players has been well documented in the literature, but no one has compared scapular positioning between volleyball players and sedentary people. Objective: To compare measurements of scapular mobility obtained using the lateral scapular slide test between volleyball players and sedentary participants without shoulder impairments and to compare changes in scapular mobility in players according to the number of years of sport participation. Design: Cross-sectional study. Setting: University research laboratory. Patients or Other Participants: A total of 121 people at a single university volunteered. Of these, 67 were sedentary (age = 24.3 ± 2.34 years, height = 1.69 ± 0.09 m, mass = 65.1 ± 11.91 kg); 54 were volleyball players from 4 professional teams and were separated into 2 groups according to their years of sport participation. The first group was named young players (n = 31; age = 17.7 ± 2.58 years, height = 1.83 ± 0.10 m, mass = 68.3 ± 12.21 kg, sport participation ≤ 9 years), and the second group was named old players (n = 23; age = 26.9 ± 3.39 years, height = 1.95 ± 4.38 m, mass = 90.7 ± 5.75 kg, sport participation ≥ 10 years). Main Outcome Measure(s): Study participants completed a rating scale for pain and a questionnaire about demographic and shoulder problems. One assessor performed the lateral scapular slide test and additional flexibility measurements around the shoulder girdle. Flexibility (external rotation, internal rotation) and scapular position (1, 2, 3) were compared among groups (young players, old players, sedentary people) and between sides (dominant, nondominant). Results: In sedentary participants, we found differences for position 1 (t66 = 3.327, P = .002), position 2 (t66 = 2.491, P = .004), position 3 (t66 = 2.512, P = .006), and internal rotation (t66 = 2.592, P = .001) between the dominant and nondominant sides. In old players, we found differences for position 2 between the dominant and nondominant sides (t22 = 2.956, P = .004). For position 2 (F2,118 = 4.265, P = .02) and position 3 (F2,118 = 4.702, P = .01), we found differences between young and old players. For internal rotation, we found differences between sedentary and old players (F2,118 = 6.578, P = .002) and between young and old players (F2,118 = 3.723, P = .01). Conclusions: Clinicians evaluating overhead athletes need to remember that asymmetric scapular posture between the dominant and nondominant sides in unilateral overhead athletes might be normal and not necessarily related to injury.


2021 ◽  
pp. 1-8
Author(s):  
Fahimeh Kamali ◽  
Narjes Ghasempour ◽  
Nasrin Salehi Dehno

BACKGROUND: Posterior shoulder tightness as demonstrated by glenohumeral internal rotation deficit (GIRD) is a common contributor to many shoulder pathologies in overhead throwing athletes. PURPOSE: This study aimed to assess immediate effect of combining glenohumeral and scapulothoracic mobilization with stretching on improving internal rotation range of motion (ROM) in overhead athletes with GIRD METHODS: This study was a single-blind randomized controlled trial with parallel groups. The participants were 30 asymptomatic male volleyball players who had a loss of shoulder internal rotation ROM of 15 degrees or more on their dominant compared to their nondominant side. They were randomly assigned to 1 of 2 groups: stretching only (n = 15) or stretching plus joint mobilization (n = 15). Participants in the stretching group performed cross-body stretches, and those in stretching plus mobilization group were treated with both cross-body stretching and mobilization techniques for the glenohumeral and scapulothoracic joints. Both groups received the intervention every other day for 1 week. Shoulder internal and external ROM were measured before and after the intervention. RESULTS: Before the intervention, dominant-side deficits in internal rotation ROM compared to the nondominant side were 20.11±5.27 degrees in the stretching group and 21.87±8.06 degrees in the stretching plus mobilization group. After the intervention, internal rotation ROM deficit between the dominant and nondominant side decreased to 11.28±5.82 in the stretching group (P <  0.001) and 10.85±9.19 in the stretching plus mobilization group (P <  0.001). However, the between-group difference was not statistically significant (P = 0.389). External rotation ROM remained unchanged in both groups (P >  0.05). CONCLUSION: Both interventions (stretching and stretching plus mobilization) can have the same beneficial effect in decreasing GIRD in asymptomatic overhead athletes.


2005 ◽  
Vol 33 (5) ◽  
pp. 693-698 ◽  
Author(s):  
Keith Meister ◽  
Timothy Day ◽  
Marybeth Horodyski ◽  
Thomas W. Kaminski ◽  
Michael P. Wasik ◽  
...  

Background Differences in range of motion and rotational motion between the dominant and nondominant shoulders in throwing athletes are well documented, although the age at which these changes begin to occur is not known. Hypothesis Changes in glenohumeral rotational motion in the shoulder of the Little League/adolescent baseball player occur during the most formative years of physical development. Study Design Cross-sectional study. Methods Elevation, internal rotation at 90° of abduction, and external rotation at 90° of abduction were measured in the dominant and nondominant shoulders of 294 baseball players, aged 8 to 16 years. Results Analysis of variance revealed 2-way interactions between arm dominance by age for elevation (P =. 005) and internal rotation (P =. 001). Significant differences were noted between dominant and nondominant arms for internal rotation at 90° (P =.001) and external rotation at 90° (P =. 001). Elevation, internal rotation at 90°, external rotation at 90°, and total range of motion varied significantly (P =. 001) among age groups. Elevation in the dominant arms of 16-year-olds was on average 5.3° less than in 8-year-olds (179.6° vs 174.3°). In the nondominant arms, mean elevation for 16-year-olds was 5.6° less than in 8-year-olds (179.7° vs 174.1°). Internal rotation at 90° for the dominant arms averaged 39.0° at age 8 and only 21.3° at age 16. In the non-dominant arms, internal rotation for 8-year-olds averaged 42.2° and only 33.1° for 16-year-olds. Conclusions Elevation and total range of motion decreased as age increased. These changes may be consequences of both bone and soft tissue adaptation. The most dramatic decline in total range of motion was seen between the 13-year-olds and 14-year-olds, in the year before peak incidence of Little Leaguer's shoulder. This decrease in rotational motion may cause increased stress at the physis during throwing.


2009 ◽  
Vol 44 (3) ◽  
pp. 230-237 ◽  
Author(s):  
Stephen John Thomas ◽  
Kathleen A. Swanik ◽  
Charles Swanik ◽  
Kellie C. Huxel

Abstract Context: Anterior instability and impingement are common in overhead athletes and have been associated with decreases in internal rotation (IR) and increases in external rotation (ER) motion. However, the chronology and the effect of different female sports on these conditions have yet to be determined. Objective: To measure glenohumeral IR and ER rotation, total range of motion, and scapular position in female overhead athletes over a single competitive season. Design: Multiple group pretest-posttest study. Setting: High school. Patients or Other Participants: Thirty-six female overhead athletes (age  =  15.29 ± 1.18 years, height  =  164.16 ± 7.14 cm, mass  =  58.24 ± 9.54 kg) with no history of shoulder or elbow surgery participating in high school swimming, volleyball, or tennis. Intervention(s): Participants were measured for all dependent variables at preseason and postseason. Main Outcome Measure(s): Participants were measured for glenohumeral IR and ER with the scapula stabilized. Total glenohumeral range of motion was calculated as the sum of IR and ER. Scapular upward rotation was measured at 0°, 60°, 90°, and 120° of glenohumeral abduction in the scapular plane, and scapular protraction was measured at 0°, 45° (hands on hips), and 90° of glenohumeral abduction. Results: Internal rotation decreased from preseason to postseason (P  =  .012). Swimmers had less IR than both volleyball and tennis players (P  =  .001). External rotation also decreased in the swimmers (P  =  .001). Overall, preseason to postseason total motion decreased for athletes participating in swimming (P  =  .001) and tennis (P  =  .019). For all participants, preseason to postseason scapular protraction at 45° glenohumeral abduction decreased (P  =  .007). Conclusions: Female overhead athletes demonstrated decreases in IR after only one competitive season. Clinically, our results indicate that overhead athletes should be monitored for motion changes throughout their competitive seasons.


2021 ◽  
Vol 11 (5) ◽  
pp. 88-93
Author(s):  
Kimaya Vinod Kini ◽  
Deepali Rathod ◽  
Ajay Kumar

Background: Cricket bowlers often have to perform overhead throwing due to which in the dominant arm, compared with the nondominant arm the magnitude of glenohumeral internal rotation is decreased and magnitude of external rotation is increased. Glenohumeral internal rotation deficits (GIRD) are deficits of internal rotation and total arc of motion in the dominant side which is common in overhead athletes including cricket bowlers. Hence the aim of the study was to compare the effectiveness of muscle energy technique vs mulligan in patients with glenohumeral internal rotation deficit. Methodology: 30 patients were included in the study which was divided into two groups; Group A with 15 patients and Group B with 15 patients.30 cricket bowlers with presence of glenohumeral internal rotation deficit were selected. Before application of muscle energy technique and mulligan active shoulder range of motion using full scale goniometer was taken. Treatment was given for 4 weeks, 6 sessions per week. All patients were given hotpacks and stretching for internal rotators before treatment. The difference of pre and post was then calculated. The data was statistically analysed using paired t-test. Results: Mulligan mobilization and met are both effective in improving glenohumeral internal rotation deficit in 4 weeks. Conclusion: Mulligan mobilization and met helps to improve glenohumeral internal rotation deficit almost with same margin. Key words: cricket bowlers, Glenohumeral internal rotation deficit, mulligan, Met


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