Glenohumeral Internal Rotation Deficit and Risk of Upper Extremity Injury in Overhead Athletes: A Meta-Analysis and Systematic Review

Keller, Robert A.; Giacomo, Anthony F. De; Neumann, Julie A.; Limpisvasti, Orr; Tibone, James E.

doi:10.1177/1941738118756577

Cited by 88 publications

(80 citation statements)

References 26 publications

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“…There was no association between ROM measured at baseline and shoulder injuries in either male or female players. This is in line with a recent study on youth elite handball players (75), and also studies on other overhead athletes (104,105,129,130). However, there is a discrepancy with another recently published study on youth handball players from Germany, which found an association between increased ROM and shoulder injury in females, but not in males (39).…”

Section: Shoulder Rom and Shoulder Injuriessupporting

confidence: 74%

“…Several factors, such as decreased or increased shoulder mobility, shoulder weakness, rapid increase in training load, and scapula dyskinesia, have been suggested to be associated with shoulder injuries in studies of overhead athletes (36,40,44,75,(101)(102)(103). However, strong scientific evidence is lacking for the causal effect of most of the suggested modifiable risk factors including the results of common clinical screening methods (52,104,105). Even though there are a growing number of observational studies in handball, only a handful of studies have attempted to investigate risk factors for shoulder injuries in adolescent handball.…”

Section: Injury Pattern and Risk Factors For Shoulder Injurymentioning

confidence: 99%

See 1 more Smart Citation

Preseason Clinical Shoulder Test Results and Shoulder Injury Rate in Adolescent Elite Handball Players: A Prospective Study

Asker¹,

Waldén²,

Källberg³

et al. 2020

Journal of Orthopaedic & Sports Physical Therapy

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Objective To investigate whether adolescent elite female and male handball players with shoulder muscle weakness, deficits in shoulder rotation range of motion (ROM) or in joint position sense (JPS), or scapular dyskinesis in the preseason had a higher rate of new shoulder injuries compared to players without these characteristics. Design Prospective cohort study. Methods We studied 344 uninjured players (452 player-seasons, 50% female). We measured their shoulder strength in isometric external rotation (IER), isometric internal rotation (IIR), isometric abduction, and eccentric external rotation, as well as their shoulder ROM, JPS, and scapular dyskinesis, during the preseason. Players were monitored weekly regarding match and training hours and shoulder injuries during 1 or 2 seasons. We used multivariable Cox proportional hazard models to calculate hazard rate ratios related to the first injury and 95% confidence intervals (CIs). Results During 2 seasons, the participants reported 48 new shoulder injuries. In female players, the hazard rate ratio was 2.37 (95% CI: 1.03, 5.44) for IER weakness and 2.44 (95% CI: 1.06, 5.61) for IIR weakness. The hazard rate ratio was 0.85 (95% CI: 0.39, 1.83) for an IER/IIR ratio of less than 0.75 and 1.53 (95% CI: 0.36, 6.52) for scapular dyskinesis. In male players, the hazard rate ratio was 1.02 (95% CI: 0.44, 2.36) for IER weakness, 0.74 (95% CI: 0.31, 1.75) for IIR weakness, 2.0 (95% CI: 0.68, 5.92) for an IER/IIR ratio of less than 0.75, and 3.43 (95% CI: 1.49, 7.92) for scapular dyskinesis. There were no associations between new shoulder injuries and deficits in ROM or JPS. Conclusion In adolescent elite handball, male players with preseason scapular dyskinesis and female players with preseason IIR or IER shoulder weakness had an increased shoulder injury rate. J Orthop Sports Phys Ther 2020;50(2):67–74. Epub 27 Nov 2019. doi:10.2519/jospt.2020.9044

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Section: Shoulder Rom and Shoulder Injuriessupporting

confidence: 74%

Section: Injury Pattern and Risk Factors For Shoulder Injurymentioning

confidence: 99%

Preseason Clinical Shoulder Test Results and Shoulder Injury Rate in Adolescent Elite Handball Players: A Prospective Study

Asker¹,

Waldén²,

Källberg³

et al. 2020

Journal of Orthopaedic & Sports Physical Therapy

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“…This may be attributed to adaptive process of at the anterior capsule [ 2 ]. A metanalysis by Keller in 2017 showed that total external rotation (ER) may increase the risk of injury when compared with contralateral arm [ 3 ]. From his report, he argued that ER gain may place an individual at risk for upper extremity injury.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Lubis

Wisnubaroto

Ilyas

et al. 2020

Annals of Medicine and Surgery

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Background The glenohumeral internal rotation deficit (GIRD) is diagnosed when there is a loss of 20° of internal rotation compared to the contralateral shoulder. This condition has already been well described in a group of throwing athletes, i.e. baseball pitchers. However, athletic athletes such as javelin throwers, discus throwers, hammer throwers, shot putters may also be susceptible to this condition. Reports are lacking to recognize these symptoms as GIRD for these group of athletes. We aim to evaluate these subgroups of athletes for the possibility of GIRD. Materials and methods We examined ten athletes (javelin, hammer throwers, and shot putters) for signs of GIRD. Signs of loss of internal rotation were assessed by measuring shoulder range of motion (internal rotation and external rotation) in supine position and posterior shoulder tightness test. Complaints of shoulder pain, evidence of scapular malposition, inferior medial border prominence, coracoid pain and malposition, and dyskinesis of scapular movement (SICK) scapula, posterior shoulder flexibility test were examined. Results The athletes had a mean training period of 3.8 years. One athlete had complaints of mild pain on their dominant shoulder. Two athletes had GIRD (20° and 25°) with no posterior shoulder tightness. Three athletes had posterior shoulder tightness, but normal total shoulder ROM (195°, 180°, and 185°). Three athletes had increased external rotation (105°, 100°, 125°). No subjects had scapular dyskinesia nor SICK scapula syndrome. All athletes had normal total shoulder ROM. Conclusion Glenohumeral internal rotation deficit could be present in non-pitcher overhead athletics athletes.

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“…A recent meta-analysis covering 2195 athletes with a mean age of 20.8 years demonstrated that shoulders with GIRD favor an upper extremity injury, with a mean difference of 3.11° (95% CI, −0.13° to 6.36°; P=0.06). 22) It has also been reported that increasing the eccentric overload to the posterior rotator cuff during the deceleration phase might result in rotator cuff stiffness of the hitting shoulder and subsequent internal rotation deficits. 5) Several studies reported that humeral retroversion of the dominant arm is increased in overheadthrowing athletes.…”

Section: Glenohumeral Internal Rotation Deficitmentioning

confidence: 99%

Glenohumeral Rotational Deficit and Suprascapular Neuropathy in the Hitting Shoulder in Male Collegiate Volleyball Players

Miura

Tsuda

Ishibashi

2019

PRM

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Repetitive overhead movements stress the dominant shoulder of volleyball players, potentially causing glenohumeral internal rotation deficit (GIRD) and suprascapular neuropathy. The aim of this study was to determine the prevalence of pathological GIRD and suprascapular neuropathy in male collegiate volleyball players. Methods: We evaluated 22 male collegiate volleyball players and compared the range of motion, the isometric shoulder strength, the thickness of the infraspinatus (ISP) muscle, and the latency and amplitude of the suprascapular nerve [in a nerve conduction study (NCS)] between the hitting and contralateral shoulders. Correlations between the physical findings and each parameter were also determined. Results: The internal rotation angle of the hitting shoulder (55.1±8.7°) was significantly less than that of the contralateral shoulder (64.5±10.2°) (P<0.001); pathological GIRD (≥20°) was found in four players (18.2%). Three players (13.6%) showed abnormal electrophysiological findings of the suprascapular nerve on the ISP muscle in the hitting shoulder. The external-to-internal rotation (ER/IR) torque ratio in the hitting shoulder (99±18%) was significantly lower than that in the contralateral shoulder (106±12%) (P=0.04); no significant differences were observed in ISP muscle thickness or NCS data between the hitting and contralateral shoulders. Conclusion: The prevalence of pathological GIRD in male collegiate volleyball players was consistent with that of previous studies. Meanwhile, the prevalence of suprascapular neuropathy was less than that previously reported in high-level volleyball players. Preventive posterior rotator cuff strengthening programs are recommended to correct imbalances between ER and IR in the hitting shoulder, thereby decreasing the risk of shoulder injury.

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Glenohumeral Internal Rotation Deficit and Risk of Upper Extremity Injury in Overhead Athletes: A Meta-Analysis and Systematic Review

Cited by 88 publications

References 26 publications

Preseason Clinical Shoulder Test Results and Shoulder Injury Rate in Adolescent Elite Handball Players: A Prospective Study

Preseason Clinical Shoulder Test Results and Shoulder Injury Rate in Adolescent Elite Handball Players: A Prospective Study

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

Glenohumeral Rotational Deficit and Suprascapular Neuropathy in the Hitting Shoulder in Male Collegiate Volleyball Players

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