Managing glenohumeral internal rotation deficit phillip b. There was a significant difference in dominant arm internal rotation, with injured players having significantly less p glenohumeral internal rotation deficit. Glenohumeral internal rotation deficit in throwing athletes. Its most often seen in baseball pitchers, but tennis players and other throwing athletes can have. Gird glenohumeral internal rotation deficit, all acronyms, viewed november 25, 2019, glenohumeral internal rotation deficit, or gird. Glenohumeral internal rotation deficit rehab sports. Measurement of glenohumeral internal rotation in asymptomatic tennis players and swimmers article pdf available in the american journal of sports medicine 375. Article pdf available in open access journal of sports medicine volume 9. Pdf measurement of glenohumeral internal rotation in. Results the dominant shoulder displayed increased external rotation 11.
Sep 23, 20 glenohumeral internal rotation deficit, or gird, continues to be one of the most polarizing topics in baseball sports medicine. Glenohumeral internal rotation deficit the throwers paradox. This deficit can be corrected through passive and active stretching methods performed by a therapist or selfadministered by the patient. Gird is a loss of internal rotation of 20 degrees or more compared to the contralateral side, frequently seen in overhead athletes. This loss of mobility is so common that the term glenohumeral internal rotation deficit gird is used to describe it. The internal rotation deficit group had significantly greater scapular anterior tilt 9. Glenohumeral internal rotation deficit orthopaedicsone. Think baseball pitchers, tennis players and maybe even swimmers. It is one of four joints that comprise the shoulder complex. Glenohumeral internal rotation deficit gird shoulder. Glenohumeral internal rotation deficit in overhead. He is prescribed a therapy regimen that involves internal rotation stretching at 90 degrees of forward flexion with the scapula stabilized.
Scapular angular positioning at end range internal rotation. Thank you, vickie smith, cpc, cpma coder saint joseph london p 606. Glenohumeral internal rotation deficit gird youtube. Prevalence of glenohumeral internal rotation deficit gird between seasons was compared with. This article is brought to you for free and open access by the graduate school at opensiuc. Aug 25, 2017 glenohumeral internal rotation deficit gird is a cause of shoulder pain in overhead athletes. The throwers shoulder must be lax enough to allow excessive external rotation, but stable enough to prevent symptomatic humeral head subluxations, thus requiring a delicate balance between mobility and functional stability. Glenohumeral internal rotation deficit gird indicates a 20 or greater loss of internal rotation of the throwing shoulder compared with the nondominant shoulder. Mar 19, 2018 glenohumeral internal rotation deficit gird is an adaptive process in which the throwing shoulder experiences a loss of internal rotation ir. Glenohumeral range of motion deficits and posterior. Panariello ms, pt, atc, cscs professional orthopedic and sports physical therapy professional athletic performance center new york, new york. Glenohumeral internal rotation deficit gird players with. See more ideas about tennis players, frozen shoulder and shoulder rehab. Multiple studies demonstrate that the athletes dominant shoulder, when compared with the nondominant shoulder, develops decreased internal rotation ir, known as glenohumeral internal rotation deficit gird.
During spring training in 1991, chris verna, an athletic trainer in the seattle mariners organization, determined that tightness in the posterior inferior shoulder was related to both. Glenohumeral internal rotation deficit and injuries. The association of scapular kinematics and glenohumeral joint. Gird has most commonly been defined by a loss of 20 of ir compared to the contralateral shoulder. Glenohumeral internal rotation deficit was calculated as the difference in measured internal rotation between the involved throwing and uninvolved limb. 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. Glenohumeral internal rotation deficits in baseball players.
Glenohumeral internal rotation deficit gird is an adaptive process in. Pdf correlation of glenohumeral internal rotation deficit. Changes in passive range of motion and development of. The throwing shoulder must be mobile enough to allow the extremes of external rotation needed to throw a ball, but it is a delicate balance between mobility and stability that is needed to perform the demands of the overhead throwing motion without undue strain on the other structures of the shoulder joint. Effects of glenohumeral internal rotation deficit on baseball. Mechanisms and treatments for shoulder injuries in. Todays guestpost is an excellent article from rob panariello, a regular guest contributor to my blog. Jul 15, 2016 gird refers to a loss of internal rotation due to repeated overhead activities. This is stuff that mike and i discuss literally every week, so im glad hes finally put it into a comprehensive article. This joint is formed from the combination of the humeral head and the glenoid fossa of the scapula. A profile of glenohumeral internal and external rotation. Introduction definedescribe the condition anatomy describe the pertinent anatomy pathogenesis describe the biomechanicsbiologic basis of the disorder or the mechanism of injury natural history describe the natural history, epidemiology and prognosis cli.
Glenohumeral internal rotation deficit request pdf researchgate. Internal rotation was measured using techniques similar to those for external rotation, as previously described. Pdf glenohumeral internal rotation deficit and injuries. Glenohumeral internal rotation deficits in baseball. Jan 01, 2010 glenohumeral internal rotation deficit in the asymptomatic professional pitcher and its relationship to humeral retroversion. Glenohumeral internal rotation deficit, or gird, continues to be one of the most polarizing topics in baseball sports medicine. This joint is considered to be the most mobile and least stable joint in. Kai explains the theories behind glenohumeral internal rotation deficit or gird, which can be an underlying cause of shoulder impingement syndrome. Effects of glenohumeral internal rotation deficit on.
Listing a study does not mean it has been evaluated by the u. Glenohumeral internal rotation deficit in division three. Arthroscopic management of the throwers shoulder with. This joint is considered to be the most mobile and least stable. Aug 23, 2011 glenohumeral internal rotation deficit gird gird the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Changes in passive range of motion and development of glenohumeral internal rotation deficit gird in the professional pitching shoulder between spring training in two consecutive years. The glenohumeral gh joint is a true synovial ballandsocket style diarthroidal joint that is responsible for connecting the upper extremity to the trunk. Glenohumeral internal rotation deficit and risk of upper.
Managing glenohumeral internal rotation deficit dr. A decrease in ir can often be attributed to overactive or shortened infraspinatus or teres minor muscles, and joint dysfunction due to capsular contraction of the posterior shoulder ligaments. Glenohumeral internal rotation deficit orland park. Posterior shoulder tightness and internal rotation deficit at the glenohumeral joint occur often in athletes who participate in throwing sports, racquet and crosse sports, or swimming.
Shoulder pain and dysfunction are a significant health issue, in the general population as well as in an athletic population. Apr 15, 2014 internal rotation ir of the shoulder is commonly diminished in overhead athletes e. Dec, 20 internal rotation deficit of the glenohumeral joint in advancedlevel handball players girdh the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Gird is known to increase and ir to decrease with years of throwing exposure,23,24 throughout a competitive season,25,26 and acutely after a throwing. Aug 12, 2011 4,5 this loss of internal rotation on the throwing arm compared to nonthrowing arm is defined as gird, or glenohumeral internal rotation deficit. Aroutine evaluation is pivotal in identifying glenohumeral internal rotation deficit gird in overhead athletes and is a crucial step to prevent subsequent, debilitating injuries. Observational studies comparing glenohumeral internal rotation range of motion rom in. Glenohumeral internal rotation deficit gird full text. Glenohumeral range of motion deficits and posterior shoulder. The association of scapular kinematics and glenohumeral joint pathologies next. Glenohumeral internal rotation deficit and total arc of motion deficit can cause alterations in.
During spring training in 1991, chris verna, an athletic trainer in the seattle mariners organization, determined that tightness in the posterior inferior shoulder was related to both shoulder. The combination of external rotation er and internal rotation ir equals total motion and is equal bilaterally in overhead athletes, although shifted posteriorly in the dominant a versus nondominant b shoulder. Cross body stretching for internal rotation deficit. Since gird was first reported,22 multiple studies have been conducted further describing it. Glenohumeral internal rotation deficit in division three collegiate football quarterbacks 2 abstract the research looked at the internal rotation loss in collegiate football quarterbacks. Therefore, the aim of the study firstly was to determine the effectiveness of mobilization with exercise in patients with glenohumeral internal rotation deficit and secondly to determine. Whilst acute shoulder injuries occur mainly in collision sports or as a result of a sports accident like falling in skiing or biking, athletes performing overhead sports such as tennis, baseball, swimming and gymnastics are also prone to chronic shoulder pain, due to. Correlation of glenohumeral internal rotation deficit and. He is examined in the office and is diagnosed with glenohumeral internal rotation deficit gird. For measurements of glenohumeral internal rotation, the athlete is placed in the supine position with the humerus abducted to 90 degrees. Describe the concept of glenohumeral internal rotation deficiency gird. Scapular angular positioning at end range internal.
There were no significant differences between the groups in terms of demographics. A goniometer was used to measure the internal and external rotation of. Glenohumeral internal rotation deficits in the overhead varsity level athlete. It has been accepted for inclusion in research papers by. The association of scapular kinematics and glenohumeral. When the amount of ir or total arc of motion difference reaches a certain threshold typically 20 or more degrees of ir or 8 degrees total arc difference, it is known as glenohumeral internal rotation deficit or total arc of motion deficit. Humeral external rotation is presumed beneficial to the subacromial space, allowing improved clearance for the greater tuberosity. Internal rotation deficit of the glenohumeral joint in. Pathological loss of internal rotation will result in a loss of total motion c. Request pdf glenohumeral internal rotation deficit overhand throwing places high loads and stresses on the joints and tissues of the shoulder and arm. Glenohumeral internal rotation deficit gird is a cause of shoulder pain in overhead athletes. Effectiveness of mobilization with exercise vs mulligan.
It has become so popular that even athletes and the general public know about gird, often exhibiting fear and anxiety with just the mention of gird. Usually it is a problem that develops over time rather than following an acute injury. There was a significant difference in dominant arm internal rotation, with injured players having significantly less p glenohumeral internal rotation deficit between players with. Considerations in elbow rehabilitation and athletic. Progression is dependent on each phase being pain free and without. Mechanisms and treatments for shoulder injuries in overhead throwing athletes. Pdf glenohumeral internal rotation deficit in throwing athletes. Pdf factors associated with shoulder deficit in total. Glenohumeral internal rotation deficit in throwing. This tightness and decreased internal rotation motion may contribute to shoulder impingement pain through elevation of subacromial contact pressure at the greatest external rotation. Scapular angular positioning at end range internal rotation in cases of glenohumeral internal rotation deficit. Jan 30, 2018 multiple studies demonstrate that the athletes dominant shoulder, when compared with the nondominant shoulder, develops decreased internal rotation ir, known as glenohumeral internal rotation deficit gird. The evaluation was composed of a scapular kinematic analysis according to the observational method in order to identify dyskinesis and external and internal rotation amplitude of the glenohumeral joint to assess the presence of internal rotation deficit gird and dtrm, both using the passive goniometry method.
Internal rotation deficit of the glenohumeral joint in advancedlevel handball players girdh the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Scapular position data at end range glenohumeral internal rotation, along with glenohumeral internal rotation range of motion measurements, were used to analyze the relationship between glenohumeral internal rotation deficit and scapular position using 2way anova and regression analyses. Sacroiliac stretching improves glenohumeral internal rotation. This change leads in turn to a higher external rotation er and lower ir of the shoulder. Glenohumeral internal rotation deficit gird is a welldocumented finding in throwi. Measuring and preventing glenohumeral internal rotation. Considerations in elbow rehabilitation and athletic performance enhancement training.