Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Oct;8(5):537-53.

Glenohumeral motion deficits: friend or foe?

Robert Manske, Kevin E Wilk, George Davies, Todd Ellenbecker, Mike Reinold

Glenohumeral motion deficits: friend or foe?

Robert Manske et al. Int J Sports Phys Ther. 2013 Oct.

Abstract

In most shoulder conditions a loss of glenohumeral motion results in shoulder performance impairments. However, in the overhead athlete loss of glenohumeral internal rotation, termed glenohumeral internal rotation deficiency (GIRD), is a normal phenomenon that should be expected. Without a loss of glenohumeral internal rotation the overhead athlete will not have the requisite glenohumeral external rotation needed to throw a baseball at nearly 100 miles per hour, or serve a tennis ball at velocities of 120 miles per hour or more. Not all GIRD is pathologic. The authors of this manuscript have defined two types of GIRD; one that is normal and one that is pathologic. Anatomical GIRD (aGIRD) is one that is normal in overhead athletes and is characterized by a loss of internal rotation of less than 18°-20° with symmetrical total rotational motion (TROM) bilaterally. Pathologic GIRD (pGIRD) is when there is a loss of glenohumeral internal rotation greater than 18°-20° with a corresponding loss of TROM greater than 5° when compared bilaterally. A more problematic motion restriction may be that of a loss of TROM in the glenohumeral joint. Recent evidence supports that a loss of TROM is predictive of future injury to the shoulder in professional athletes. Additionally, external rotation deficiency (ERD), the difference between external rotation (ER) of the throwing shoulder and the non-throwing shoulder of less than 5°, may be another predictor of future shoulder injury and disability.

Level of evidence: 5.

Keywords: External rotation deficiency; glenohumeral internal rotation deficit; total rotation motion.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Measurement of glenohumeral internal rotation with scapula stabilized.
Figure 2.
Figure 2.
Measurement of glenohumeral external rotation.
Figure 3.
Figure 3.
a. Total range of motion (TROM) dominant shoulder, b. TROM, non‐dominant shoulder.
Figure 4.
Figure 4.
Sleeper stretch, performed at 90 degrees of abduction.
Figure 5.
Figure 5.
Sleeper stretch, performed at 45 degrees of abduction.
Figure 6.
Figure 6.
“Rollover” sleeper stretch, top view, b. front view of same.
Figure 7.
Figure 7.
a. Alternate sleeper stretch position, quarter turn backward to decrease impingement symptoms. b. front view of same.
Figure 8.
Figure 8.
Supine cross body stretch, with scapular stabilization.
See this image and copyright information in PMC

References

    1. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: Spectrum of pathology. Part I: Pathoanatomy and biomechanics. Arthroscopy. 2003;19:404–420 - PubMed
    1. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder. Spectrum of pathology. Part II: Evaluation and treatment of SLAP lesions in throwers. Arthroscopy. 2003;19:531–539 - PubMed
    1. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: Spectrum of pathology. Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003;19:641–661 - PubMed
    1. Dillman CJ, Fleisig GS, Andrews JR. Biomechanics of pitching with emphasis upon shoulder kinematics. J Orthop Sports Phys Ther. 1993;18:402–408 - PubMed
    1. Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF. Kinetics of baseball pitching with implications about injury mechanism. Am J Sports Med. 1995;23(2):233–239 - PubMed