Dataset Information

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

ABSTRACT:

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.

SUBMITTER: Keller RA

PROVIDER: S-EPMC5857737 | biostudies-literature | 2018 Mar/Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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

Keller Robert A RA De Giacomo Anthony F AF Neumann Julie A JA Limpisvasti Orr O Tibone James E JE

Sports health 20180130 2

<h4>Context</h4>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.<h4>Objective</h4>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.<h4>Data sources</h4>An electronic database search was performed using Medline, Embase ...[more]

PMID: 29381423

Similar Datasets

Project description:BackgroundThe cross-body and the modified sleeper stretch have been used to improve posterior shoulder soft tissue flexibility and to increase glenohumeral joint internal rotation (GHJ IR) in overhead athletes. However, due to the inability to stabilize patient's scapula and control GHJ rotation with the cross-body stretch and the potential for subacromial impingement or symptoms' aggravation with the modified sleeper stretch, a new stretching technique (Passive Glenohumeral Internal Rotation with Clam Shell Bridging) was developed as an alternative to these commonly used stretches that may allow for greater stability of the scapula without reproducing symptoms. Thus, the current study aimed to examine and compare a novel stretching technique to the traditional modified sleeper stretch to determine the effect on glenohumeral IR range of motion (ROM) and self-reported pain in overhead athletes with glenohumeral internal rotation deficits (GIRD).MethodsForty-two overhead athletes with GIRD [mean age 25.9 ± 2.6 years, 20 males and 22 females] participated in this study. Participants were randomly assigned into either novel stretching group or modified sleeper stretching group. IR ROM was measured with a digital inclinometer before, immediately, and at week 4 post intervention, while pain was measured with Numeric Pain Rating Scale before and at week 4 post intervention.ResultsThere was no significant group by time interaction effect for IR ROM (p = 0.27); however, there was a significant change over time (p < 0.001, η2 = 0.77). Both groups demonstrated a significant increase in IR from baseline to immediate and week 4, and from immediate to week 4 (p < 0.001). There was a significant group by time interaction for pain intensity (p < 0.001, η2 = 0.72). Results showed a significant reduction in pain intensity over time in the novel group (p = 0.001, d = 2.18), but not in the traditional group (p = 0.231, d = 0.46).ConclusionBoth stretches appear to be effective at improving IR ROM in overhead athletes with GIRD. However, the novel stretching might be more effective at reducing shoulder pain and thus may be more appropriate for symptomatic patients.Trial registrationProspectively registered in February 6, 2017 under Clinical Trial Registry # NCT03044236 .

Project description:BackgroundBased on Euler/Cardan analysis, prior investigations have reported up to 80° of glenohumeral (GH) external rotation during arm elevation, dependent on the plane of elevation (PoE). However, the subtraction of Euler/Cardan angles does not compute the rotation around the humerus' longitudinal axis (i.e. axial rotation). Clinicians want to understand the true rotation around the humerus' longitudinal axis and rely on laboratories to inform their understanding of underlying shoulder biomechanics, especially for the GH joint since its motion cannot be visually ascertained. True GH axial rotation has not been previously measured in vivo, and its difference from Euler/Cardan (apparent) axial rotation is unknown.Research questionWhat is the true GH axial rotation during arm elevation and external rotation, and does it vary from apparent axial rotation and by PoE?MethodsTwenty healthy subjects (10 M/10 F, ages 22-66) were recorded using biplane fluoroscopy while performing arm elevation in the coronal, scapular and sagittal planes, and external rotation in 0° and 90° of abduction. Apparent GH axial rotation was computed using the xz'y'' and yx'y'' sequences. True GH axial rotation was computed by integrating the projection of GH angular velocity onto the humerus' longitudinal axis. One-dimensional statistical parametric mapping was utilized to compare apparent versus true axial rotation, axial rotation versus 0°, and detect differences in axial rotation by PoE.ResultsIn contrast to apparent axial rotation, true GH axial rotation does not differ by PoE and is not different than 0° during arm elevation at higher elevation angles. The spherical area between the sequence-specific and actual humeral trajectory explains the difference between apparent and true axial rotation.SignificanceProper quantification of axial rotation is important because biomechanics literature informs clinical understanding of shoulder biomechanics. Clinicians care about true axial rotation, which should be reported in future studies of shoulder kinematics.

Dataset Information

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

Context

Objective

Data sources

Study selection

Study design

Level of evidence

Data extraction

Results

Conclusion

Publications

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

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