Clinical Outcomes and Quality of Literature Addressing Glenohumeral Internal Rotation Deficit: A Systematic Review.
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ABSTRACT: Background
Glenohumeral internal rotation deficit (GIRD) can negatively impact shoulder function particularly in the throwing athlete.Questions/purpose
This study aimed to systematically evaluate recent trends in clinical outcomes and quality of published evidence pertaining to GIRD.Methods
A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, MEDLINE, PubMed Central, and Embase were searched from January 1, 2011, through April 23, 2017, for all articles evaluating GIRD. Two reviewers independently screened articles for eligibility and extracted data for analysis.Results
Eighty-two articles were included in the final review. In general, the overall number of articles published increased over time. Two-thirds of all studies were conducted in the USA. Seventy-eight percent (N = 64) of included studies were level-III to level-V evidence, with no level-I study performed during the study period. Eighty-five percent of studies were either epidemiologic, review, or imaging articles, and only 12% were clinical studies. Significant variability in the clinical definition of GIRD was identified. All studies evaluating non-operative management of GIRD demonstrated significant improvements in internal rotation of the affected extremity.Conclusion
Current trends in GIRD-related literature demonstrate limited focus on clinical, therapeutic, or patient-reported outcomes and mostly consist of low-level evidence. There is a lack of consensus in the literature on what clinically constitutes GIRD.
SUBMITTER: Kirsch JM
PROVIDER: S-EPMC7534890 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ContextCurrent 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.ObjectiveTo 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 sourcesAn 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 selectionSeventeen 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 designSystematic review and meta-analysis.Level of evidenceLevel 4.Data extractionData 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.ResultsThe 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).ConclusionThe 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.
| S-EPMC5857737 | biostudies-literature
Project description:BackgroundThe 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 methodsWe 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.ResultsThe 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.ConclusionGlenohumeral internal rotation deficit could be present in non-pitcher overhead athletics athletes.
| S-EPMC7493035 | biostudies-literature
Project description:BackgroundReverse total shoulder arthroplasty (RTSA) can lead to limited postoperative internal rotation (IR). We assessed how IR is measured and reported in the RTSA literature and examined the relationships between these measures and patient-reported ability to perform activities of daily living.MethodsWe searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for articles published in English from January 2000 through September 2018 that reported clinical outcomes after RTSA (minimum 12-month follow-up). We included studies reporting IR range of motion (ROM) and/or patient-reported functional outcomes related to IR. We identified 255 studies, 35% of which were excluded because they reported no IR outcome measures, leaving 165 studies for analysis.ResultsStudies reported 3 methods of measuring IR ROM: (1) vertebral level (VL) method (ie, the most proximal VL reached by the extended thumb with the arm behind the back), (2) degrees of IR with the arm abducted to 90°, and (3) degrees of IR with the arm in a neutral position. The VL measurement was reported in 89% of studies, but the methods of reporting this measure varied. Only 9% of studies reported functional outcomes related to IR. No study correlated clinical measurements of IR ROM with functional outcomes.ConclusionsMeasures and reporting of shoulder IR after RTSA varied widely. This variability makes it difficult to assess associations between postoperativce IR limitation and functional abilities. Standardization of IR measures and reporting is needed to allow meta-analysis of data related to this important outcome.
| S-EPMC7075784 | biostudies-literature
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.
| S-EPMC8316370 | biostudies-literature
Project description:BackgroundThe middle glenohumeral ligament (MGHL) is one of the three ligaments that stabilize the anterior capsule of the shoulder. Recent work suggests that it inserts distally into the deep layer of the subscapularis tendon. The role of the MGHL remains debated. The hypothesis of this study was that the MGHL plays a significant functional role in limiting external rotation of the shoulder while allowing a wide range of motion through its distal insertion into the subscapularis rather than directly onto the humerus.MethodsIn a cadaveric study performed on 20 shoulders (10 subjects), the MGHL and the other anterior structures of the shoulder were successively cut according to a standardized protocol. At each stage, the external rotation range of the shoulder was measured with the arm at the side (ER 1) and in 90° abduction (ER 2) using a goniometer. After dissection, the structure of the MGHL and its distal insertion were analyzed.ResultsCutting the MGHL led to significant increases in ER 1 but not in ER 2. Shoulder range of motion in ER 1 increased on average by 15 ± 5° (P < .001) after cutting the MGHL and by 21 ± 11° (P < .001) after subscapularis peel. The range of motion in ER 2 increased by 3 ± 4° (P = .048) after cutting the MGHL, by 4 ± 6° (P = .02) after subscapularis peel and by 25 ± 8° (P < .001) after cutting the inferior glenohumeral ligament. The MGHL was present in all dissected shoulders. It was leaf-like in 12 cases, cord-like in 6 cases and had a vestigial appearance in 2 cases. The distal insertion was in all cases in the deep layer of the subscapularis in a thickening of the anterior capsule in the superior part of the muscle, except for two cases in which the tendinous part of the subscapularis was also involved.ConclusionThe MGHL limited shoulder external rotation by a similar amount as the subscapularis muscle. Further studies are required to understand the clinical relevance of these findings, notably for the treatment of shoulder stiffness.
| S-EPMC9998722 | biostudies-literature
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 .
| S-EPMC8091767 | biostudies-literature
Project description:Glenohumeral and scapulothoracic motion combine to generate humerothoracic motion, but their discrete contributions towards humerothoracic axial rotation have not been investigated. Understanding their contributions to axial rotation is important to judge the effects of pathology, surgical intervention, and physiotherapy. Therefore, the purpose of this study was to investigate the kinematic coupling between glenohumeral and scapulothoracic motion and determine their relative contributions towards axial rotation. Twenty healthy subjects (10 M/10F, ages 22-66) were previously recorded using biplane fluoroscopy while performing arm elevation in the coronal, scapular, and sagittal planes, and external rotation in 0° and 90° of abduction. Glenohumeral and scapulothoracic contributions towards axial rotation were computed by integrating the projection of glenohumeral and scapulothoracic angular velocity onto the humeral longitudinal axis, and analyzed using one dimensional statistical parametric mapping and linear regression. During arm elevation, scapulothoracic motion supplied 13-20° (76-94%) of axial rotation, mainly via scapulothoracic upward rotation. The contribution of scapulothoracic motion towards axial rotation was strongly correlated with glenohumeral plane of elevation during arm elevation. During external rotation, scapulothoracic motion contributed 10° (8%) towards axial rotation in 0° of abduction and 15° (15%) in 90° of abduction. The contribution of scapulothoracic motion towards humerothoracic axial rotation could explain the simultaneous changes in glenohumeral plane of elevation and axial rotation associated with some pathologies and surgeries. Understanding how humerothoracic motion results from the functional coupling of scapulothoracic and glenohumeral motions may inform diagnostic and treatment strategies by targeting the source of movement impairments in clinical populations.
| S-EPMC9081276 | biostudies-literature
Project description:The inferior glenohumeral ligament, the most important static anterior stabilizer of the shoulder, becomes disrupted in humeral avulsion of the glenohumeral ligament (HAGL) lesions. Unfortunately, HAGL lesions commonly go unrecognized. A missed HAGL during an index operation to treat anterior shoulder instability may lead to persistent instability. Currently, there are no large studies describing the indications for surgical repair or the outcomes of patients with HAGL lesions.To search the literature to identify surgical indications for the treatment of HAGL lesions and discuss reported outcomes.Systematic review; Level of evidence, 4.Two reviewers completed a comprehensive literature search of 3 online databases (MEDLINE, EMBASE, and Cochrane Library) from inception until May 25, 2016, using the keywords "humeral avulsion of the glenohumeral ligament" or "HAGL" to generate a broad search. Systematic screening of eligible studies was undertaken in duplicate. Abstracted data were organized in table format, with descriptive statistics presented.After screening, 18 studies comprising 118 patients were found that described surgical intervention and outcomes for HAGL lesions. The mean patient was 22 years (range, 12-50 years), and 82% were male. Sports injuries represented 72% of all HAGL injuries. The main surgical indication was primary anterior instability, followed by pain and failed nonoperative management. Commonly associated injuries in patients with identified HAGL lesions included a Bankart lesion (15%), Hill-Sachs lesions (13%), and glenoid bone loss (7%). Reporting of outcome scores varied among the included studies. Meta-analysis was not possible, but all included studies reported significantly improved postoperative stability and function. There were no demonstrated differences in outcomes for patients treated with open versus arthroscopic surgical techniques. All but 2 patients undergoing operative management for HAGL lesions were able to return to sport at their previous levels; these included Olympians and professional athletes.HAGL lesions typically occur in younger male patients and are often associated with Bankart lesions and bone loss. Open and arthroscopic management techniques are both effective in preventing recurrent instability.
| S-EPMC5560515 | biostudies-other
Project description:BackgroundIntegrating teaching and hands-on experience in quality improvement (QI) may increase the learning and the impact of resident QI work.ObjectiveWe sought to determine the clinical and educational impact of an integrated QI curriculum.MethodsThis clustered, randomized trial with early and late intervention groups used mixed methods evaluation. For almost 2 years, internal medicine residents from Dartmouth-Hitchcock Medical Center on the inpatient teams at the White River Junction VA participated in the QI curriculum. QI project effectiveness was assessed using statistical process control. Learning outcomes were assessed with the Quality Improvement Knowledge Application Tool-Revised (QIKAT-R) and through self-efficacy, interprofessional care attitudes, and satisfaction of learners. Free text responses by residents and a focus group of nurses who worked with the residents provided information about the acceptability of the intervention.ResultsThe QI projects improved many clinical processes and outcomes, but not all led to improvements. Educational outcome response rates were 65% (68 of 105) at baseline, 50% (18 of 36) for the early intervention group at midpoint, 67% (24 of 36) for the control group at midpoint, and 53% (42 of 80) for the late intervention group. Composite QIKAT-R scores (range, 0-27) increased from 13.3 at baseline to 15.3 at end point (P < .01), as did the self-efficacy composite score (P < .05). Satisfaction with the curriculum was rated highly by all participants.ConclusionsLearning and participating in hands-on QI can be integrated into the usual inpatient work of resident physicians.
| S-EPMC5058590 | biostudies-literature
Project description:IntroductionTo evaluate the possibility that switching from reference biologic medicines to biosimilars could lead to altered clinical outcomes, including enhanced immunogenicity, compromised safety, or diminished efficacy for patients, a systematic literature review was conducted of all switching studies between related biologics (including biosimilars).MethodsA systematic search was conducted using the Medline® and Embase® databases up to 30 June 2017 employing specific medical subject heading terms. Additionally, the snowball method and a hand search were also applied. Publications were considered if they contained efficacy or safety information related to a switch from a reference medicine to a biosimilar. Non-English, non-human studies, editorials, notes, and short surveys were excluded.ResultsPrimary data were available from 90 studies that enrolled 14,225 unique individuals. They included protein medicines used in supportive care as well as those used as therapeutic agents. The medicines contained seven different molecular entities that were used to treat 14 diseases. The great majority of the publications did not report differences in immunogenicity, safety, or efficacy. The nature and intensity of safety signals reported after switching from reference medicines to biosimilars were the same as those already known from continued use of the reference medicines alone. Three large multiple switch studies with different biosimilars did not show differences in efficacy or safety after multiple switches between reference medicine and biosimilar. Two publications reported a loss of efficacy or increased dropout rates.ConclusionsWhile use of each biologic must be assessed individually, these results provide reassurance to healthcare professionals and the public that the risk of immunogenicity-related safety concerns or diminished efficacy is unchanged after switching from a reference biologic to a biosimilar medicine.
| S-EPMC5854749 | biostudies-literature