Abstract
Objectives
Clinicians commonly interpret the findings of shoulder rotational ranges of motion
using various approaches: an apparent reduction in dominant arm internal rotation
(“GIRD”), a difference in total rotational range of motion—i.e. differences in the
sum of internal and external rotational range (TRROM), and a combination of rotational
ROM and torsional difference (“GIRD-torsion”). We have noticed that these approaches
are being considered to provide equivalent estimates of shoulder rotational range.
This investigation sought to document the extent of agreement of these three different
approaches when classifying athletes’ “at-risk” status.
Design
Observational cohort study.
Methods
162 professional male athletes participating in overhead sports (baseball, handball,
and volleyball) had their GIRD, TRROM, and GIRD-torsion calculated, and classified
as “at risk” using standard cut-points of 20°, 5°, and 10°, respectively.
Results
25 (15.4%) athletes were classified as “at-risk” using GIRD, 55 (34%) with TRROM,
and 30 (18.5%) using GIRD-torsion. Only 3/162 (1.9%) athletes were classified as “at-risk”
by all 3 approaches, 4 athletes were concurrently classified as “at-risk” by GIRD
and TRROM (Kappa = −0.142, poor agreement), 11 by GIRD and GIRD-torsion (Kappa = 0.279, fair agreement), and 11 by TRROM and GIRD-torsion (Kappa = 0.025, slight agreement).
Results
25 (15.4%) athletes were classified as at risk using GIRD, 55 (34%) with TRROM, and
30 (18.5%) using GIRD-torsion. Only 3/162 (1.9%) athletes were classified as at risk
by all 3 approaches, 4 athletes were concurrently classified as at risk by GIRD and
TRROM (Kappa = −0.142, poor agreement), 11 by GIRD and GIRD-torsion (Kappa = 0.279, fair agreement), and 11 by TRROM and GIRD-torsion (Kappa = 0.025, slight agreement).
Conclusions
The three described approaches yield demonstrably different findings, and these approaches
cannot be used interchangeably. Examples of clinical reasoning are provided to assist
with the interpretation of these different measures.
Keywords
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References
- Epidemiology of major league baseball injuries.Am J Sports Med. 2011; 39: 1676-1680
- The disabled throwing shoulder: spectrum of pathology part I: Pathoanatomy and biomechanics.Arthroscopy. 2003; 19: 404-420
- Glenohumeral range of motion in handball players with and without throwing-related shoulder pain.J Shoulder Elbow Surg. 2013; 22: 602-607
- The effect of glenohumeral internal rotation deficit due to posterior capsular contracture on passive glenohumeral joint motion.Am J Sports Med. 2012; 40: 2794-2800
- A bilateral comparison of posterior capsule thickness and its correlation with glenohumeral range of motion and scapular upward rotation in collegiate baseball players.J Shoulder Elbow Surg. 2011; 20: 708-716
- The disabled throwing shoulder: spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation.Arthroscopy. 2003; 19: 641-661
- Analysis of the pitching arm of the professional baseball pitcher.Clin Orthop Relat Res. 1969; 67: 116-123
- Shoulder range of motion in elite tennis players. Effect of age and years of tournament play.Am J Sports Med. 1996; 24: 279-285
- Current concepts in the rehabilitation of the overhead throwing athlete.Am J Sports Med. 2002; 30 (Current concepts): 136-151
- The modified sleeper stretch and modified cross-body stretch to increase shoulder internal rotation range of motion in the overhead throwing athlete.J Orthop Sports Phys Ther. 2013; 43: 891-894
- The definition of humeral torsion: a comment on Rhodes (2006).Am J Phys Anthropol. 2007; 133 (discussion 820–811): 819-820
- Humeral torsion in the throwing arm of handball players.Am J Sports Med. 1998; 26: 247-253
- Indirect ultrasound measurement of humeral torsion in adolescent baseball players and non-athletic adults: reliability and significance.J Sci Med Sport. 2006; 9: 310-318
- Why is the humeral retroversion of throwing athletes greater in dominant shoulders than in nondominant shoulders?.J Shoulder Elbow Surg. 2006; 15: 571-575
- Playing level achieved, throwing history, and humeral torsion in Masters baseball players.J Sports Sci. 2010; 28: 1223-1232
- Ultrasonographic assessment of humeral retrotorsion in baseball players: a validation study.Am J Sports Med. 2012; 40: 1155-1160
- Sports participation and humeral torsion.J Orthop Sports Phys Ther. 2009; 39: 256-263
- Rehabilitation of the throwing athlete: where we are in 2014.Clin Sports Med. 2015; 34: 247-261
- Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement.Am J Sports Med. 2006; 34: 385-391
- Reliability of shoulder internal rotation passive range of motion measurements in the supine versus sidelying position.J Orthop Sports Phys Ther. 2010; 40: 589-594
- Clinical measurement of posterior shoulder flexibility.Man Ther. 2007; 12: 386-389
- Measuring shoulder internal rotation range of motion: a comparison of 3 techniques.Arch Phys Med Rehabil. 2002; 83: 1229-1234
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159-174
- Relationship between humeral torsion and injury in professional baseball pitchers.Am J Sports Med. 2013; 41 (Epub 2013 Jun 20): 2015-2021https://doi.org/10.1177/0363546513493249
- Reduced humeral torsion predicts throwing-related injury in adolescent baseballers.J Sci Med Sport. 2010; 13: 392-396
Article info
Publication history
Published online: January 28, 2016
Accepted:
December 19,
2015
Received in revised form:
December 18,
2015
Received:
August 14,
2015
Identification
Copyright
© 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
