The Contribution of Posterior Capsule Hypertrophy to Soft Tissue Glenohumeral Internal Rotation Deficit in Healthy Pitchers

Abstract

Background:

The relationship between posterior capsule adaptations and soft tissue glenohumeral internal rotation deficit (GIRD) in healthy pitchers remains unclear.

Purpose/Hypothesis:

This study aimed to identify if posterior capsule thickness (PCT) was associated with soft tissue GIRD in healthy pitchers. We hypothesized that there would be a positive relationship between soft tissue GIRD and PCT in the dominant arm, no relationship between soft tissue GIRD and PCT in the nondominant arm, and a strong positive relationship between soft tissue GIRD and the bilateral difference in PCT (posterior capsule hypertrophy [PCH]).

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 45 healthy collegiate and professional pitchers were included. Glenohumeral internal rotation and external rotation range of motion, humeral retroversion, and PCT were measured bilaterally. PCT was determined for unilateral posterior capsule measurements, and PCH of the throwing shoulder was calculated as the bilateral difference in PCT. Soft tissue GIRD was calculated as the sum of clinical GIRD and the bilateral difference in humeral retroversion. Pearson correlation coefficients were determined to evaluate the relationships between dominant arm PCT, nondominant arm PCT, and PCH and soft tissue GIRD.

Results:

Pearson correlations showed that both dominant arm PCT (R = −0.13; P = .378) and nondominant arm PCT (R = 0.21; P = .165) were not related to soft tissue GIRD. However, Pearson correlations did show that the amount of PCH was moderately related to soft tissue GIRD (R = 0.40; P = .007). Therefore, as the posterior capsule hypertrophied, soft tissue GIRD moderately increased.

Conclusion:

Increased PCH was associated with an increase in soft tissue GIRD in healthy pitchers. If PCT measurements are feasible, clinicians should consider performing bilateral ultrasound assessments to isolate posterior capsule adaptations (ie, PCH). This will allow clinicians to identify pitchers with potentially maladaptive structural adaptations and optimize management strategies throughout the season to counteract them.

Keywords

baseball pitching GIRD ultrasound range of motion

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References

Awan

Smith

Boon

. Measuring shoulder internal rotation range of motion: a comparison of 3 techniques. Arch Phys Med Rehabil. 2002;83(9):1229-1234.

Burkhart

Morgan

Kibler

. The disabled throwing shoulder: spectrum of pathology, part I. Pathoanatomy and biomechanics. Arthroscopy. 2003;19(4):404-420.

Burkhart

Morgan

Kibler

. The disabled throwing shoulder: spectrum of pathology, part III. The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003;19(6):641-661.

Case

Mannava

Fallin

Stone

Freehill

. Acute changes in glenohumeral range-of-motion following in-season minor league pitching starts. Phys Sportsmed. 2015;43(4):360-365.

Chant

Litchfield

Griffin

Thain

LMF

. Humeral head retroversion in competitive baseball players and its relationship to glenohumeral rotation range of motion. J Orthop Sports Phys Ther. 2007;37(9):514-520.

Clabbers

Kelly

Bader

, et al. Effect of posterior capsule tightness on glenohumeral translation in the late-cocking phase of pitching. J Sport Rehabil. 2007;16(1):41-49.

Dashottar

Borstad

. Quantifying range-of-motion changes across 4 simulated measurements of the glenohumeral joint posterior capsule: an exploratory cadaver study. J Orthop Sports Phys Ther. 2016;46(12):1080-1085.

Davis

. Conservative Surgery. Appleton; 1867.

Dillman

Fleisig

Andrews

. Biomechanics of pitching with emphasis upon shoulder kinematics. J Orthop Sports Phys Ther. 1993;18(2):402-408.

10.

Edelson

. The development of humeral head retroversion. J Shoulder Elbow Surg. 2000;9(4):316-318.

11.

Fitzpatrick

Tibone

Grossman

McGarry

Lee

. Development of cadaveric models of a thrower’s shoulder. J Shoulder Elbow Surg. 2005;14(1)(suppl S):49S-57S.

12.

Fleisig

Andrews

Dillman

Escamilla

. Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med. 1995;23(2):233-239.

13.

Hall

Lewis

Moore

Ridehalgh

. Posterior shoulder tightness: an intersession reliability study of 3 clinical tests. Arch Physiother. 2020;10(1):14.

14.

Ishigaki

Ishida

Samukawa

, et al. Does restriction of glenohumeral horizontal adduction reflect posterior capsule thickening of the throwing shoulder? J Phys Ther Sci. 2015;27(5):1299-1302.

15.

Keller

Marshall

Mehran

Moutzouros

. Pitching speed and glenohumeral adaptation in high school pitchers. Orthopedics. 2015;38(8):e668-e672.

16.

Laudner

Wong

Latal

Meister

. Posterior shoulder tightness and subacromial impingement characteristics in baseball pitchers: a blinded, matched control study. Int J Sports Phys Ther. 2020;15(2):188-195.

17.

Mihata

McGarry

Akeda

, et al. Posterior shoulder tightness can be a risk factor of scapular malposition: a cadaveric biomechanical study. J Shoulder Elbow Surg. 2020;29(1):175-184.

18.

Myers

Laudner

Pasquale

Bradley

Lephart

. Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med. 2006;34(3):385-391.

19.

Myers

Oyama

Clarke

. Ultrasonographic assessment of humeral retrotorsion in baseball players: a validation study. Am J Sports Med. 2012;40(5):1155-1160.

20.

Noonan

Shanley

Bailey

, et al. Professional pitchers with glenohumeral internal rotation deficit (GIRD) display greater humeral retrotorsion than pitchers without GIRD. Am J Sports Med. 2015;43(6):1448-1454.

21.

Olsen

Fleisig

Dun

Loftice

Andrews

. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. Am J Sports Med. 2006;34(6):905-912.

22.

Reagan

Meister

Horodyski

Werner

Carruthers

Wilk

. Humeral retroversion and its relationship to glenohumeral rotation in the shoulder of college baseball players. Am J Sports Med. 2002;30(3):354-360.

23.

Reuther

Sheridan

Thomas

. Differentiation of bony and soft-tissue adaptations of the shoulder in professional baseball pitchers. J Shoulder Elbow Surg. 2018;27(8):1491-1496.

24.

Rosa

Borstad

Ferreira

Gava

Santos

Camargo

. Comparison of specific and non-specific treatment approaches for individuals with posterior capsule tightness and shoulder impingement symptoms: a randomized controlled trial. Braz J Phys Ther. 2021;25(5):648-658.

25.

Shanley

Thigpen

Clark

, et al. 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. J Shoulder Elbow Surg. 2012;21(11):1605-1612.

26.

Takenaga

Goto

Tsuchiya

, et al. Relationship between bilateral humeral retroversion angle and starting baseball age in skeletally mature baseball players: existence of watershed age. J Shoulder Elbow Surg. 2019;28(5):847-853.

27.

Takenaga

Sugimoto

Goto

, et al. Posterior shoulder capsules are thicker and stiffer in the throwing shoulders of healthy college baseball players: a quantitative assessment using shear-wave ultrasound elastography. Am J Sports Med. 2015;43(12):2935-2942.

28.

Tehranzadeh

Fronek

Resnick

. Posterior capsular fibrosis in professional baseball pitchers: case series of MR arthrographic findings in six patients with glenohumeral internal rotational deficit. Clin Imaging. 2007;31(5):343-348.

29.

Thomas

Swanik

Higginson

, et al. 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(5):708-716.

30.

Thomas

Swanik

Kaminski

, et al. Humeral retroversion and its association with posterior capsule thickness in collegiate baseball players. J Shoulder Elbow Surg. 2012;21(7):910-916.

31.

Thomas

Swanik

Huxel

Kelly

. Change in glenohumeral rotation and scapular position after competitive high school baseball. J Sport Rehabil. 2010;19(2):125-135.

32.

Thomas

Swanik

Kelly

. Internal rotation and scapular position differences: a comparison of collegiate and high school baseball players. J Athl Train. 2010;45(1):44-50.

33.

Tokish

Curtin

Kim

Y-K

Hawkins

Torry

. Glenohumeral internal rotation deficit in the asymptomatic professional pitcher and its relationship to humeral retroversion. J Sports Sci. 2008;7(1):78-83.

34.

Usuba

Akai

Shirasaki

Miyakawa

. Experimental joint contracture correction with low torque—long duration repeated stretching. Clin Orthop Relat Res. 2007;456:70-78.

35.

Whiteley

Ginn

Nicholson

Adams

. Indirect ultrasound measurement of humeral torsion in adolescent baseball players and non-athletic adults: reliability and significance. J Sci Med Sport. 2006;9(4):310-318.

36.

Wilk

Macrina

Fleisig

, et al. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011;39(2):329-335.

37.

Wilk

Macrina

Fleisig

, et al. Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers: a prospective study. Am J Sports Med. 2014;42(9):2075-2081.

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