Humeral torsion (HT) has been linked to various injuries and benefits. However, the exact interplay between HT, shoulder range of motion (ROM), competition level differences, and injury risk is unclear.
Objective:
To determine the relationship between HT, ROM, and injury risk in baseball players. Secondarily, to determine HT based on competition level.
Data Sources:
PubMed, Embase, Web of Science, CINAHL, and Cochrane databases were searched from inception until November 4, 2018.
Study Selection:
Inclusion criteria consisted of (1) HT measurements and (2) arm injury or shoulder ROM.
Study Design:
Systematic review.
Level of Evidence:
Level 3.
Data Extraction:
Two reviewers recorded patient demographics, competition level, HT, shoulder ROM, and injury data.
Results:
A total of 32 studies were included. There was no difference between baseball players with shoulder and elbow injuries and noninjured players (side-to-side HT difference: mean difference [MD], 1.75 [95% CI, –1.83 to 2.18]; dominant arm: MD, 0.17 [95% CI, –1.83 to 2.18]). Meta-regression determined that for every 1° increase in shoulder internal rotation (IR), there was a subsequent increase of 0.65° in HT (95% CI, 0.28 to 1.02). HT did not explain external rotation (ER ROM: 0.19 [95% CI, –0.24 to 0.61]) or horizontal adduction (HA ROM: 0.18 [95% CI, –0.46 to 0.82]). There were no differences between HT at the high school, college, or professional levels.
Conclusion:
No relationship was found between HT and injury risk. However, HT explained 65% of IR ROM but did not explain ER ROM or HA ROM. There were no differences in HT pertaining to competition level. The majority of IR may be nonmodifiable. Treatment to restore and maintain clinical IR may be important, especially in players with naturally greater torsion. HT adaptation may occur prior to high school, which can assist in decisions regarding adolescent baseball participation.
AskerMBrookeHLWaldénM, et al. Risk factors for, and prevention of, shoulder injuries in overhead sports: a systematic review with best-evidence synthesis. Br J Sports Med. 2018;52:1312-1319.
2.
AstolfiMMStrumingerAHRoyerTDKaminskiTWSwanikCB.Adaptations of the shoulder to overhead throwing in youth athletes. J Athl Train. 2015;50:726-732.
3.
BaileyLBShanleyEHawkinsR, et al. Mechanisms of shoulder range of motion deficits in asymptomatic baseball players. Am J Sports Med. 2015;43:2783-2793.
4.
BaileyLBThigpenCAHawkinsRJBeattiePFShanleyE.Effectiveness of manual therapy and stretching for baseball players with shoulder range of motion deficits. Sports Health. 2017;9:230-237.
5.
BarrosASoligoC.Bilateral asymmetry of humeral torsion and length in African apes and humans. Folia Primatol. 2013;84:220-238.
BullockGSFahertyMSLedbetterLThigpenCASellTC.Shoulder range of motion and with baseball arm injuries: a systematic review and meta-analysis. J Athl Train. 2018;53:1190-1199.
8.
BurkhartSSMorganCDBen KiblerW.The disabled throwing shoulder: spectrum of pathology part I: pathoanatomy and biomechanics. Arthroscopy. 2003;19:404-420.
9.
ChantCBLitchfieldRGriffinSThainLM.Humeral head retroversion in competitive baseball players and its relationship to glenohumeral rotation range of motion. J Orthop Sports Phys Ther. 2007;37:514-520.
10.
CrockettHCGrossLBWilkKE, et al. Osseous adaptation and range of motion at the glenohumeral joint in professional baseball pitchers. Am J Sports Med. 2002;30:20-26.
11.
DerSimonianRLairdN.Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177-188.
12.
DinesJSFrankJBAkermanMYocumLA.Glenohumeral internal rotation deficits in baseball players with ulnar collateral ligament insufficiency. Am J Sports Med. 2009;37:566-570.
13.
DownsSHBlackN.The feasibility of creating a checklist for the assessment of the methodological quality of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52:377-384.
14.
FortenbaughDFleisigGSAndrewsJR.Baseball pitching biomechanics in relation to injury risk and performance. Sports Health. 2009;1:314-320.
15.
GarrisonJCColeMAConwayJEMacKoMJThigpenCShanleyE.Shoulder range of motion deficits in baseball players with an ulnar collateral ligament tear. Am J Sports Med. 2012;40:2597-2603.
16.
GreenbergEMFernandez-FernandezALawrenceJTRMcClureP.The development of humeral retrotorsion and its relationship to throwing sports. Sports Health. 2015;7:489-496.
17.
HaradaMTakaharaMMuraNSasakiJItoTOginoT.Risk factors for elbow injuries among young baseball players. J Shoulder Elbow Surg. 2010;19:502-507.
18.
HarrisPATaylorRThielkeRPayneJGonzalezNCondeJG.Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377-381.
19.
HibberdEEOyamaSMyersJB.Increase in humeral retrotorsion accounts for age-related increase in glenohumeral internal rotation deficit in youth and adolescent baseball players. Am J Sports Med. 2014;42:851-858.
20.
HibberdEEOyamaSTatmanJMyersJB.Dominant-limb range-of-motion and humeral-retrotorsion adaptation in collegiate baseball and softball position players. J Athl Train. 2014;49:507-513.
21.
HibberdEEShuttCEOyamaSBlackburnJTMyersJB.Physical contributors to glenohumeral internal rotation deficit in high school baseball players. J Sport Health Sci. 2015;4:299-306.
22.
HigginsJPTThompsonSG.Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;1558:1539-1558.
23.
ItamiYMihataTShibanoKSugamotoKNeoM.Site and severity of the increased humeral retroversion in symptomatic baseball players. Am J Sports Med. 2016;44:1825-1831.
24.
KayJKirschJMBakshiN, et al. Humeral retroversion and capsule thickening in the overhead throwing athlete: a systematic review. Arthroscopy. 2018;34:1308-1318.
25.
KellerRADe GiacomoAFNeumannJALimpisvastiOTiboneJE.Glenohumeral internal rotation deficit and risk of upper extremity injury in overhead athletes: a meta-analysis and systematic review. Sports Health. 2018;10:125-132.
26.
KrahlV.The torsion of the humerus: its localization, cause and duration in man. Am J Anat. 1947;80:275-319.
27.
LeeBJSGarrisonJCConwayJEPollardKAryalS. The relationship between humeral retrotorsion and shoulder range of motion in baseball players with an ulnar collateral ligament tear. Orthop J Sports Med. 2016;4:2325967116667497.
28.
LymanSFleisigGSAndrewsJROsinskiED.Pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med. 2002;30:463-468.
29.
MeisterK.Current concepts injuries to the shoulder in the throwing athlete. Part one: biomechanics/pathophysiology/classification of injury. Am J Sports Med. 2000;28:265-275.
30.
MeyerCJGarrisonJCConwayJE.Baseball players with an ulnar collateral ligament tear display increased nondominant arm humeral torsion compared with healthy baseball players. Am J Sports Med. 2017;45:144-149.
31.
MihataTTakedaAKawakamiTetal.Isolated glenohumeral range of motion, excluding side-to-side difference in humeral retroversion, in asymptomatic high-school baseball players. Knee Surg Sports Traumatol Arthrosc. 2016;24:1911-1917.
32.
MoherDLiberatiATetzlaffJAltmanDG; The Prisma Group.Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. Ann Intern Med. 2009;151:264-269.
33.
MyersJBLaudnerKGPasqualeMRBradleyJPLephartSM.Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med. 2006;34:385-391.
34.
MyersJBOyamaSClarkeJP.Ultrasonographic assessment of humeral retrotorsion in baseball players: a validation study. Am J Sports Med. 2012;40:1155-1160.
35.
MyersJBOyamaSGoergerBMRucinskiTJBlackburnJTCreightonRA.Influence of humeral torsion on interpretation of posterior shoulder tightness measures in overhead athletes. Clin J Sport Med. 2009;19:366-371.
36.
MyersJBOyamaSRucinskiTJCreightonRA.Humeral retrotorsion in collegiate baseball pitchers with throwing-related upper extremity injury history. Sports Health. 2011;3:383-389.
37.
NakaseCMihataTItamiYTakedaANeoM.Relationship between humeral retroversion and length of baseball career before the age of 16 years. Am J Sports Med. 2016;44:2220-2224.
38.
NoonanTJShanleyEBaileyLB, et al. Professional pitchers with glenohumeral internal rotation deficit (GIRD) display greater humeral retrotorsion than pitchers without GIRD. Am J Sports Med. 2015;43:1448-1454.
39.
NoonanTJThigpenCABaileyLB, et al. Humeral torsion as a risk factor for shoulder and elbow injury in professional baseball pitchers. Am J Sports Med. 2016;44:2214-2219.
40.
OsbahrDCCannonDLSpeerKP.Retroversion of the humerus in the throwing shoulder of college baseball. Am J Sports Med. 2002;30:347-353.
41.
OyamaSHibberdEEMyersJB.Preseason screening of shoulder range of motion and humeral retrotorsion does not predict injury in high school baseball players. J Shoulder Elbow Surg. 2017;26:1182-1189.
42.
OyamaSHibberdEEMyersJB.Changes in humeral torsion and shoulder rotation range of motion in high school baseball players over a 1-year period. Clin Biomech (Bristol, Avon). 2013;28:268-272.
43.
PolsterJMBullenJObuchowskiNABryanJASoloffLSchickendantzMS.Relationship between humeral torsion and injury in professional baseball pitchers. Am J Sports Med. 2013;41:2015-2021.
44.
ReaganKMMeisterKHorodyskiMBWernerDWCarruthersCWilkK.Humeral retroversion and its relationship to glenohumeral rotation in the shoulder of college baseball players. Am J Sports Med. 2002;30:354-360.
45.
ReimanMPWalkerMDPetersSKilbornEThigpenCAGarriguesGE.Risk factors for ulnar collateral ligament injury in professional and amateur baseball players: a systematic review with meta-analysis. J Shoulder Elbow Surg. 2018;28:186-195.
46.
ReinoldMMWilkKEMacrinaLC, et al. Changes in shoulder and elbow passive range of motion after pitching in professional baseball players. Am J Sports Med. 2008;36:523-527.
47.
ReutherKESheridanSThomasSJ.Differentiation of bony and soft-tissue adaptations of the shoulder in professional baseball pitchers. J Shoulder Elbow Surg. 2018;27:1491-1496.
48.
RhiSYSoWY.Analysis of range of motion and isokinetic strength of internal and external rotation according to humeral retroversion of the dominant shoulder in youth baseball players: a pilot study. Iran J Public Health. 2014;43:178-184.
49.
RoachNTLiebermanDEGillTJPalmerWEGillTJ.The effect of humeral torsion on rotational range of motion in the shoulder and throwing performance. J Anat. 2012;220:293-301.
50.
SabickMBKimYKTorryMRKeirnsMAHawkinsRJ.Biomechanics of the shoulder in youth baseball pitchers: implications for the development of proximal humeral epiphysiolysis and humeral retrotorsion. Am J Sports Med. 2005;33:1716-1722.
51.
SchwabLMBlanchP.Humeral torsion and passive shoulder range in elite volleyball players. Phys Ther Sport. 2009;10:51-56.
52.
SchwarzerG.meta: an R package for meta-analysis. R News. 2007;7(3):40-45.
53.
ShanleyERauhMJMichenerLAEllenbeckerTS.Incidence of injuries in high school softball and baseball players. J Athl Train. 2011;46:648-654.
54.
ShanleyEThigpenCAClarkJC, 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;21:1605-1612.
55.
SweitzerBAThigpenCAShanleyE, et al. A comparison of glenoid morphology and glenohumeral range of motion between professional baseball pitchers with and without a history of SLAP repair. Arthroscopy. 2012;28:1206-1213.
56.
TakenagaTGotoHSugimotoK, et al. Left-handed skeletally mature baseball players have smaller humeral retroversion in the throwing arm than right-handed players. J Shoulder Elbow Surg. 2017;26:2187-2192.
57.
ThomasSJSwanikCBKaminskiTW, et al. Humeral retroversion and its association with posterior capsule thickness in collegiate baseball players. J Shoulder Elbow Surg. 2012;21:910-916.
58.
TokishJMCurtinMSKimYKHawkinsRJTorryMR.Glenohumeral internal rotation deficit in the asymptomatic professional pitcher and its relationship to humeral retroversion. J Sports Sci Med. 2008;7:78-83.
59.
TylerTFNicholasSJRoyTGleimGW.Quantification of posterior capsule tightness and motion loss in patients with shoulder impingement. Am J Sports Med. 2000;28:668-673.
60.
ViechtbauerW.Conducting meta-analyses in R with metafor package. J Stat Softw. 2010;36(3):1-48.
61.
WhiteleyRAdamsRGinnKNicholsonL.Playing level achieved, throwing history, and humeral torsion in masters baseball players. J Sports Sci. 2010;28:1223-1232.
62.
WhiteleyRJAdamsRDNicholsonLLGinnKA.Reduced humeral torsion predicts throwing-related injury in adolescent baseballers. J Sci Med Sport. 2010;13:392-396.
WylandDJPillSGShanleyE, et al. Bony adaptation of the proximal humerus and glenoid correlate within the throwing shoulder of professional baseball pitchers. Am J Sports Med. 2012;40:1858-1862.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
