Throwing Shoulder Adaptations Are Not Related to Shoulder Injury or Pain: A Preliminary Report

Abstract

Background:

Overhead throwing in baseball and softball athletes induces shoulder adaptations theorized to increase risk of shoulder musculoskeletal injury (MSI) and/or pain due to range of motion (ROM) deficits.

Hypothesis:

Shoulder ROM adaptations are associated with a higher risk for developing shoulder MSI and pain.

Study Design:

Prospective cohort study.

Level of Evidence:

Level 3.

Methods:

A total of 60 National Collegiate Athletic Association Division I athletes cleared for full athletic participation and free from upper extremity MSI in the last 4 weeks (age, 19.0 ± 1.2 years; weight, 82.1 ± 13.7 kg; height, 178.6 ± 11.2 cm; softball, n = 23; baseball, n = 37). Passive glenohumeral internal rotation (IR), external rotation (ER), and horizontal adduction (HA) ROM were measured with the scapula stabilized and used to categorize participants with/without external rotation gain (ERG), external rotation insufficiency (ERI), glenohumeral internal rotation deficit (GIRD), pathological GIRD, and posterior shoulder tightness (PST) before the competitive season. Groups were then compared to assess the incidence of shoulder MSI prospectively and prevalence of shoulder pain at the initial evaluation.

Results:

Baseball and softball athletes demonstrated significantly less IR ROM in the dominant shoulder (50.6° ± 9.4°) compared with the nondominant shoulder (59.1° ± 8.6°; P < 0.01) and significantly more ER ROM (dominant, 104.6° ± 12.1°; nondominant, 97.7° ± 12.0°; P < 0.01). Incidence of shoulder MSI was 15% but was not significantly related to any shoulder adaptations. No significant relationship was found between prevalence of pain and any shoulder adaptations in the 27% of athletes with pain.

Conclusion:

Increased ER and decreased IR ROM adaptations in intercollegiate overhead throwing athletes do not appear to be correlated to risk of shoulder MSI or pain.

Clinical Relevance:

The findings of this level 3 prospective study provide clinicians working with overhead athletes information regarding shoulder MSI risk and pain. It is recommended that clinicians should not use ROM adaptations exclusively to determine increased risk of shoulder MSI.

Keywords

athlete glenohumeral internal rotation deficit pain shoulder upper extremity

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References

Boltz

Powell

Robison

Morris

Collins

Chandran

. Epidemiology of injuries in National Collegiate Athletic Association men’s baseball: 2014-2015 through 2018-2019. J Athl Train. 2021;56(7):742-749.

Borsa

Laudner

Sauers

. Mobility and stability adaptations in the shoulder of the overhead athlete. Sports Med. 2008;38(1):17-36.

Burkhart

Morgan

Kibler

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

Dick

Sauers

Agel

, et al. Descriptive epidemiology of collegiate men’s baseball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl Train. 2007;42(2):183-193.

Downar

Sauers

. Clinical measures of shoulder mobility in the professional baseball player. J Athl Train. 2005;40(1):23-29.

Dwelly

Tripp

Eberman

Gorin

. Glenohumeral rotational range of motion in collegiate overhead-throwing athletes during an athletic season. J Athl Train. 2009;44(6):611-616.

Ellenbecker

Roetert

Bailie

Davies

Brown

. Glenohumeral joint total rotation range of motion in elite tennis players and baseball pitchers. Med Sci Sports Exerc. 2002;34(12):2052-2056.

Frisch

Clark

Hanson

Fagerness

Conway

Hoogendoorn

. High prevalence of nontraumatic shoulder pain in a regional sample of female high school volleyball athletes. Orthop J Sports Med. 2017;5(6):2325967117712236.

Hall

Davies

. Gender differences in perceived intensity and affect of pain between athletes and nonathletes. Percept Mot Skills. 1991;73(3):779-786.

10.

Harp

. Analysis of Glenohumeral Range of Motion in Division I Collegiate Softball and Baseball Athletes. Masters Thesis. University of Pittsburgh; 2021. http://d-scholarship.pitt.edu/40004/. Accessed August 11, 2021.

11.

Hellem

Shirley

Schilaty

Dahm

. Review of shoulder range of motion in the throwing athlete: distinguishing normal adaptations from pathologic deficits. Curr Rev Musculoskelet Med. 2019;12(3):346-355.

12.

Hibberd

Oyama

Tatman

Myers

. Dominant-limb range-of-motion and humeral-retrotorsion adaptation in collegiate baseball and softball position players. J Athl Train. 2014;49(4):507-513.

13.

Johnson

Fullmer

Nielsen

Johnson

Moorman

III . Glenohumeral internal rotation deficit and injuries: a systematic review and meta-analysis. Orthop J Sports Med. 2018;6(5):2325967118773322.

14.

Keller

De Giacomo

Neumann

Limpisvasti

Tibone

. Glenohumeral internal rotation deficit and risk of upper extremity injury in overhead athletes: a meta-analysis and systematic review. Sports Health. 2018;10(2):125-132.

15.

Kibler

Kuhn

Wilk

, et al. The disabled throwing shoulder: spectrum of pathology - 10-year update. Arthroscopy. 2013;29(1):141-161.e126.

16.

Kolber

Hanney

. The reliability, minimal detectable change and construct validity of a clinical measurement for identifying posterior shoulder tightness. North Am J Sports Phys Ther. 2010;5(4):208-219.

17.

Kolber

Vega

Jr Widmayer

Cheng

M-SS

. The reliability and minimal detectable change of shoulder mobility measurements using a digital inclinometer. Physiother Theory Prac. 2011;27(2):176-184.

18.

Laudner

Wong

Evans

Meister

. The effects of restricted glenohumeral horizontal adduction motion on shoulder and elbow forces in collegiate baseball pitchers. J Shoulder Elbow Surg. 2021;30(2):396-400.

19.

Marcondes

de Jesus

Bryk

de Vasconcelos

Fukuda

. Posterior shoulder tightness and rotator cuff strength assessments in painful shoulders of amateur tennis players. Brazilian J Phys Ther. 2013;17:185-193.

20.

Mohseni-Bandpei

Keshavarz

Minoonejhad

Mohsenifar

Shakeri

. Shoulder pain in Iranian elite athletes: the prevalence and risk factors. J Manip Physiol Therapeut. 2012;35(7):541-548.

21.

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.

22.

Myers

Oyama

Wassinger

, et al. Reliability, precision, accuracy, and validity of posterior shoulder tightness assessment in overhead athletes. Am J Sports Med. 2007;35(11):1922-1930.

23.

Myklebust

Hasslan

Bahr

Steffen

. High prevalence of shoulder pain among elite Norwegian female handball players. Scand J Med Sci Sports. 2013;23(3):288-294.

24.

Norkin

White

. Measurement of joint motion. In: Norkin

White

, eds. A Guide to Goniometry. New York: McGraw Hill Medical; 2003:181-198.

25.

Rose

Noonan

. Glenohumeral internal rotation deficit in throwing athletes: current perspectives. Open Access J Sports Med. 2018;9:69-78.

26.

Schilling

Mallace

Elazzazi

. Shoulder range of motion characteristics in Division III collegiate softball and baseball players. Int J Sports Phys Ther. 2019;14(5):770-784.

27.

Shanley

Michener

Ellenbecker

Rauh

. Shoulder range of motion, pitch count, and injuries among interscholastic female softball pitchers: a descriptive study. Int J Sports Phys Ther. 2012;7(5):548-557.

28.

Shanley

Rauh

Michener

Ellenbecker

Garrison

Thigpen

. Shoulder range of motion measures as risk factors for shoulder and elbow injuries in high school softball and baseball players. Am J Sports Med. 2011;39(9):1997-2006.

29.

Shitara

Kobayashi

Yamamoto

, et al. Prospective multifactorial analysis of preseason risk factors for shoulder and elbow injuries in high school baseball pitchers. Knee Surg Sports Traumatol Arthrosc. 2017;25(10):3303-3310.

30.

Stelter

Roessler

. New Approaches to Sport and Exercise Psychology. Aachen: Meyer & Meyer Verlag; 2005.

31.

Ticker

Beim

Warner

. Recognition and treatment of refractory posterior capsular contracture of the shoulder. Arthroscopy. 2000;16(1):27-34.

32.

Varnell

Keenan

Rafferty

Csonka

Salesi

Sell

. Musculoskeletal characteristics of the dominant shoulder complex in intercollegiate baseball and softball players by position and sport. Athl Train Sports Health Care. 2016;8(2):70-81.

33.

Veillard

Boltz

Robison

Morris

Collins

Chandran

. Epidemiology of injuries in National Collegiate Athletic Association women's softball: 2014-2015 through 2018-2019. J Athl Train. 2021;56(7):734-741.

34.

Whiteley

Oceguera

. GIRD, TRROM, and humeral torsion-based classification of shoulder risk in throwing athletes are not in agreement and should not be used interchangeably. J Sci Med Sport. 2016;19(10):816-819.

35.

Whiteley

Ginn

Nicholson

Adams

. Sports participation and humeral torsion. J Orthop Sports Phys Ther. 2009;39(4):256-263.

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 shoulder injury in professional baseball pitchers: a prospective study. Am J Sports Med. 2015;43(10):2379-2385.

38.

Wilk

Meister

Andrews

. Current concepts in the rehabilitation of the overhead throwing athlete. Am J Sports Med. 2002;30(1):136-151.