Glenohumeral Internal Rotation Deficit (GIRD) Assessment

Problem

  1. To measure the amount of internal rotation in the dominant shoulder of baseball and softball pitchers after the use of corrective stretching and exercises for 6 months.

Refining the Problem

  1. Glenohumeral Internal Rotation Deficit (GIRD) is common when assessing the dominant arm in active baseball and softball pitchers. It is vaguely defined as having 20 degress or greater loss of internal rotation in the dominant (throwing) shoulder than in the non-dominant shoulder. GIRD happens with excessive external rotation (i.e. throwing), which causes the anterior capsule of the glenohumeral joint to become stretched and lengthened. The posterior capsule of the glenohumeral joint becomes tightened, causing a deficit in internal rotation. GIRD can be associated with instability of the shoulder as well as shoulder impingement. GIRD, as well as these other associated conditions can have a significant decrease in throwing performance. ((Note: Normal internal rotation ROM in glenohumeral joint is 70 degrees while normal external rotation ROM is 90 degrees.)
  1. The overall point of the GIRD assessment scale is to measure the amount of internal rotation in the dominant shoulder of baseball and softball pitchers after the use of corrective stretching and exercises for 6 months. First, the players must be assessed before the corrective stretching and exercise program. The range of motion (ROM) will be measured for internal rotation as well as external rotation. At the end of the 6 month corrective stretching and exercise program, player’s ROM will be measured. When comparing the ROM in the dominant arm and the non-dominant arm, less than a 20 degree difference would like to be shown by the end of the program. Improvement in external rotation ROM (less ROM) and of internal rotation (more ROM) in the dominant arm, if GIRD is discovered, is the goal of the program.
  1. In the GIRD assessment, the ROM in the glenohumeral joint will be assessed. The glenohumeral joint is the joint that allows internal and external rotation. It is imperative to focus on this joint in baseball and softball pitchers because this is the joint that controls throwing movements and their overall pitching performance. Because of this, the degree of internal rotation and external rotation will be assessed in both the dominant (throwing) arm as well as the non-dominant arm. This will be done in the beginning of the corrective exercise program and 6 months from the start of the program. Muscle stiffness in the area of the infraspinatus, teres minor, and posterior deltoid will also be assessed.
  1. The internal rotation, external rotation, and muscle stiffness will be assessed in both the dominant arm and the non-dominant arm. This will be done by simply having the player do internal and external rotation of the glenohumeral joint and the range of motion will be measured, as well as if the player has any muscle stiffness. The normal ROM for internal rotation is 70 degrees while the normal ROM for external rotation is 90 degrees. If the ROM is 20 degrees more in external rotation of the dominant arm than the non-dominant arm, the player is a candidate for GIRD. The assessment will be in a form of a excellent-good-needs work assessment. If the player has the normal ROM for internal rotation for the dominant arm, the player will get a “excellent” If the player has a ROM for external rotation of 120 degrees in the dominant arm while having 90 degrees of external rotation in the non-dominant arm, the player will get a check mark in the “needs work” box. If the player has a ROM for internal rotation of significantly less than 70 degrees in the dominant arm, the player will get a check mark in the “needs work” box. Each ROM will be recorded as well to determine the difference in ROM between the dominant arm and the non-dominant arm.
  1. To complete the GIRD assessment, a flat bed or table is required. The player will lay on the bed or table and a physical examination will be completed. To help with measuring ROM, the assessor will use two straight objects (i.e. ruler, pencil, stick) to create an angle from the start position of the arm to the end position of the arm. This will be done for both the dominant arm and non-dominant arm for internal and external rotation. During these motions, the player will need to be asked if any stiffness and how uncomfortable that stiffness is during each motion; dominant internal rotation, dominant external rotation, non-dominant internal rotation, and non-dominant external rotation.
  1. If the player “needs work” in the area of external rotation and/or internal rotation in the dominant arm, the player passed for having GIRD. The player will then take 6 months off from throwing and be placed in a corrective exercise and stretching program (physical therapy). Players with “excellent” scores will be able to continue to throw. Players with “good” scores will be given exercises and stretches to perform and asked to take time off from throwing, considering they are developing GIRD. This assessment will be a summative evaluation because at the end of the 6 months, we want to see an outcome or a change from the previous data given by the players.

Muscle Stiffness

Excellent
Player has no muscle stiffness during the motion / Good
Player has some stiffness during the motion but isn’t limiting the movement / Needs Work
The stiffness felt during the motion is effecting the players range of motion
Internal Rotation (Dom)
External Rotation (Dom)
Internal Rotation (Non-Dom)
External Rotation (Non-Dom)

Internal & External Rotation

ROM
Internal ROM should be 70 degrees, while external should be 90. / Excellent
Player’s internal rotation ROM is 70 degrees.
Player’s external rotation ROM is 90 degrees. / Good
Player’s internal rotation is 5-10 degrees above or below 70 degrees.
Player’s external rotation is 5-10 degrees above or below 90 degrees. / Needs Work
(Dom) Player’s internal and external rotation is ≥ or ≤ 15-20 degrees the average.
(Non-Dom) Player’s internal and external is > or < than 15-20 degrees, compared to dominant arm.
Internal Rotation (Dom)
External Rotation (Dom)
Internal Rotation (Non-Dom)
External Rotation (Non-Dom)