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Rotational glenohumeral adaptations are associated with shoulder pathology in professional male handball players

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Glenohumeral range of motion adaptations may affect throwing athletes and contribute to shoulder injury. The purpose of this study was to evaluate shoulder rotation deficits among elite professional handball players and its correlation to the presence of shoulder pain and morphological changes.

Methods

Eighty-seven elite professional handball players and 41 healthy non-athlete volunteers participated in the study. Evaluations included measurement of range of internal and external rotation, total arch of motion, identification of shoulder pain and ultrasound scan for diagnosis of rotator cuff tears and internal impingement.

Results

Glenohumeral rotational deficits (>20–25°) were found among 11 players group (13%). The throwing shoulders in the players group showed a decrease in internal rotation and an increase in external rotation with significantly larger ranges among players compared to the non-athlete group. Internal rotation deficit >20° was associated with higher incidence of shoulder pain among players. Both internal rotation deficits (>25°) and total arch of motion deficit (>20°) co-existed with higher incidence of internal impingement. Shoulder pain was common (36/97–41%) and was associated with decreased external rotation and total arch of motion. Internal impingement (found in 13/87–15%) correlated with decreased rotation ranges and a greater deficit in total arch of motion, whereas higher gain in external rotation correlated with a partial rotator cuff tear (found in 12/87–14%).

Conclusions

Shoulder pathologies and problems commonly affected the group of handball players. Greater glenohumeral rotational deficits in throwing shoulders of handball players correlate with shoulder pain and internal impingement, while increased external rotation with partial rotator cuff tears. Such deficits affect 13% of the athlete population. Major clinical relevance of the study is to monitor handball players’ shoulders both clinically and by proper imaging. Evaluation of range of rotation seems to identify shoulders at risk of the pathology.

Level of evidence

Cross-Sectional study with control group, Level II.

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Abbreviations

GIRD:

Glenohumeral internal rotation deficit

ER:

External rotation

ERG:

External rotation gain

D:

Dominant

IR:

Internal rotation

MRI:

Magnetic resonance imaging

ND:

Non-dominant

RCT:

Rotator cuff tear

ROM:

Range of motion

SD:

Standard deviation

SLAP:

Superior labral anterior to posterior tear

TAM:

Total arch of motion

TAMD:

Total arch of motion deficit

TAMG:

Total arch of motion gain

US:

Ultrasound scan

References

  1. Almeida GP, Silveira PF, Rosseto NP, Barbosa G, Ejnisman B, Cohen M (2014) Glenohumeral range of motion in handball players with and without throwing-related shoulder pain. J Shoulder Elbow Surg 22:602–607

    Article  Google Scholar 

  2. Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy 19:404–420

    Article  PubMed  Google Scholar 

  3. Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology. Part II: evaluation and treatment of SLAP lesions in throwers. Arthroscopy 19(5):531–539

    Article  PubMed  Google Scholar 

  4. Casáis L, Martínez M (2012) Intervention strategies in the prevention of sports injuries from physical activity; In: KR Zaslav (ed) An International Perspective on Topics in Sports Medicine and Sports Injury. InTech, Rijeka, pp 355–378

    Google Scholar 

  5. Clarsen B, Bahr R, Andersson SH, Munk R, Myklebust G (2014) Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study. Br J Sports Med 48(17):1327–1333

    Article  PubMed  Google Scholar 

  6. de Jesus JO, Parker L, Frangos AJ, Nazarian LN (2009) Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. Am J Roentgenol 192:1701–1707

    Article  Google Scholar 

  7. Dwelly PM, Tripp BL, Tripp PA, Eberman LE, Gorin S (2009) Glenohumeral rotational range of motion in collegiate overhead-throwing athletes during an athletic season. J Athl Train 44:611–616

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ellenbecker TS, Roetert EP, Bailie DS, Davies GJ, Brown SW (2002) Glenohumeral joint total rotation range of motion in elite tennis players and baseball pitchers. Med Sci Sports Exerc 34(12):2052–2056

    Article  PubMed  Google Scholar 

  9. Halbrecht JL, Tirman P, Atkin D (1999) Internal impingement of the shoulder: comparison of findings between the throwing and nonthrowing shoulders of college baseball players. Arthroscopy 15:253–258

    Article  CAS  PubMed  Google Scholar 

  10. Hoeberigs J, van Galen W, Philipsen H (1986) Pattern of injury in handball and comparison of injured versus noninjured handball players. Int J Sport Med 7:333–337

    Article  CAS  Google Scholar 

  11. Jost B, Zumstein M, Pfirrmann CW, Zanetti M, Gerber C (2005) MRI findings in throwing shoulders: abnormalities in professional handball players. Clin Orthop Relat Res 434:130–137

    Article  Google Scholar 

  12. Kaczmarek P, Lubiatowski P, Cisowski P, Grygorowicz M, Łepski M, Długosz, J, Romanowski L (2014) Shoulder problems in overhead sports. Part I—biomechanics of throwing. Pol Orthop Traumatol 15(79): 50–58

    Google Scholar 

  13. Kaplan KM, Elattrache NS, Jobe FW et al (2011) Comparison of shoulder range of motion, strength, and playing time in uninjured high school baseball pitchers who reside in warm- and cold-weather climates. Am J Sports Med 39:320–328

    Article  PubMed  Google Scholar 

  14. Kibler WB, Kuhn JE, Wilk K, Sciascia A, Moore S, Laudner K, Uhl T (2013) The disabled throwing shoulder: spectrum of pathology-10-year update. Arthroscopy 29:141–161

    Article  PubMed  Google Scholar 

  15. Kibler WB, Sciascia A, Thomas SJ (2012) Glenohumeral internal rotation deficit: pathogenesis and response to acute throwing. Sports Med Arthrosc 20:34–38

    Article  PubMed  Google Scholar 

  16. Laudner KG, Sipes RC, Wilson JT (2008) The acute effects of sleeper stretches on shoulder range of motion. J Athl Train 43:359–363

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lintner D, Mayol M, Uzodinma O, Jones R, Labossiere D (2007) Glenohumeral internal rotation deficits in professional pitchers enrolled in an internal rotation stretching program. Am J Sports Med 35:617–621

    Article  PubMed  Google Scholar 

  18. Lintner D, Noonan TJ, Kibler WB (2008) Injury patterns and biomechanics of the athlete’s shoulder. Clin Sports Med 27:527–551

    Article  PubMed  Google Scholar 

  19. Lubiatowski P, Kaczmarek P, Dzianach M, Ogrodowicz P, Bręborowicz M, Długosz JD, Romanowski L (2013) Clinical and biomechanical performance of patients with failed rotator cuff repair. Int Orthop 37:2395–2401

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lubiatowski P, Kaczmarek PK, Ślęzak M, Długosz J, Bręborowicz M, Dudziński W, Romanowski L (2014) Problems of the glenohumeral joint in overhead sports—literature review. Part II—pathology and pathophysiology. Pol Orthop Traumatol 23: 59–66

    Google Scholar 

  21. McConnell J, Donnelly C, Hamner S, Dunne J, Besier T (2012) Passive and dynamic shoulder rotation range in uninjured and previously injured overhead throwing athletes and the effect of shoulder taping. PM R 4:111–116

    Article  PubMed  Google Scholar 

  22. Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart SM (2006) Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med 34:385–391

    Article  PubMed  Google Scholar 

  23. Myklebust G, Hasslan L, Bahr R, Steffen K (2013) High prevalence of shoulder pain among elite Norwegian female handball players. Scand J Med Sci Sports 23:288–294

    Article  CAS  PubMed  Google Scholar 

  24. Nakamizo H, Nakamura Y, Nobuhara K, Yamamoto T (2008) Loss of glenohumeral internal rotation in little league pitchers: a biomechanical study. J Shoulder Elbow Surg 17:795–801

    Article  PubMed  Google Scholar 

  25. Ruotolo C, Price E, Panchal A (2006) Loss of total arc of motion in collegiate baseball players. J Shoulder Elbow Surg 15:67–71

    Article  PubMed  Google Scholar 

  26. Shanley E, Thigpen CA, Clark JC, Wyland DJ, Hawkins RJ, Noonan TJ, Kissenberth MJ (2012) 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 21:1605–1612.

    Article  PubMed  Google Scholar 

  27. Tehranzadeh AD, Fronek J, Resnick D (2007) Posterior capsular fibrosis in professional baseball pitchers: case series of MR arthrographic findings in six patients with glenohumeral internal rotational deficit. Clin Imaging 31:343–348

    Article  PubMed  Google Scholar 

  28. Torres RR, Gomes JL (2009) Measurement of glenohumeral internal rotation in asymptomatic tennis players and swimmers. Am J Sports Med 37(5):1017–1023

    Article  PubMed  Google Scholar 

  29. Trakis JE, McHugh MP, Caracciolo PA, Busciacco L, Mullaney M, Nicholas SJ (2008) Muscle strength and range of motion in adolescent pitchers with throwing-related pain: implications for injury prevention. Am J Sports Med 36:2173–2178

    Article  PubMed  Google Scholar 

  30. Wagner H, Pfusterschmied J, von Duvillard SP, Müller E (2011) Performance and kinematics of various throwing techniques in team-handball. J Sports Sci Med 10:73–80

    PubMed  PubMed Central  Google Scholar 

  31. Wilk KE, Macrina LC, Fleisig GS, Porterfield R, Simpson CD, Harker P, Andrews JR (2011) Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med 39:329–335

    Article  PubMed  Google Scholar 

  32. Wilk KE, Reinold MM, Macrina LC, Porterfield R, Devine KM, Suarez K, Andrews JR (2009) Glenohumeral internal rotation measurements differ depending on stabilization techniques. Sports Health (London) 1:131–136

    Article  Google Scholar 

  33. Yamaguchi K, Sher JS, Andersen WK, Garretson R, Uribe JW, Hechtman K, Neviaser RJ (2000) Glenohumeral motion in patients with rotator cuff tears: a comparison of asymptomatic and symptomatic shoulders. J Shoulder Elbow Surg 9:6–11

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The work was supported by the National Science Center under Grant DEC-2011/01/B/NZ7/03596.

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Correspondence to Przemyslaw Lubiatowski.

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The author(s) declare that they have no competing interests.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards

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Informed consent was obtained from all individual participants included in the study.

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Lubiatowski, P., Kaczmarek, P., Cisowski, P. et al. Rotational glenohumeral adaptations are associated with shoulder pathology in professional male handball players. Knee Surg Sports Traumatol Arthrosc 26, 67–75 (2018). https://doi.org/10.1007/s00167-017-4426-9

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