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Adhesive capsulitis; > 25° decrease in affected shoulder internal rotation compared to contralateral shoulder
2%
48/2555
Glenohumeral internal rotation deficit (GIRD); > 25° decrease in affected shoulder internal rotation compared to contralateral shoulder
85%
2168/2555
Posterior labral tear; < 15° decrease in affected shoulder internal rotation compared to contralateral shoulder
3%
79/2555
Adhesive capsulitis; < 15° decrease in affected shoulder internal rotation compared to contralateral shoulder
1%
24/2555
GIRD; < 15° decrease in affected shoulder internal rotation compared to contralateral shoulder
8%
205/2555
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The patient has glenohumeral internal rotation deficit (GIRD), a condition usually seen in throwing athletes that is characterized by a decrease in internal rotation of 25° or more of the affected shoulder compared to the contralateral side. In patients with GIRD, initial treatment consists of rest from throwing as well as posterior capsular stretching. The sleeper stretch is a common way to stretch the posterior capsule. The stretch is performed in a lateral position on the table on the affected side with your arm forward flexed 90 degrees, elbow flexed 90°, and pushing the ipsilateral forearm towards the table, which increases shoulder internal rotation. The majority of patients with GIRD respond positively to sleeper stretches, with arthroscopic posterior capsular release or anterior stabilization only indicated for failure of nonoperative management. Wilk et al. describe in a review article a multiphase rehabilitation and exercise program that restores shoulder range of motion, strength, and endurance, allowing for an early return to unrestricted sporting activity. They recommend that when true posterior capsular tightness is present, posterior mobilization efforts including sleeper stretches should be utilized to increase the pliability of the posterior capsule. Braun et al. report in a review on shoulder injuries in the throwing athlete that the majority will respond to rehabilitation programs that emphasize stretching of the tight posterior capsule. In those patients unresponsive to conservative management, especially the older elite throwers, they recommend selective arthroscopic postero-inferior capsulotomy. Illustration A demonstrates the sleeper stretch. Incorrect Answers: Answers 1 and 3: Adhesive capsulitis is characterized by global active and passive range of motion loss in the shoulder, and is not limited to internal rotation. Answer 4: Posterior labral tears manifest as posterior instability. Answer 5: Clinically relevant GIRD classically manifests with internal rotation deficits of at least 25°, with some studies demonstrating deficits of up to 50°.
2.5
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