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Posterosuperior
55%
1415/2587
Posteroinferior
11%
275/2587
Anteroinferior
296/2587
Anterosuperior
20%
513/2587
Directly anterior
3%
76/2587
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The clinical presentation is consistent for a glenohumeral internal rotation deficit (GIRD), typically caused by a posterior cuff and capsular contracture. Biomechanical studies have shown that the humerus is translated in a posterosuperior direction during the cocking phase of throwing in the setting of a posterior capsular contracture. GIRD is a common finding in pitchers and other throwing athletes. While it is not necessarily a painful condition, it has been shown to to alter the mechanics of the shoulder during throwing and may lead to injury of the superior labrum and articular side of the rotator cuff. Physical exam is significant for increased external rotation and loss of internal rotation compared to the contralateral shoulder. Tests for a SLAP tear may also be positive. In this condition, radiographs and MRI are often be normal. Grossman et al in a cadaveric study simulating GIRD by creating a posterior capsular contracture showed that the humerus moves in a posterosuperior direction during the cocking phase of throwing (external rotation in 90 degrees of abduction). Lintner et al report "therapy is directed at posterior capsular stretching to prevent loss of internal rotation and to protect the superior labrum and posterior rotator cuff". They also report that increased external rotation may be attributable to increased humeral retroversion, while the internal rotation deficit is caused by soft tissue adaptations. Illustration A shows an algorithm for clinical reasoning in the examination of impingement related shoulder pain.
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