3.9 of 46 Ratings
A 20-year-old male college-level thrower complains of chronic right shoulder pain and has been prescribed formal physical therapy with stretches consisting of laying in the lateral position on the affected side with your arm forward flexed 90°, elbow flexed 90°, and pushing the ipsilateral forearm towards the table. What is the correct diagnosis and the associated physical examination finding?
Adhesive capsulitis; > 25° decrease in affected shoulder internal rotation compared to contralateral shoulder
Glenohumeral internal rotation deficit (GIRD); > 25° decrease in affected shoulder internal rotation compared to contralateral shoulder
Posterior labral tear; < 15° decrease in affected shoulder internal rotation compared to contralateral shoulder
Adhesive capsulitis; < 15° decrease in affected shoulder internal rotation compared to contralateral shoulder
GIRD; < 15° decrease in affected shoulder internal rotation compared to contralateral shoulder
Select Answer to see Preferred Response
A 19-year-old right hand dominant collegiate pitcher presents for worsening right shoulder pain and decreased velocity. On physical exam, he has decreased internal rotation but increased external rotation on his right compared to left side. He has pain and tenderness over his coracoid. An MRI arthrogram is performed and is normal. Which of the following is the next best step in management?
Weighted ball throwing program
Subacromial steroid injection
Arthroscopic biceps tenodesis and subacromial decompression
Arthoscopic capsular release
Pectoralis minor stretching and sleeper stretches
Posterior shoulder tightness can lead to a glenohumeral internal rotation deficit (GIRD). This has been linked most closely to which of the following shoulder pathologies?
Humeral avulsion of the glenohumeral ligament
A 31-year-old professional baseball pitcher has increased external rotation and a 30 degree deficit on internal rotation on his throwing shoulder compared to his non-dominant side. Motion analysis of the glenohumeral joint will show what abnormal movement of the humerus in relation to the glenoid during the cocking phase of throwing?
A 22-year-old female collegiate javelin thrower has shoulder pain. She notes that her pain is primarily located in the posterior aspect of her shoulder, is exacerbated with throwing, and she experiences maximal tenderness in the extreme cocking phase of the throwing cycle. On examination, she reports deep posterior shoulder pain when the arm is abducted 90 degrees and maximally externally rotated to 110 degrees. This reproduces her symptoms precisely. Shoulder radiographs are normal. What is the most likely diagnosis?
Anterior shoulder instability
Early adhesive capsulitis
Full-thickness rotator cuff tear
Which of the following shoulder motions is characteristically decreased in the throwing arm of athletes when compared to the nondominant side?
A college baseball pitcher has posterior-superior and anterior pain in his throwing shoulder. On exam, he has a 30 degree loss of internal rotation on the affected side and a positive O'Brien's test. Radiographs and MRI are normal. While all of the following may be helpful, which of the following exercises should be emphasized most in this patient's rehabilitation program?
Sleeper stretches, cross-body stretches, periscapular strengthening
Sleeper stretches and subscapularis stengthening
External rotation stretches with cuff strengthening
External rotation stretches and periscapular strengthening
Altering his arm slot and improving pitching mechanics
A 22-year-old minor league baseball pitcher is being treated for shoulder pain with a focused rehabilitation program. Figures A and B display rehabilitation manuevers that are critical in the treatment of his shoulder pathology. What is the most likely diagnosis in this athlete?
Long head of the biceps tendonosis
Glenohumeral internal rotation deficit (GIRD)
Superior labral anterior posterior (SLAP) tear
A 24-year-old minor league baseball pitcher presents with shoulder pain. On exam, his strength is normal. At 90 degrees of abduction, he has a total arc of motion of 150 degrees and a loss of internal rotation of 30 degrees. His scapula hangs lower than on the non-throwing shoulder. Initial management should consist of
shoulder arthroscopy and SLAP repair
shoulder arthroscopy and a capsular release
intra-articular cortisone injection, rest and a pitching program
diagnostic arthrosopy and subacromial decompression with coracoacromial ligament resection
aggressive physical therapy involving posterior capsular stretching and scapular strengthening
A 22-year-old collegiate pitcher is having pain and decreased velocity with throwing. He is examined in the office and is diagnosed with Glenohumeral Internal Rotation Deficit (GIRD). He is prescribed a therapy regimen that involves internal rotation stretching at 90 degrees of forward flexion with the scapula stabilized. This will stretch which region of the shoulder joint?