Review Question - QID 2168

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Glenohumeral Internal Rotation Deficit (GIRD) Treatment Nonoperative QID: 2168 (SBQ04SM.83)

QID 2168 (Type "2168" in App Search)

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?

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Anterior capsule

28/1623

Posterior capsule

91%

1475/1623

Antero-inferior capsule

62/1623

Rotator interval

23/1623

MGHL

29/1623

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The "sleeper stretch", or internal rotation stretch with the arm flexed 90-degrees and the scapula stabilized, stretches the posterior capsule preferentially as shown in Illustration A. Posterior capsular tightness is felt to be a cause of decreased internal rotation (GIRD) often seen in baseball pitchers. The other capsular areas are not significantly addressed by this stretch.

Kibler et al provide a comprehensive discussion of shoulder rehabilitation, including principles of following a proximal-to-distal activation pathway, integrating various shoulder functions together in the rehab protocol, and emphasizing scapular control coupled with rotator cuff activation.

ILLUSTRATIONS: