Quantifying humeral retrotorsion in young swimmers and association with swim volume

Increased humeral retrotorsion is not a risk factor for overuse injury of the throwing shoulder in elite youth handball athletes

BACKGROUND

To identify the potential role of humeral retrotorsion (HRT) and range of motion (ROM) as a risk factor for shoulder overuse injury in elite youth handball players. The hypothesis was that increased HRT is associated with an increased risk of shoulder overuse injury.

METHODS

Over 2 seasons, 258 elite youth handball players (52% boys; age:14 ± 0.8 years) were included. Preseason assessment included HRT and glenohumeral internal and external (ER) rotational ROM using ultrasound and a manual goniometer. Sports-specific adaptations between male and female athletes and the dominant and nondominant shoulder were calculated. In addition, players completed standardized questionnaires over the 2018-2019 or 2019-20 season and reported any shoulder overuse symptoms using the Western Ontario Shoulder Index questionnaire.

RESULTS

Comparing male and female players showed significantly decreased HRT and decreased internal ROM in the dominant side of male athletes (P ≤ .027). No other difference was found. Significant side-to-side differences between the dominant and nondominant shoulder were found for HRT, internal rotation, and ER, regardless of sex (P < .001). For total range of motion, only female athletes showed a significant increase in the dominant arm (P = .032). The dominant side showed a significantly higher glenohumeral internal rotation deficit in male athletes than in female athletes (10° ± 17° vs 5° ± 10°, P = .011). Adaptations in HRT, ER gain, and total range of motion gain were not significant. Over the course of the 2 seasons, 20 athletes reported shoulder overuse injuries. Although glenohumeral internal rotation deficit was borderline nonsignificant (P = .056), none of the parameters tested were significantly associated with shoulder overuse injuries.

CONCLUSION

Despite significant side-to-side differences and sport-specific adaptations, individual preseason screening of humeral retrotorsion and soft tissue adaptations does not identify elite youth handball athletes at increased risk of shoulder overuse injury.

Evaluation of glenohumeral range of motion and humeral retroversion at ages after major change and differences in wrestlers

PURPOSE

This study aimed to present the change in humeral retroversion (HR) angle (HRA) that occurs in childhood and young adulthood and the potential developmental difference that is observed in wrestlers.

METHODS

HRA of dominant and non-dominant shoulders (DSHRA and NDSHRA, respectively) were measured using ultrasonography in a group of 30 wrestlers who started wrestling before the age of 13 years (Group 1), a group of 30 young adults, aged between 16-20 years, who were not actively engaged in any branch of overhead sports (Group 2) and a group of children aged between 11-13 years and not actively engaged in any branch of overhead sports (Group 3). Range of motion (ROM) degrees of dominant and non-dominant shoulders in all groups were compared within each group and between the groups.

RESULTS

DSHRA (mean: 88.73°, 88.93° and 89.40°) values were significantly higher than NDSHRA (mean: 81.13°, 81.83° and 84.37°) values (p < 0.001, p < 0.001 and p < 0,05) in Groups I, II and III, respectively. Internal rotation and total ROM degrees of the dominant shoulder in Group 1 and 3 were higher than those in Group 2.

CONCLUSION

There is no significant change in terms of HRA in people aged between 11-13 and 16-20 years because of natural development or wrestling. DSHRA values are higher than NDSHRA ones. In contrast to the shoulders of throwers, the shoulders of wrestlers are characterized by an increase in internal rotation, described as "Wrestler's shoulder."

LEVEL OF EVIDENCE

Level III.

Master swimmers with shoulder pain and disability have altered functional and structural measures

CONTEXT

Supraspinatus tendinopathy and shoulder pain are common in competitive youth swimmers; however, no studies have investigated clinical and structural factors contributing to shoulder pain and disability in master level swimmers.

OBJECTIVE

The objectives of this study were: 1) to determine the prevalence of shoulder pain and disability in master level swimmers, 2) to identify the most provocative special tests for shoulder pain, and 3) to determine if shoulder clinical and tissue specific measures, training variables and volume vary between those with and without shoulder pain, dissatisfaction and disability.

DESIGN

Cross-sectional.

SETTING

Collegiate swimming facilities.

PATIENTS OR OTHER PARTICIPANTS

Thirty-nine adult masters level swimmers were evaluated and included in the data analysis.

MAIN OUTCOME MEASURES

A survey of demographics, training, and pain and disability ratings using the Penn Shoulder Score and Disability of Arm Shoulder Hand sports module. Swimmers underwent a clinical exam including shoulder passive range of motion (PROM), posterior shoulder endurance test (PSET), supraspinatus tendon structure and posterior capsule thickness. One-way ANOVAs were used to compare demographics, clinical and structural findings between those with significant pain, dissatisfaction and disability (+PDD) and those without (-PDD).

RESULTS

Fifteen percent of subjects reported pain at rest, 28% with normal activities (eating, dressing), and 69% with strenuous activities (sports) and 50% reported disability. The +PDD group had less shoulder internal rotation (10°), less ER (8°), and completed less yardage per day and per year. There were significant differences in the supraspinatus tendon structure between the +PDD and -PDD groups.

CONCLUSION

Masters swimmers with pain and disability are able to self-limit yardage and likely why they recorded less yardage. The reduced shoulder motion (IR and ER) without posterior capsule differences may be due to rotator cuff muscle/tendon restrictions and the supraspinatus tendon structure may indicate degeneration caused by previous overuse resulting in pain.

Effect of Posterior Capsule Tightness and Humeral Retroversion on 5 Glenohumeral Joint Range of Motion Measurements: A Cadaveric Study

BACKGROUND

Altered glenohumeral joint range of motion can be caused by increased humeral retroversion (HR) and/or posterior capsule tightness (PCT). To make informed clinical decisions, it is vital to understand how HR and PCT alterations, individually and in combination, affect joint range of motion measurements.

PURPOSE

To evaluate the effect of experimental tissue alterations on clinical range of motion measures.

STUDY DESIGN

Controlled laboratory study.

METHODS

Five clinical measurements were quantified in 8 fresh-frozen cadavers under 4 experimentally created conditions: baseline (no alterations), HR condition (20° increase in HR by transecting the bone), PCT condition (20% decrease in length via thermal energy), and PCT + HR combined. Clinical measurements included bicipital forearm angle, low flexion, glenohumeral internal and external rotation, and horizontal adduction. All measurements were taken by the same blinded tester. Separate 1-factor repeated measures analyses of variance were used to evaluate the effect of the alterations on each clinical measurement.

RESULTS

There was a significant main effect of condition for bicipital forearm angle ( P = .02, F = 4.03), low flexion ( P = .02, F = 3.86), internal rotation ( P = .03, F = 3.65), and external rotation ( P < .001, F = 15.15) but not for horizontal adduction ( P = .29, F = 1.33). The HR condition resulted in a decreased bicipital forearm angle of 16.1° and 15.8° as compared with the PCT and PCT + HR conditions, respectively. When compared with baseline, the PCT + HR condition decreased the low flexion test by 13.5°, and the HR condition decreased internal rotation range of motion by 14.2°. All conditions increased external rotation when compared with baseline.

CONCLUSION

Greater measurement changes were noted in both HR conditions, suggesting that bony alterations influence motion to a greater extent than posterior capsule alterations.

CLINICAL RELEVANCE

Clinicians should be aware that humeral retroversion will influence the measurement of posterior shoulder tightness.

The influence of posterior glenohumeral joint capsule tightness and humeral retroversion on clinical measurements

OBJECTIVES

To assess the influence of posterior capsule tightness and humeral retroversion on shoulder motion measurements.

DESIGN

Cross-Sectional study.

SETTING

Controlled university laboratory.

PARTICIPANTS

75 asymptomatic individuals were assigned to one of 4 groups: control (n = 28); posterior capsule tightness only (n = 17); humeral retroversion only (n = 15); and combined posterior capsule tightness and retroversion (n = 15).

MAIN OUTCOME MEASURES

Six clinical measurements were compared across groups: bicipital forearm angle, low flexion, glenohumeral internal and external rotation, horizontal adduction and extension with internal rotation.

RESULTS

The group with both adaptations had decreased internal rotation compared to the control and retroversion only groups, as well as increased external rotation compared to the control and posterior capsule only groups. There were no between group differences for the horizontal adduction or extension with internal rotation measurements. The retroversion only and combined groups showed decreased bicipital forearm angle compared with the control and posterior tightness groups. The posterior capsule tightness and combined groups demonstrated decreased low flexion compared to the other groups.

CONCLUSION

The combination of osseous and soft tissue adaptions alter shoulder motion measures more than a single adaption, making a comprehensive clinical assessment vital when managing individuals with shoulder pain.