Glenohumeral internal rotation deficit in volleyball players with and without a history of shoulder pain

Damage for gain: The useful damage of the Pitcher's paradox

Introduction

Sport-specific adaptations of the glenohumeral joint may arise in adolescent overhead athletes who begin high-performance sports early in life. Research mainly addresses overuse injuries, leaving gaps in prevention, with adults studied more than youths.

Objective

This study aims to investigate sport-adaptations of the glenohumeral joint in asymptomatic adolescent volleyball players to identify potential shoulder injury risk factors.

Design

Observational study.

Setting

Clinical screening campaign conducted at the Physical Medicine and Rehabilitation Unit of Policlinic Hospital in Catania, Italy.

Participants

Forty asymptomatic under-16 athletes were evaluated.

Interventions

Shoulder internal rotation (IR) and external rotation (ER), range of motion (ROM), total-rotation ROM, glenohumeral IR deficit (GIRD), general joint laxity using Beighton score, apprehension, relocation, O'Brian tests, and ultrasound (US) glenohumeral distance were tested bilaterally. Variables such as the player's position, the age they began the sport, limb dominance, weight, and height were also considered.

Results

The median US glenohumeral distance was at 0.42 ± 0.26 cm, which is consistent with the range found in non-dislocated shoulders of a healthy non-athletic population. The ER ROM was significantly greater in the dominant shoulder than the contralateral one (P = 0.0001), and there was a significant correlation between the ER ROM of attackers and their US glenohumeral distance (P = 0.0413). Furthermore, shoulder IR ROM and US glenohumeral distance were not significantly different between the dominant and contralateral limbs (P = 0.05). None of the athletes presented GIRD. Other tests, including the Beighton score, apprehension, and relocation tests, yielded no significant differences between the dominant and contralateral limbs.

Conclusions

Despite an increased shoulder ER in the dominant limb, the glenohumeral joint remains stable, suggesting that greater ROM in ER does not equate to instability in overhead athletes without hyperlaxity. Nevertheless, increased ER impacts glenohumeral distance in attacker volleyball players. This finding suggests that the shoulder morphological adaptation process starts early in attackers.

Risk and protective factors for shoulder complaints in indoor volleyball players: A comprehensive systematic review

OBJECTIVE

This systematic review aimed to answer the question: "What are the risk and protective factors for shoulder complaints (pain, injury, or problem) in indoor volleyball players?".

METHODS

Searches were conducted in electronic databases: PubMed/MEDLINE, Embase, CINAHL, and SPORTDiscus, as well as reference lists of the included studies. We included studies evaluating potential intrinsic and extrinsic factors associated with shoulder complaints in indoor volleyball players of any country, age, sex, and competitive level. The Quality in Prognosis Studies (QUIPS) tool was used to assess the risk of bias.

RESULTS

The risk factors for shoulder complaints in volleyball players were identified through four prospective studies, which exhibited a moderate to low risk of bias. These factors included previous shoulder pain or injury, playing in outside and opposite positions, subacromial bursa thickening, and having an average external rotator (ER) isokinetic eccentric torque lower than the average internal rotator (IR) concentric torque. Protective factors were enhancing shoulder IR and ER isokinetic eccentric strength, being male sex, being older, and maintaining a concentric strength ratio ER/IR within the 0.60-0.75 range.

CONCLUSIONS

This systematic review highlights risk factors that clinicians and researchers should consider when assessing and tracking indoor volleyball players.

Scapular Resting Posture and Scapulohumeral Rhythm Adaptations in Volleyball Players: Implications for Clinical Shoulder Assessment in Athletes

Volleyball players develop shoulder sports-related adaptations due to repetitive overhead motions. It is essential to differentiate between these sports-related adaptations and pathological patterns in clinical assessments, particularly on scapular resting posture and scapulohumeral rhythm. Using an electromagnetic tracking system, the 3D shoulder kinematics of 30 male elite asymptomatic volleyball players and a matching control group were recorded at rest and in eight humeral elevation positions, in 15-degree increments from 15 to 120 degrees. The results indicated that the dominant scapular resting posture of the volleyball group was more anteriorly tilted than the control group (Volleyball: mean = -12.02°, STD = 4.16°; Control: mean = -7.45°, STD = 5.42°; Mean difference = 4.57°; STD = 6.85°; CI95% = 2.1° to 7.1°). The scapulohumeral rhythm in the volleyball group showed greater scapular internal rotation (Volleyball: mean = 41.60°, STD = 9.14°; Control: mean = 35.60°, STD = 6.03°; mean difference = 6.02°, STD = 1.47°; CI95% = 4.80° to 7.25°) and anterior tilt (Volleyball: mean = -9.10°, STD = 5.87°; mean = -2.3°, STD = 9.18°; mean difference = 6.88°, STD = 0.66°; CI95% = 6.34° to 7.43°). These findings suggest that volleyball players have developed a sports-related scapular adaptive pattern. This information may be valuable for clinical assessment and rehabilitation planning in injured volleyball players and may aid in the decision-making process for determining a safe return-to-play after a shoulder injury.

Prevalence of Glenohumeral Internal Rotation Deficit and Sex Differences in Range of Motion of Adolescent Volleyball Players: A Case-Control Study

Shoulder range of motion (ROM) adaptation is common observed among volleyball players, but studies on the shoulder joint function of adolescent athletes are lacking. This study aimed to clarify the prevalence of glenohumeral internal rotation deficit (GIRD) among adolescent players and differences in ROM based on sex. A questionnaire survey and ROM measurements of the shoulder joint and trunk using a plastic goniometer were conducted on 123 volleyball players (63 males and 60 females; mean age, 15.8 years). The prevalence of GIRD was investigated for internal rotation differences of >10° and total rotation motion of <5°. Questionnaire items and ROM were compared between GIRD and non-GIRD patients, and sex differences in ROM were also presented. Of the participants, 38.2% (n = 47/123) had GIRD. The GIRD group showed a decrease in external rotation on the dominant side (p = 0.003, 1 − beta = 0.84), but this was not associated with a history of shoulder injury. Sex differences in shoulder ROM showed hypomobility in males and hypermobility in females. However, there was no association between shoulder injury and GIRD among adolescent players. There are sex differences in ROM, which should be considered in future studies.