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Glenohumeral Internal Rotation Deficits in Professional Pitchers Enrolled in an Internal Rotation Stretching Program

David Lintner, MD^,*, Magdiel Mayol, MD, Obinna Uzodinma, Rex Jones, ATC^|| and David Labossiere, ATC^||

From the Methodist Center for Sports Medicine, Houston, Texas, University Puerto Rico Medical School, San Juan, Puerto Rico, Northwestern School of Medicine, Chicago, Illinois, and the ^|| Houston Astros Baseball Club, Houston, Texas

^* Address correspondence to David Lintner, MD, Methodist Center for Sports Medicine, The Methodist Hospital, 6560 Fannin, Suite 400, Houston, TX 77030 (e-mail: dlintner{at}tmh.tmc.edu).

Background: Repetitive throwing motion creates increased external rotation and decreased internal rotation in the glenohumeral joint. There is controversy regarding the contribution of osseous and soft tissue adaptations to these changes in rotation.

Objective: To evaluate internal rotation deficits in the professional baseball thrower’s shoulder and determine the impact of an internal rotation stretch program on that deficit.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: Eighty-five male professional pitchers were evaluated in this study. Players were divided into 2 groups based on length of participation in an appropriate internal rotation stretch program. Data were collected on internal and external rotations and total range of motion in both dominant and nondominant arms using a goniometer. Internal rotation deficit (the lack of internal rotation relative to the opposite side) was calculated. Generalized comparative statistical tests were used.

Results: Pitchers with 3 or more years in a stretch program (group 1) had greater internal rotation (74.3° vs 54.3°) and greater total range of motion (217.0° vs 194.2°) in dominant shoulders than did pitchers with less than 3 years (group 2). Total range of motion was greater in the dominant than in the nondominant arm for group 1. Internal rotation deficit in dominant arms was significantly greater for group 2 than for group 1. The analysis of dominant arm rotation relative to years in an internal rotation stretching program for pitchers in both groups showed a progressive increase in both internal rotation and total arc of motion with the number years in such a program plateauing after year 3.

Conclusion: The throwing motion shifts the total arc of motion toward external rotation and diminishes internal rotation. The increased external rotation may be attributable to increased humeral retroversion. The internal rotation deficit, however, is caused by soft tissue adaptations that can be addressed by consistent participation in a stretching program focused on internal rotation.

Key Words: internal rotation deficit • shoulder motion • professional baseball pitcher • soft tissue adaptation

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