Glenohumeral Internal Rotation Deficit (GIRD) Assessment

Glenohumeral internal rotation deficit, abbreviated as GIRD can be a cause of shoulder impingement. GIRD is a sport-specific adaptation of posterior shoulder structures due to chronic excessive overload during frequent throwing. There are 3 different theories about those adaptations:

• The first assumes a contracture of the posterior capsule, which is sometimes followed by associated gains in external rotation
• Theory two says that GIRD develops as a bony adaptation that begins in the early years of overhead throwing
•  The third hypothesis assumes hypertrophy of the external rotators due to frequent eccentric loading

To assess for GIRD, check internal rotation in the supine position with the arm at 90° of abduction. You can use a digital inclinometer, which has been shown to be most reliable in shoulder range of motion assessment. So have the patient in supine lying position, abduct the arm to 90°and then use the thumb of one hand to palpate the coracoid process to check for scapular movement and then, grab the arm at the wrist and induce internal rotation.

A loss of more than 10° between sides is considered a positive sign for GIRD. However, it’s not that simple to diagnose GIRD solely based on a more than 10° difference between sides in internal rotation. What’s more interesting is to see the total range of motion from external to internal rotation. This TROM commonly varies between 135-180° with no more than a 10° difference between sides.

While you may have seen a side-to-side difference of more than 10 degrees of internal rotation, the TROM for both shoulders might be the same with the side having less internal rotation displaying an increase in external rotation.

So to diagnose GIRD, assess the total range of motion of internal and external rotation in both shoulders and see if there is a more than 10° difference.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Cools, A. M., Cambier, D., & Witvrouw, E. E. (2008). Screening the athlete’s shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology. British journal of sports medicine, 42(8), 628-635.