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Altered shoulder rotation:

This article discusses the real and necessary treatment for altered shoulder rotation, exploring factors such as bony structure, capsule tightness, and muscle tension. It highlights the impact of altered shoulder rotation on elbow forces and emphasizes the importance of individualized treatment approaches based on exposure history and tissue involvement.

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Altered shoulder rotation:

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  1. Altered shoulder rotation: It is real and must be treated

  2. W. Ben Kibler, MD Medical director

  3. GIRD- history • Kibler et al, Clin Sports Med 1986 • Asymmetrical ROM, overhead • Kibler et al ITPYS 1993 • GH ROM- soccer> tennis/baseball • Burkhart/Morgan/Kibler Arthroscopy • GIRD injury risk, > 25 deg

  4. 14 12 Tight Capsule 10 8 6 Translation (mm) 4 2 Intact Capsule 0 -2 -4 -20 0 20 40 60 80 100 120 Flexion Angle (degrees) G-H TRANSLATION • Int rot- anterior/superior • Ext rot- posterior/superior Harryman JBJS 1991

  5. C I S Humeral Head Position with Respect to the Glenoid Following Maximum External Rotation Superior I: Intact S: Stretched C: Simulated Posterior Contracture MAX External Rotation Posterior Anterior Inferior Huffman et al AJSM 2005

  6. Shoulder motion Bony- retroversion- no change after growth- ?affects soft tissue changes Capsule- tension > scar, thick tissue Muscle- high tensile loads- thixotropy, muscle stiffness, weakness Variable effect- arm position

  7. Shoulder motion Shoulder ROM- Internal, External Rotation, Total ROM All may be altered- acute, chronic Prominent associated factor- injury Frequently during season- >50% will progress

  8. Significant change

  9. Significant change

  10. GER Wilk- may be key factor in shoulder injury- 90 deg GER- forearm positions- pronated(P), neutral(N) Cocking/power position- forearm pronation GERP < GERN

  11. GERP/GERN High school/college N= 25, 15 GERP < GERN Avg difference- 10 degrees Pro KC 2015/2016 N= 26, 17 (all six UCL) GERP < GERN Avg difference- 12 degrees

  12. GIRD/Elbow • Shoulder IR decreases elbow valgus loads Putnam J Biomech 1993 • GIRD > 20 deg associated with elbow injury Dines AJSM 2014 • Biceps eccentric tightness > decreased GIR

  13. Equation for the proximal segment: JMpp + (rpMpsinθp+ lpMasinθp+ ramasinθd)App - (rpmpcosθp + lpmacosθp + ramacosθd)App IMp app - (lp2md + rdlpmjcosØ) θpIMp app - rdlpmasinØθp2IMp app - (rdlpmdcosØ + lcd + rd2md) θdIMp app + rdlpmdsinØ θd2 IMp app - (rpmpcosθp + lpmdcosθp+ rdmdcosθd)g IMpg = (lcp+ rp2mp) θ = lppθp = Net moment on proximal segment JF(aau) JF(as) JF(aau) JMs JF(as) Putnam,C.A. Journal of Biomechanics 26: 125-135, 1993 Interactive Moments Forces from position/ motion of adjacent segments

  14. Conclusions • Altered GH ROM is a fact • Bony, capsule, muscle factors • Response to imposed loads • Produces altered GH kinematics, also affects elbow forces, loads • IR, ER, TROM- all are important

  15. Conclusions • Shoulder rotation- continuous, not discrete data • ROM values may vary based on exposure history, individual responses, involved tissues • Group means may not accurately reflect all variables

  16. Conclusions • Curves of change after exposure • Sub populations in response to exposure- variable risk • Modifiable- stretching, eccentric strength, endurance exercise • Better methods- categorize the data

  17. THANK YOU www.shouldercenterofky.com

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