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Glenohumeral internal rotation deficit (GIRD) is a diminished range of motion and it mainly affects  the internal rotation of the shoulder. Internal rotation refers to the shoulder rotating towards the centre of the body. The reduction in internal rotation can be 20 degrees or even more when compared to the contralateral shoulder. However, GIRD is not always pathologic; it’s considered so when the total rotational motion reduces over 5 degrees when compared to the contralateral shoulder. When this happens, it decreases the strength of the shoulder, which is responsible for several kinds of shoulder injuries.

GIRD affects mainly those people who are more involved in overhead sports with repeated throwing. It is highly seen in athletes, sportspersons, baseball pitchers, tennis players, discus throwers, swimmers and overhead throwers. Sometimes, it is also seen in gymnasts applying symmetric loads on both right and left shoulders.

Causes of glenohumeral internal rotation deficit

• Throwing action is a complicated motion with high velocities and force. When the throwing activity is done repeatedly with elevated speeds, it leads to consistent stress, which creates chronic alterations in the shoulder and elbow joints, resulting in GIRD.
• In overhead throwing motion, there is repeated cocking, which causes tightness of the posterior capsular and rotator cuff.
• An increase in stress levels on the static and dynamic shoulder stabilizers results in GIRD.
• Sometimes severe injury also causes GIRD.

What symptoms are seen in GIRD?

• An imprecise pain in the shoulder, which increases with an increase in overhead activities.
• The posterior joint line and associated soft tissues become tender. 
• Reduction in the speed of throws in baseball players.
• Movement of the affected shoulder decreases.

Diagnosis of GIRD

• The physician will check your medical history, and do a physical examination of your shoulder for determining the range of motion. Here are some of the methods through which GIRD assessment is done:
• Measuring decrease in internal rotation along with active and passive motion through a goniometer. The total rotational motion must be the same in both shoulders, and if there is a difference of over 20 degrees, it confirms GIRD.
• The posterior tightness is assessed by letting the patient lie on their lateral side. The shoulder which is affected is held at 90 degrees, and then it’s brought in the direction of the floor with high adduction. Here the motion of the humerus is calculated, and if there is a reduction of 4 cm, it confirms GIRD.
• Ultrasonography can be done for diagnosing GIRD, but radiography is non-diagnostic.
• MRI or magnetic resonance imaging can be used for detecting the width of the rotator cuff muscle tear and SLAP lesions and for ruling out the pathologies.

Conclusion

Glenohumeral internal rotation deficit is the reduction in internal rotation of the throwing shoulder when compared with the non-throwing shoulder. Recently, it has been seen that its prevalence has increased because of heavy competition in overhead sports.  It mainly causes vague pain, muscle tightness and reduced motion in the shoulder. It is possible to manage the condition through conservative and surgical ways. Because it remains asymptomatic in most individuals, it is important for the players to go for screening frequently to prevent the occurrence of GIRD.

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