Clinical Outcomes and Quality of Literature Addressing Glenohumeral Internal Rotation Deficit: A Systematic Review
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REVIEW ARTICLE
Clinical Outcomes and Quality of Literature Addressing Glenohumeral Internal Rotation Deficit: A Systematic Review Jacob M. Kirsch, MD & Neil K. Bakshi, MD & Olufemi R. Ayeni, MD, PhD, FRCSC & Moin Khan, MD, MSc, FRCSC Asheesh Bedi, MD
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Received: 5 January 2019/Accepted: 23 April 2019 * Hospital for Special Surgery 2019
Abstract Background: Glenohumeral internal rotation deficit (GIRD) can negatively impact shoulder function particularly in the throwing athlete. Questions/Purpose: This study aimed to systematically evaluate recent trends in clinical outcomes and quality of published evidence pertaining to GIRD. Methods: A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, MEDLINE, PubMed Central, and Embase were searched from January 1, 2011, through April 23, 2017, for all articles evaluating GIRD. Two reviewers independently screened articles for eligibility and extracted data for analysis. Results: Eighty-two articles were included in the final review. In general, the overall number of articles published increased over time. Two-thirds of all studies were conducted in the USA. Seventy-eight percent (N = 64) of included studies were level-III to level-V evidence, with no level-I study performed during the study period. Eighty-five percent of studies were either epidemiologic, review, or imaging
Level of Evidence: Level IV Systematic Review Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11420-019-09691-1) contains supplementary material, which is available to authorized users. J. M. Kirsch, MD : N. K. Bakshi, MD : M. Khan, MD, MSc, FRCSC : A. Bedi, MD Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA O. R. Ayeni, MD, PhD, FRCSC Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, Hamilton, Ontario, Canada M. Khan, MD, MSc, FRCSC (*) McMaster University, Hamilton, Ontario, Canada e-mail: [email protected]
articles, and only 12% were clinical studies. Significant variability in the clinical definition of GIRD was identified. All studies evaluating non-operative management of GIRD demonstrated significant improvements in internal rotation of the affected extremity. Conclusion: Current trends in GIRD-related literature demonstrate limited focus on clinical, therapeutic, or patient-reported outcomes and mostly consist of low-level evidence. There is a lack of consensus in the literature on what clinically constitutes GIRD. Keywords glenohumeral internal rotation deficit . throwers shoulder . literature Introduction Glenohumeral rotation is an essential component of normal mechanics in the overhead athlete. Differences in side-toside glenohumeral rotation and range of motion have been well documented [3, 7, 18, 22, 31]; however, the implication of these differences has only recently been understood. Adaptive changes that allow for greater external rotation of the arm are advantageous for
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