title: GIRD, TRROM, and humeral torsion-based classification of shoulder risk in throwing athletes are not in agreement and should not be used interchangeably.
abstract: OBJECTIVE
  Clinicians commonly interpret the findings of shoulder rotational ranges of motion using various approaches: an apparent reduction in dominant arm internal rotation ("GIRD"), a difference in total rotational range of motion-i.e. differences in the sum of internal and external rotational range (TRROM), and a combination of rotational ROM and torsional difference ("GIRD-torsion"). We have noticed that these approaches are being considered to provide equivalent estimates of shoulder rotational range. This investigation sought to document the extent of agreement of these three different approaches when classifying athletes' "at-risk" status.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  162 professional male athletes participating in overhead sports (baseball, handball, and volleyball) had their GIRD, TRROM, and GIRD-torsion calculated, and classified as "at risk" using standard cut-points of 20°, 5°, and 10°, respectively.
  
  
  RESULTS
  25 (15.4%) athletes were classified as "at-risk" using GIRD, 55 (34%) with TRROM, and 30 (18.5%) using GIRD-torsion. Only 3/162 (1.9%) athletes were classified as "at-risk" by all 3 approaches, 4 athletes were concurrently classified as "at-risk" by GIRD and TRROM (Kappa=-0.142, poor agreement), 11 by GIRD and GIRD-torsion (Kappa=0.279, fair agreement), and 11 by TRROM and GIRD-torsion (Kappa=0.025, slight agreement).
  
  
  RESULTS
  25 (15.4%) athletes were classified as at risk using GIRD, 55 (34%) with TRROM, and 30 (18.5%) using GIRD-torsion. Only 3/162 (1.9%) athletes were classified as at risk by all 3 approaches, 4 athletes were concurrently classified as at risk by GIRD and TRROM (Kappa=-0.142, poor agreement), 11 by GIRD and GIRD-torsion (Kappa=0.279, fair agreement), and 11 by TRROM and GIRD-torsion (Kappa=0.025, slight agreement).
  
  
  CONCLUSIONS
  The three described approaches yield demonstrably different findings, and these approaches cannot be used interchangeably. Examples of clinical reasoning are provided to assist with the interpretation of these different measures.
authors: Aspetar Sports Medicine Hospital, Qatar; University of Sydney, School of Physiotherapy, Australia. Electronic address: Rodney.whiteley@aspetar.com.
authors: Rod
authors: R
authors: Whiteley
authors: Atlanta Braves Baseball Organisation, United States.
authors: Marc
authors: M
authors: Oceguera
mesh_terms: D001265:Athletic Injuries / Q000145:classification*; D001484:Baseball / Q000293:injuries; D001696:Biomechanical Phenomena; D015331:Cohort Studies; D006801:Humans; D006811:Humerus / Q000503:physiopathology*; D008297:Male; D016059:Range of Motion, Articular; D012306:Risk; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000503:physiopathology*; D009626:Terminology as Topic; D014102:Torsion Abnormality / Q000503:physiopathology*; D054798:Volleyball / Q000293:injuries
keywords: Baseball; Handball; Injury; Sport; Throwing; Volleyball