title: Rotational glenohumeral adaptations are associated with shoulder pathology in professional male handball players.
abstract: OBJECTIVE
  Glenohumeral range of motion adaptations may affect throwing athletes and contribute to shoulder injury. The purpose of this study was to evaluate shoulder rotation deficits among elite professional handball players and its correlation to the presence of shoulder pain and morphological changes.
  
  
  METHODS
  Eighty-seven elite professional handball players and 41 healthy non-athlete volunteers participated in the study. Evaluations included measurement of range of internal and external rotation, total arch of motion, identification of shoulder pain and ultrasound scan for diagnosis of rotator cuff tears and internal impingement.
  
  
  RESULTS
  Glenohumeral rotational deficits (>20-25°) were found among 11 players group (13%). The throwing shoulders in the players group showed a decrease in internal rotation and an increase in external rotation with significantly larger ranges among players compared to the non-athlete group. Internal rotation deficit >20° was associated with higher incidence of shoulder pain among players. Both internal rotation deficits (>25°) and total arch of motion deficit (>20°) co-existed with higher incidence of internal impingement. Shoulder pain was common (36/97-41%) and was associated with decreased external rotation and total arch of motion. Internal impingement (found in 13/87-15%) correlated with decreased rotation ranges and a greater deficit in total arch of motion, whereas higher gain in external rotation correlated with a partial rotator cuff tear (found in 12/87-14%).
  
  
  CONCLUSIONS
  Shoulder pathologies and problems commonly affected the group of handball players. Greater glenohumeral rotational deficits in throwing shoulders of handball players correlate with shoulder pain and internal impingement, while increased external rotation with partial rotator cuff tears. Such deficits affect 13% of the athlete population. Major clinical relevance of the study is to monitor handball players' shoulders both clinically and by proper imaging. Evaluation of range of rotation seems to identify shoulders at risk of the pathology.
  
  
  METHODS
  Cross-Sectional study with control group, Level II.
authors.affiliation: Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznan, ul. 28 Czerwca 1956r 135, 62-545, Poznań, Poland. p.lubiatowski@rehasport.pl.|Rehasport Clinic, ul. Górecka 20, 60-201, Poznań, Poland. p.lubiatowski@rehasport.pl.
authors.forename: Przemyslaw
authors.identifier: http://orcid.org/0000-0002-1011-981X
authors.initials: P
authors.lastname: Lubiatowski
authors.affiliation: Rehasport Clinic, ul. Górecka 20, 60-201, Poznań, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Kaczmarek
authors.affiliation: Rehasport Clinic, ul. Górecka 20, 60-201, Poznań, Poland.
authors.forename: Pawel
authors.initials: P
authors.lastname: Cisowski
authors.affiliation: Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznan, ul. 28 Czerwca 1956r 135, 62-545, Poznań, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Breborowicz
authors.affiliation: Rehasport Clinic, ul. Górecka 20, 60-201, Poznań, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Grygorowicz
authors.affiliation: Rehasport Clinic, ul. Górecka 20, 60-201, Poznań, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Dzianach
authors.affiliation: Rehasport Clinic, ul. Górecka 20, 60-201, Poznań, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Krupecki
authors.affiliation: Department of Orthopaediscs, University Hospital Coventry and Warwickshire, Clifford Bridge Rd, Coventry, CV2 2DX, UK.
authors.forename: Lior
authors.initials: L
authors.lastname: Laver
authors.affiliation: Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznan, ul. 28 Czerwca 1956r 135, 62-545, Poznań, Poland.
authors.forename: Leszek
authors.initials: L
authors.lastname: Romanowski
mesh_terms: D000222:Adaptation, Physiological; D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D006801:Humans; D008297:Male; D016059:Range of Motion, Articular; D012399:Rotation; D000070636:Rotator Cuff Injuries / Q000000981:diagnostic imaging; D019534:Shoulder Impingement Syndrome / Q000000981:diagnostic imaging; D000070599:Shoulder Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology*; D020069:Shoulder Pain / Q000209:etiology / Q000503:physiopathology*; D014463:Ultrasonography; D055815:Young Adult
keywords: Glenohumeral internal rotation deficit (GIRD); Handball; Internal impingement; Shoulder pathology; Throwing athlete