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With the Australian Open just wrapping up, it’s got us at Spectrum thinking of some of the injuries we might see in tennis players. When we think of tennis, we think of high speed efforts, powerful shots and very long times on court. Some injuries are so common in these athletes that they are named for the sport, take Tennis Elbow for example. Today, however, we’re going to discuss a lesser known injury that happens in tennis players, overhead athletes and even overhead workers too. It’s called Glenohumeral Internal Rotation Deficit, or GIRD for short. This condition involves a significant loss of internal rotation in the shoulder joint. While it can start as an adaptive change that boosts throwing or serving power, it becomes problematic when it leads to pain, reduced performance, and higher injury risk.

What Is Happening?

So what’s actually going on? The glenohumeral joint is a ball-and-socket structure where the rounded head of the humerus (upper arm bone) fits into the shallow glenoid socket of the scapula (shoulder blade). This design allows for a great range of motion. The joint relies on the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis), the labrum (a fibrous cartilage rim that deepens the socket), the joint capsule, and ligaments for support. GIRD is defined as a loss of internal rotation in the dominant shoulder. Anatomically, the posterior (back) and posteroinferior capsule often tightens or thickens. This posterior band of the inferior glenohumeral ligament (IGHL) becomes contracted from repetitive stress. The anterior capsule may stretch out, and bony adaptations like increased humeral retroversion can occur in young athletes. These changes shift the humeral head’s position during motion, altering joint mechanics.

How Does GIRD Happen?

Essentially, GIRD happens as a repetitive stress adaptation. For those overhead athletes, repetitive microtrauma and inflammation can lead to fibrosis and tightening of the posterior capsule and muscles (infraspinatus, teres minor). This process therefore can lead to internal impingement, where the rotator cuff and labrum get pinched against the glenoid. Oftentimes, GIRD presents with injuries to these structures. Non-athletes can develop it too from poor posture, repetitive overhead work, or shoulder pain conditions; though it’s far more common in sports.

What Does It Feel Like?

Early on, it may be asymptomatic or present only as mild stiffness. Common signs include:

• Reduced internal rotation: Sounds a bit obvious, but is the hallmark feature of GIRD.
• Vague shoulder pain: Often posterior or deep, worse with throwing or overhead activities; sometimes painless until secondary issues arise.
• Decreased performance: Loss of throwing velocity, accuracy, or endurance due to a ‘dead arm’ feeling.
• Stiffness or tightness in the back of the shoulder, especially after activity.

What Can We At Spectrum Healthcare North Ryde Do To Help?

The good news? When caught early, there is an excellent response rate to conservative care. This process is run by our Spectrum team, who can assist with using our in-house technology, like the Game-Ready for pain relief, along with many hands-on manual therapy techniques:

• Sports Massage and soft tissue therapies: These include massage, cupping, dry needling and all work to reduce the pain and swelling of the affected area. There are great benefits to attain from reducing sensitivity of an injured area, including the ability to then perform rehabilitation and reconditioning exercises effectively.
• Joint Mobilisation: Gentle mobility techniques to restore shoulder, elbow, wrist and thoracic spine joint mobility. Addressing the kinematic chain, not just the shoulder itself can combat compensatory stress.
• Rehabilitation and reconditioning: Supervised gradual transition through strengthening, proprioceptive conditioning and functional training is vital. To return to play or return to your previous level of function, it is important to recondition tissues and systems that have suffered injury to prevent re-injury, and should be guided by a professional Spectrum Physio or Sport’s Chiro.

In some rare cases, it may be necessary to refer for further evaluation. In this case, corticosteroid injections, platelet rich plasma (PRP) injection or hyaluronic acid injections can be implemented to assist in healing and restoring function. In very rare conditions, or when GIRD presents with concurrent major injuries, surgery may be considered.