Factors associated with shoulder deficit in total rotational motion (DTRM) in adolescent athletes


  • Valéria Mayaly Alves de Oliveira University of Pernambuco, Brazil https://orcid.org/0000-0001-8562-483X
  • Ana Carolina Rodarti Pitangui University of Pernambuco, Brazil
  • Rodrigo Cappato de Araújo University of Pernambuco, Brazil




Joint range of motion, Upper extremity, Risk factors, Sports medicine


Deficit in Total Rotational Motion (DTRM) is a frequent condition in athletes which is directly associated with risk of shoulder injury. However, the identification of risk factors for DTRM in adolescent athletes is not yet established. Thus, the aim of this study was to identify which factors are associated with shoulder deficit in total rotational motion among adolescent athletes. This is an observational cross-sectional study which recruited 178 male adolescent volleyball, handball, swimming, basketball and judo athletes. Information on age, dominance, training frequency, practice time and duration of each session were recorded. The evaluation was composed of a scapular kinematic analysis according to the observational method in order to identify dyskinesis and external and internal rotation amplitude of the glenohumeral joint to assess the presence of internal rotation deficit (GIRD) and DTRM, both using the passive goniometry method. Data analysis was performed using the STATA software in which binary logistic regression was performed with the outcome DTRM and inputting the independent variables of age, training frequency, duration of each session, practice time, modality, scapular dyskinesis and GIRD to identify possible factors. Results shows that adolescent athletes with a weekly training frequency of more than three times a week and affected by GIRD were 2.68 [1.27;5.63] and 9.28 [3.03;28.15] times more likely to present DTRM, respectively. Based on these results, the presence of DTRM was associated with modifiable factors. Physical fitness strategies are advisable in order to control such factors and prevent injuries associated with DTRM.


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Amin N. H., Ryan J., Fening S. D., Soloff L., & Schickendantz M. S. (2015). The Relationship Between Glenohumeral Internal Rotational Deficits, Total Range of Motion, and Shoulder Strength in Professional Baseball Pitchers. Journal of the American Academy Orthopaedic Surgeons, 23(12), 789–796. https://doi.org/10.5435/JAAOS-D-15-00292

Borsa, P. A., Laudner, K. G., & Sauers, E. L. (2008). Mobility and Stability Adaptations in the Shoulder of the Overhead Athlete. A Theoretical and Evidence-Based Perspective. Sports Medicine, 38(1), 17–36. https://doi.org/10.2165/00007256-200838010-00003

Carter, D. (1987). Mechanical loading history and skeletal biology. Journal of Biomechanics, 20(11–12), 1095–109. https://doi.org/10.1016/0021-9290(87)90027-3

Chandler T. J., Kibler W. B., Uhl T. L., et al. (1990). Flexibility comparisons of junior elite tennis players to other athletes. Sports Medicine, 18, 134–136. https://doi.org/10.1177/036354659001800204

Clarsen, B., Bahr, R., Andersson, S. H., Munk, R., & Myklebust, G. (2014). Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study. British Journal of Sports Medicine, 48(17), 1327–1333. https://doi.org/10.1136/bjsports-2014-093702

Crockett, H., Gross, L., Wilk, W., Schwartz, M., Reed, J., O'Mara, J., Andrew, J. (2002). Osseous adaptation and range of motion at the glenohumeral joint in professional baseball pitchers. The American Journal of Sports Medicine, 30(1), 20–6. https://doi.org/10.1177/03635465020300011701

Freehill, M. T., Ebel, B. G., Archer, K. R., Bancells, R. L., Wilckens, J. H., Mcfarland, E. G., & Cosgarea, A. J. (2011). Glenohumeral Range of Motion in Major League Pitchers : Changes Over the Playing Season. Sports Health, 3(1), 97–104. https://doi.org/10.1177/1941738110374627

Greenberg, E. M., Fernandez-fernandez, A., & Mcclure, P. (2015). The Development of Humeral Retrotorsion and Its Relationship to Throwing Sports. Sports Health, 7(6), 489–496. https://doi.org/10.1177/1941738115608830

Hibberd, E. E., Oyama, S., Tatman, J., & Myers, J. B. (2014). Dominant-Limb Range-of-Motion and Humeral-Retrotorsion Adaptation in Collegiate Baseball and Softball Position Players. Journal of Athletic Training, 49(4), 507–513. https://doi.org/10.4085/1062-6050-49.3.23

Kibler, W. B., Sciascia, A., & Moore, S. (2012). An acute throwing episode decreases shoulder internal rotation. Clinical Orthopaedics and Related Research, 470(6). https://doi.org/10.1007/s11999-011-2217-z

Kibler, W. Ben, & Sciascia, A. (2010). Current concepts: scapular dyskinesis. British Journal of Sports Medicine, 44(5), 300–5. https://doi.org/10.1136/bjsm.2009.058834

Kibler, W. Ben, Sciascia, A., & Thomas, S. J. (2012). Glenohumeral Internal Rotation Deficit : Pathogenesis and Response to Acute Throwing. Sports Medicine and Arthroscopy Review., 20(1), 34–38. https://doi.org/10.1097/JSA.0b013e318244853e

Kibler, W. Ben, Uhl, T. L., Maddux, J. W. Q., Brooks, P. V, Zeller, B., & McMullen, J. (2002). Qualitative clinical evaluation of scapular dysfunction : a reliability study. Journal of Shoulder and Elbow Surgery, 11(6), 550–556. https://doi.org/10.1067/mse.2002.126766

Lubiatowski, P., Kaczmarek, P. K., Ślęzak, M., Długosz, J., Bręborowicz, M., Dudziński, W., & Romanowski, L. (2014). Problems of the glenohumeral joint in overhead sports - literature review. Part II - pathology and pathophysiology. Polish Orthopedics and Traumatology, 79, 59–66.

Mair, S. D., Uhl, T. L., Robbe, R. G., & Brindle, K. A. (2004). Physeal changes and range-of-motion differences in the dominant shoulders of skeletally immature baseball players. Journal of Shoulder and Elbow Surgery, 13(5), 487–491. https://doi.org/10.1016/j.jse.2004.02.008

Manske, R., Wilk, K., Davies, G., Ellenbecker, T., & Reinold, M. (2013). Glenohumeral motion deficits: friend or foe? International Journal of Sports Physical Therapy, 8(5), 537–553.

Meister, K., Day T., Horodyski, M., Kaminski, T.W., Masik, M.P, & Tillman, S. (2005). Rotational Motion Changes in the Glenohumeral Joint of the Adolescent/Little League Baseball Player. American Journal of Sports Medicine, 33(5), 693–698. https://doi.org/10.1177/0363546504269936

Myklebust, G., Hasslan, L., Bahr, R., & Steffen, K. (2011). High prevalence of shoulder pain among elite Norwegian female handball players. Scandinavian Journal of Medicine & Science in Sports, 23(3), 288–94. https://doi.org/10.1111/j.1600-0838.2011.01398.x

Oliveira, V.M.A., Pitangui, A.C.R., Gomes, M.R.A., Silva, H.A., Passos, M.H.P., & Araújo, R.C. (2017). Shoulder pain in adolescent athletes: prevalence, associated factors and its influence on upper limb function. Brazilian Journal of Physical Therapy, 21(2), 107–113. https://doi.org/10.1016/j.bjpt.2017.03.005

Ruotolo, C., Price, E., & Panchal, A. (2006). Loss of total arc of motion in collegiate baseball players. Journal of Shoulder and Elbow Surgery, 15(1), 67–71. https://doi.org/10.1016/j.jse.2005.05.006

Shanley, E., Rauh, M J., Michener, L.A., Ellenbecker, T.S., Garrison, J.C., & Thigpen, C.A. (2011). Shoulder range of motion measures as risk factors for shoulder and elbow injuries in high school softball and baseball players. The American Journal of Sports Medicine, 39(9), 1997–2006. https://doi.org/10.1177/0363546511408876

Shanley, E., & Thigpen, C. (2013). Throwing injuries in the adolescent athlete. International Journal of Sports Physical Therapy, 8(5), 630–40.

Uhl, T. L., Kibler, W. B., Gecewich, B., & Tripp, B. L. (2009). Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy, 25(11), 1240–8. https://doi.org/10.1016/j.arthro.2009.06.007

Wilk, K.E., Macrina, L.C., Fleisig, G.S., Porterfield, R., Simpson, C.D., Harker, P., Andrews, J.R. (2010). Correlation of Glenohumeral Internal Rotation Deficit and Total Rotational Motion to Shoulder Injuries in Professional Baseball Pitchers. The American Journal of Sports Medicine, 39(2), 329–335. https://doi.org/10.1177/0363546510384223

Wilk, K. E., Reinold, M. M., Macrina, L. C., Porterfi, R., Devine, K. M., Suarez, K., & Andrews, J. R. (2009). Glenohumeral Internal Rotation Measurements Differ Depending on Stabilization Techniques. Sports Physical Therapy, 1(2), 131–136. https://doi.org/10.1177/1941738108331201

Wilk K.E., Meister K, A. J. (2002). Current concepts in the rehabilitation of the overhead throwing athlete. The American Journal of Sports Medicine, 30(1), 136–151. https://doi.org/10.1177/03635465020300011201


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How to Cite

Alves de Oliveira, V. M., Rodarti Pitangui, A. C., & Cappato de Araújo, R. (2020). Factors associated with shoulder deficit in total rotational motion (DTRM) in adolescent athletes. Journal of Human Sport and Exercise, 15(1), 43–51. https://doi.org/10.14198/jhse.2020.151.05