Glenohumeral Internal Rotation Deficit – GIRD

Glenohumeral internal rotation deficit is a cause of shoulder pain in throwing athletes. It is most commonly seen in baseball players, although you can see it in high-level tennis players and other overhead athletes. Usually it is a problem that develops over time rather than following an acute injury.

Most athletes with GIRD complain of vague shoulder pain with overhead activity. Throwers might notice decreased control or velocity on their throws. Occasionally they might note a decrease in motion.

Athletes with glenohumeral internal rotation deficits will have decreased internal rotation of the involved shoulder.

Physical examination by a sports medicine physician is usually diagnostic. The physician will examine the internal rotation and external rotation with the shoulder abducted. The physician often notices increased external rotation but decreased internal rotation compared to the nondominant shoulder. Now this is common in throwing athletes to a certain extent. But if the loss of internal rotation is significant, then GIRD is likely the cause of the patient’s pain and decreased performance.

Treatment starts with physical therapy for stretching the posterior and inferior capsules. Often the therapist will teach the athlete stretches that can be done on his or her own as well. In the rare circumstances where physical therapy for posterior capsular stretching fails to relieve the problem, surgical treatment can be employed. Surgery usually involves arthroscopically releasing the affected posterior and/or inferior capsules to restore range of motion.

Elbow position and injuries.

Another consideration with glenohumeral internal rotation deficit is the potential risk of associated lesions. This problem is often part of a spectrum that involves other pathologic entities. If a thrower is not getting better or continuing to have symptoms after resolution of the posterior capsule or tightness, the physician will also look for secondary injuries, such as a superior labral tear (SLAP tear) or rotator cuff injury.

14 Responses to Glenohumeral Internal Rotation Deficit – GIRD

  1. I was recently diagnosed with GIRD and scapular dyskinesis in my right shoulder. I am a softball and volleyball player. I’m currently doing physical therapy 3 times a week. Say if physical therapy did not help the rotation of my shoulder, would that mean the physical therapist or I did not do a good job? And if not, would surgery be the option if physical therapy did not work?

    • Sometimes physical therapy fails to stretch the posterior capsule even if the patient is compliant and the therapists does his or her best to push to restore motion. Surgery would be one of the options at least.

      • I am going back to the dr on Wednesday after 6 weeks of therapy. My lower shoulder blade feels much stronger, but where the ball and socket is, it is very loose. I asked if surgery would help, but my physical therapist said he couldn’t garentee because my muscles will tighten as I age, but with playing overhead sports the majority of the year, is surgery an option? Also, he is confused as to why my shoulder cracks where my Levator is, which is weak in the first place. My shoulder also still does not glide into place like my left one. It cracks and jolts, and sometimes there is pain where the cracking is. Would more therapy fix this or surgery?

  2. I am a swimmer.The doctors want to do Surgery because I have GIRD. What is the surgery like and what is the average age for doctor to preform surgery on beacuse they think I am too young because i am not yet a teenager.

    • I can’t day that I have performed that surgery on a very young athlete. Generally it is a capsular release, so there is a lot of work with PT after surgery to regain motion and strength.

  3. I am a coach of a baseball player, pitcher diagnosed with GIRD, What is the recovery time? I dont want to do anything wrong.

    • Mike, thanks for reaching out and taking care of your players. Every athletes responds to physical therapy for that differently. It can take anywhere from 4 to 12 weeks.

  4. Dr. Geier,
    I am a second year DPT student on a clinical rotation. I came across an article in reference to over head athletes with tight teres majors. There was also a reference article accompanying the prior post, in the American Journal of sports medicine talking about reduced IR after pitchers throw 45 pitches off the mound. In my limited knowledge, and I may be misinterpreting the combination of the article in AJSM as well as the online post referencing shortened Teres Majors, but from what I can gather it seemed that the author was stating a shortened teres major reduces IR. How can a muscle that performs IR actually reduce IR? Or am I just mistaken what was being said. I do know that if the TM is tight this could cause upward rotation and ABD of the scapula, which may reduce elevation of the humerus Sorry for the winded post. thanks in advance


    confused student

    • Can you send me a link to the article? I would have to read it to figure out what the authors were trying to say? Send it to me through the Contact section of my website if you can.

  5. I was recently informed I have GIRD by an orthopedic specialist. I am a softball player and have played for 15 years. Some years all year round. I never pitched. He is sending me for physical therapy for 3 months. Is that longer than usual for therapy or normal time length? And I was told by a friend he may be having me do it so long to possibly strengthen it for surgery to reduce rehab time after. Could that be? Also, what is the different between GIRD and issues with the rotator cuff? Thank you so much!

  6. I’ve been recently diagnosed with GIRD in my right shoulder, to release pain I was told to do sleepers stretch. If PT doesn’t work and I have to undergo surgery what is the recovery time.

Leave a reply

Please note: I cannot and will not provide specific medical information within these comments, just as I won't anywhere else. Also, I reserve the right to delete comments that are offensive, off-topic, or spam. If you have questions, please read My Comments Policy.

david-headshot I am an orthopaedic surgeon and sports medicine specialist in Charleston, South Carolina.

On this blog, on my podcast, and in articles for numerous publications and in media interviews, I aim to provide you leading commentary and education on injury treatment and prevention to keep you performing at your best! Learn more about me >>


I'm excited to help with information and interviews for print, radio, television, and online media. Media information >>


Writing I write articles and columns for a number of publications and organizations. Writing information >>
Sports Medicine Simplified: A Glossary of Sports Injuries, Treatments, Prevention and Much More

Learn more about the glossary >>
© 2017 Dr. David Geier Enterprises, LLC

Site Designed by Launch Yourself