The impact of glenohumeral rotational asymmetries on the risk of shoulder pain in volleyball players: a cross-sectional study, article
ScienceDirect, 2025
The impact of glenohumeral rotational asymmetries on the risk of shoulder pain in volleyball players: a cross-sectional study
Catarina T. Sá , MDa ,*, Daniel M. Dias, MDb, João B. Nunes, MDa,b, and Manuel A. Gutierres, MD, PhDa,b
a Faculty of Medicine, University of Porto, Porto, Portugal
b Orthopedic Department ULS S~ao Jo~ao, Porto, Portugal
Background: Shoulder rotational imbalances are common adaptations in volleyball players due to repetitive overhead movements. This study investigates the relationship between shoulder rotational asymmetries and the risk of shoulder pain in professional and semiprofessional volleyball players.
Results: The pain group exhibited significantly higher GIRD (median: 18 ? vs. 10 ? , P < .001) and greater TROM asymmetry (median: 8 ? vs. 4 ?, P = .033) compared to the no pain group. No significant differences were observed in external rotation gain. Logistic regression identified a weak but statistically significant association between GIRD (odds ratio = 1.100, P = .011) and shoulder pain and a stronger association with playing position (attackers: odds ratio = 11.101, P = .005). Receiver operating characteristic analysis determined cutoff values of 17 ? for pathological GIRD and 5 ? for pathological TROM asymmetry.
Conclusion: Increased GIRD and TROM asymmetry were statistically associated with shoulder pain in volleyball players. Despite the weak associations, these measures may signal early dysfunction in high-demand athletes. Attackers appear particularly at risk due to repetitive overhead movements. These findings support monitoring rotational imbalances and exploring preventive strategies in future prospective studies.
Level of evidence: Level III; Cross-Sectional Design; Prognosis Study
Keywords: Range of motion; shoulder pain; shoulder injury; glenohumeral joint; overhead athlete; volleyball
Background: Shoulder rotational imbalances are common adaptations in volleyball players due to repetitive overhead movements. This study investigates the relationship between shoulder rotational asymmetries and the risk of shoulder pain in professional and semiprofessional volleyball players.
Methods: A cross-sectional study was conducted on 84 volleyball players, divided into groups with and without a history of shoulder pain (n = 29 and n = 55, respectively). Shoulder internal rotation and external rotation were measured using a goniometer. Glenohumeral internal rotation deficit (GIRD), external rotation gain, total range of motion (TROM), and TROM asymmetry were calculated. Multivariable
logistic regression was used to determine independent risk factors, and receiver operating characteristic curve analysis was performed to define pathological thresholds.
Results: The pain group exhibited significantly higher GIRD (median: 18 ? vs. 10 ? , P < .001) and greater TROM asymmetry (median: 8 ? vs. 4 ?, P = .033) compared to the no pain group. No significant differences were observed in external rotation gain. Logistic regression identified a weak but statistically significant association between GIRD (odds ratio = 1.100, P = .011) and shoulder pain and a stronger association with playing position (attackers: odds ratio = 11.101, P = .005). Receiver operating characteristic analysis determined cutoff values of 17 ? for pathological GIRD and 5 ? for pathological TROM asymmetry.
Conclusion: Increased GIRD and TROM asymmetry were statistically associated with shoulder pain in volleyball players. Despite the weak associations, these measures may signal early dysfunction in high-demand athletes. Attackers appear particularly at risk due to repetitive overhead movements. These findings support monitoring rotational imbalances and exploring preventive strategies in future prospective studies.
Level of evidence: Level III; Cross-Sectional Design; Prognosis Study
Keywords: Range of motion; shoulder pain; shoulder injury; glenohumeral joint; overhead athlete; volleyball
