Published: 2018-12-26

Arthroscopic posterior-inferior capsular release in the treatment of overhead athlete with GHIRD: a case report

Stedy Adnyana Christian, I. G. N. Wien Aryana, I. B. Aditya Wirakarna, I. G. B. Indra Angganugraha P. J., Komang Arie Trysna Andika, Hafidz Addatuang Ambong, Soehartono Hadi Pranata


Glenohumeral internal rotation deficit (GHIRD) is one of most controversial joint diseases in terms of diagnosis and treatment. The use of arthroscopy has improved the recognition of pathologic findings in glenohumeral internal rotation deficit (GHIRD) and allowed a better understanding of the etiology of it and the correlation between symptoms and lesion patterns. We present our technique for arthroscopic posterior-inferior capsular release in athlete with symptomatic glenohumeral internal rotation deficit (GIRD) that was unresponsive to nonoperative treatment and was preventing him from returning to sport. By this technique resulted in a successful outcome. We evaluate a 28 years old male with right shoulder pain and limitation in abduction internanal rotation after 3 months conservative treatment. We performed Arthrospcopic posterior-inferior capsular release. After 2 months correspondingly, we performed follow-up assessments on shoulder function (using the ases and rowe score) and pain (using a visual analogue scale) were made. Arthroscopic posterior-inferior capsular release can be recommended as a reasonable operative solution for overhead athletes with symptomatic GIRD that has not responden to conservative management. Evaluation of patient in whom we performed arthroscopic repair base on ases and rowe score. Arthroscopic posterior-inferior capsular release showed satisfactory shoulder function after 2 months follow up correspondingly.


Arthroscopic, Athlete, GHIRD, Posterior-inferior capsular

Full Text:



Abrams JS. Thermal capsulorrhaphy for instability of the shoulder: Concerns and applications of the heat probe. InstrCourse Lect. 2001;50:29-36.

Andrews JR, Angelo RL. Shoulder arthroscopy for the throwing athlete. Techniques in Orthopaedic. 1988 Apr 1;3(1):75-82.

Andrews JR, Carson WG, McLeod WD. Glenoid labrum tears related to the long head of the biceps. Am J Sports Med. 1985;13:337-41.

Braun S, Kokmeyer D, Millett PJ. Shoulder injuries in the throwing athlete. J Bone Joint Surg Am. 2009;91(4):966-78.

Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy: The JArthro and Related Surgery. 2003 Apr 1;19(4):404-20.

Curtis AS, Deshmukh R. Throwing injuries: diagnosis and treatment. Arthros. 2003;19(suppl 1):80-5.

Davidson PA, El Attrache NW, Jobe CM, Jobe FW. Rotator cuff and posterior-superior glenoid labrum injury associated with increased glenohumeral motion: A new site of impingement. J Shoulder Elbow Surg. 1995;4:384-90.

Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF. Kinetics of baseball pitching with implications about injury mechanisms. Amer J Spo Med. 1995 Mar;23(2):233-9.

Gerber A, Warner JJ. Thermal capsulorrhaphy to treat shoulder instability. Clin Orthop ResĀ®. 2002 Jul 1;400:105-16.

Harryman 2nd DT, Sidles JA, Clark JM, McQuade KJ, Gibb TD, Matsen 3rd FA. Translation of the humeral head on the glenoid with passive glenohumeral motion. JBJS. 1990 Oct 1;72(9):1334-43.

Jobe CM. Superior glenoid impingement, expanded spectrum. Arthroscopy. 1995;11:530-7.

Jobe FW, Giangarra CE, Kvitne RS, Glousman RE. Anterior capsulolabral reconstruction of the shoulder in athletes in overhand sports. The Ameri J Spor Med. 1991 Sep;19(5):428-34.

Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med. 1998;26:325-37.

Kuhn JE, Huston LJ, Soslowsky LJ, Shyr Y, Blasier RB. External rotation of the glenohumeral joint: ligament restraints and muscle effects in the neutral and abducted positions. J Shoulder Elbow Surg. 2005 Jan 1;14(1):S39-48.

Lajtai G, Pfirrmann CW, Aitzetmuller G, Pirkl C, Gerber C, Jost B. The shoulders of fully competitive professional beach volleyball players: high prevalence of infraspinatus atrophy. Am J Sports Med.2009;37(7):1375-83.

Meister K. Injuries to the shoulder in the throwing athlete. Part one: biomechanics/ pathophysiology/classification of injury. Am J Sports Med. 2000;28(2):265-75.

Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg. 2002;11(6):587-94.

Mileski RA, Snyder SJ. Superior labral lesions in the shoulder: Pathoanatomy and surgical management. J Am Acad Orthop Surg. 1998;6:121-31.

Morgan CD, Burkhart SS, Palmeri M, Gillespie M. Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy: J Arthroscop Rel Sur. 1998 Sep 1;14(6):553-65.

Nakajima T, Rokuuma N, Hamada K, Tomatsu T, Fukuda H. Histologic and biomechanical characteristics of the supraspinatus tendon: reference to rotator cuff tearing. J Sho Elbo Sur. 1994 Mar 1;3(2):79-87.