Glenohumeral internal rotation deficit (GIRD) is a loss of inward rotation of the throwing shoulder compared with the other shoulder. It is seen in baseball pitchers, softball players, tennis players, volleyball players and other overhead athletes, and is usually caused by tightness of the back of the shoulder capsule and muscles from repeated throwing. GIRD matters because it has been linked to shoulder and elbow injuries in throwers. Dr. Andrew Dold, a board-certified, fellowship-trained sports medicine surgeon in Frisco, Texas, evaluates throwing athletes and treats GIRD with a targeted stretching and strengthening program.
- GIRD is classically defined as a loss of 20° or more of internal rotation in the throwing shoulder compared with the other side
- Some gain in outward rotation in throwers is normal; the concern is when total motion is also lost
- GIRD has been associated with shoulder and elbow injuries in overhead athletes
- Daily posterior-shoulder stretching, such as the sleeper and cross-body stretches, improves internal rotation
What is GIRD?
Throwers commonly gain external (outward) rotation and lose some internal (inward) rotation in the throwing shoulder. This is partly a normal adaptation, including changes in the bone, and partly due to tightness at the back of the shoulder. GIRD is classically defined as a loss of 20° or more of internal rotation compared with the non-throwing shoulder.1 A loss of total rotational motion (internal plus external rotation) may also matter.1
Why GIRD matters
In professional pitchers followed over 3 seasons, those with GIRD were nearly twice as likely to be injured as those without (although the difference was not statistically significant), and pitchers who lost more than 5° of total rotational motion had a higher rate of injury.1 A meta-analysis of 819 overhead athletes found more internal rotation loss in injured athletes than uninjured athletes, with a stronger link in adults than adolescents, and noted that the traditional 20° threshold may be too conservative.2 Throwers with shoulder or elbow problems such as SLAP tears, partial rotator cuff tears and UCL injuries of the elbow are routinely checked for GIRD.
Diagnosis
Dr. Dold measures internal and external rotation in both shoulders with the arm out to the side and the shoulder blade stabilized, and compares total motion. He also checks shoulder-blade control, rotator cuff strength, the labrum and the elbow, and asks about pitch counts, training load and throwing mechanics. Imaging is used when pain, weakness or loss of velocity suggests a structural injury.
Treatment
- Posterior shoulder stretching: the cross-body stretch and the sleeper stretch, done daily. In a randomized trial, the cross-body stretch improved internal rotation by an average of 20° over 4 weeks.3 A 2026 meta-analysis of randomized trials in overhead athletes with GIRD found that sleeper and cross-body stretching improved internal rotation compared with no stretching.4
- Rotator cuff and shoulder-blade strengthening, with attention to the muscles that slow the arm down after release
- Throwing load management: following age-appropriate pitch counts and rest days and avoiding year-round throwing without breaks
- Mechanics review with a coach or therapist
Surgery is rarely needed for GIRD itself. When GIRD is associated with a structural injury such as a labral or rotator cuff tear that does not respond to rehabilitation, that injury is treated on its own merits.
Why see Dr. Dold
- Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
- Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
- Fellow of the American College of Surgeons (FACS), the American Academy of Orthopaedic Surgeons (FAAOS), the American Orthopaedic Association (FAOA) and the Royal College of Surgeons of Canada (FRCSC)
- Author of a SLAP repair book chapter (Springer, 2017) and research on shoulder suture anchors (KSSTA, 2013)
- Team physician and surgical consultant to Rugby Canada; has cared for professional athletes from the NFL, NBA, NHL, MLS, PGA Tour and Major League Rugby
- D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google
Frequently asked questions
What is GIRD?
A loss of inward (internal) rotation of the throwing shoulder compared with the other shoulder, classically 20° or more.1
Does GIRD cause injuries?
It has been linked to shoulder and elbow injuries in overhead athletes, although the research is still evolving.1,2
How do I fix GIRD?
Daily posterior shoulder stretching, such as the cross-body and sleeper stretches, along with strengthening and workload management.3,4
Should my child stop throwing?
Not necessarily. Many young athletes keep throwing with a stretching program and appropriate pitch counts. Pain, loss of velocity or elbow pain should be evaluated. See also Little Leaguer’s shoulder.
Is some loss of internal rotation normal in throwers?
Yes. Some change is a normal adaptation to throwing. The concern is a large loss of internal rotation or a loss of total motion.1
Do you accept my insurance?
Dr. Dold accepts most major insurance plans, including Medicare and Tricare. Please call 469-850-0680 to confirm your coverage.
Research cited on this page
- Wilk KE, Macrina LC, Fleisig GS, et al. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011;39(2):329-335. PubMed
- Johnson JE, Fullmer JA, Nielsen CM, et al. Glenohumeral Internal Rotation Deficit and Injuries: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2018;6(5):2325967118773322. PubMed
- McClure P, Balaicuis J, Heiland D, et al. A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther. 2007;37(3):108-114. PubMed
- Iida N, Velasquez Garcia A, Kuroiwa T, et al. Role of stretching interventions in enhancing the shoulder range of motion in overhead athletes with glenohumeral internal rotation deficit: A systematic review and meta-analysis. PM R. 2026;18(2):200-209. PubMed
Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. This page is general information, not medical advice. Individual results vary.
