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The throwing shoulder in youth elite handball: soft-tissue adaptations but not humeral retrotorsion differ between the two sexes

  • SHOULDER
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

In youth handball players, knowledge about the development of soft-tissue adaptation and humeral retrotorsion is limited. The purpose of this study was to investigate differences in adaptations in the glenohumeral rotational range of motion and humeral retrotorsion of the throwing arm between male and female youth elite handball players.

Methods

One-hundred and thirty-eight youth elite handball players (mean age: 14.1 ± 0.7 years) were assessed for glenohumeral external (ER) and internal (IR) rotational ranges of motion and humeral retrotorsion (HRT) by means of a manual goniometer and a portable ultrasound device. Sports-specific adaptations between the dominant and non-dominant shoulders and between male and female adolescents were calculated.

Results

Handball players showed side-to-side differences in IR and ER in the throwing shoulder. HRT did not correlate with the measurements of rotational ROM of the throwing arm. Male athletes showed a more pronounced glenohumeral internal rotation deficit than female athletes (13.1° ± 22.8° vs. 5.1° ± 14.0°, p = 0.014). Adaptations in HRT but no sex differences could be seen in the throwing shoulder (16.5° ± 9.6°) compared to the non-throwing shoulder (13.5° ± 9.4°, p < 0.001).

Conclusion

Loss of internal rotation and gain in external rotation in youth handball players seem to be more related to adaptive changes in the soft-tissues than to HRT. Male athletes showed stronger throwing-related adaptations in the rotational range of motion but not in humeral torsion in their dominant shoulder than female athletes.

Level of evidence

Cross-sectional study, Level II.

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References

  1. Aasheim C, Stavenes H, Andersson SH, Engebretsen L, Clarsen B (2018) Prevalence and burden of overuse injuries in elite junior handball. BMJ Open Sport Exerc Med 4(1):e000391

    Article  Google Scholar 

  2. Achenbach L, Laver L, Walter SS, Kuhr M, Angele P, Krutsch W (2019) Decreased external rotation strength is a risk factor for overuse shoulder injury in youth elite handball athletes. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05493-4

    Article  PubMed  Google Scholar 

  3. Andersson SH, Bahr R, Clarsen B, Myklebust G (2018) Risk factors for overuse shoulder injuries in a mixed-sex cohort of 329 elite handball players: previous findings could not be confirmed. Br J Sports Med 52(18):1191–1198

    Article  Google Scholar 

  4. Asker M, Walden M, Källberg H, Walden M, Skillgate E (2018) Female adolescent elite handball players are more susceptible to shoulder problems than their male counterparts. Knee Surg Sports Traumatol Arthrosc 26(7):1892–1900

    Article  Google Scholar 

  5. Asker M, Walden M, Källberg H, Holm LW, Skillgate E (2017) A prospective cohort study identifying risk factors for shoulder injuries in adolescent elite handball players: the Karolinska Handball Study (KHAST) study protocol. BMC Musculoskelet Disord 18(1):485

    Article  Google Scholar 

  6. Bailey LB, Beattie PF, Shanley E, Seitz AL, Thigpen CA (2015) Current rehabilitation applications for shoulder ultrasound imaging. J Orthop Sports Phys Ther 45(5):394–405

    Article  Google Scholar 

  7. Clarsen B, Bahr R, Andersson SH, 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. Br J Sports Med 48(17):1327–1333

    Article  Google Scholar 

  8. Fleisig GS, Andres JR, Cutter GR, Weber A, Loftice J, McMichael C, Hassell N, Lyman S (2011) Risk of serious injury for young baseball pitchers: a 10-year prospective study. Am J Sports Med 39(2):253–257

    Article  Google Scholar 

  9. Greenberg EM, Fernandez-Fernandez A, Lawrence JTR, McClure P (2015) The development of humeral retrotorsion and its relationship to throwing sports. Sports Health 7(6):489–496

    Article  Google Scholar 

  10. Guenoun D, Le Corroller T, Lagier A, Pauly V, Champsaur P (2015) Correlation between the retroversion of the humeral head and the orientation of the intertubercular sulcus: a CT scan anatomical study. Surg Radiol Anat 37(4):357–361

    Article  Google Scholar 

  11. Hibbert EE, Oyama S, Myers JB (2014) Increase in humeral retrotorsion accounts for age-related increase in glenohumeral internal rotation deficit in youth and adolescent baseball players. Am J Sports Med 42(4):851–858

    Article  Google Scholar 

  12. Kay J, Kirsch JM, Bakshi N, Ekhtiari S, Horner N, Gichuru M, Alolabi B, Khan M, Bedi A (2018) Humeral retroversion and capsule thickening in the overhead throwing athlete a systematic review. Arthroscopy 34(4):1308–1318

    Article  Google Scholar 

  13. Lee BJ, Garrison JC, Conway JE, Pollard K, Aryal S (2016) The relationship between humeral retrotorsion and shoulder range of motion in baseball players with an ulnar collateral ligament tear. Orthop J Sports Med 4(10):2325967116667497

    Article  Google Scholar 

  14. Lubiatowski P, Kaczmarek P, Cisowski P, Breborowicz E, Grygorowicz M, Dzianach M, Krupecki T, Laver L, Romanowski L (2018) Rotational glenohumeral adaptions are associated with shoulder pathology in professional male handball players. Knee Surg Sports Traumatol Arthrosc 26(1):67–75

    Article  Google Scholar 

  15. Luig P, Krutsch W, Nerlich M, Henke T, Klein C, Bloch H, Platen P, Achenbach L (2018) Increased injury rates after the restructure of Germany’s national second league of team handball. Knee Surg Sports Traumatol Arthrosc 26(7):1884–1891

    Article  Google Scholar 

  16. Moller M, Attermann J, Myklebust G, Lind M, Sorensen H, Hebert JJ, Nielsen RO, Bertelsen SL, Wedderkopp N (2018) The inter- and intrarater reliability and agreement for field-based assessment of scapular control, shoulder range of motion, and shoulder isometric strength in elite adolescent athletes. Phys Ther Sport 32:212–220

    Article  CAS  Google Scholar 

  17. Myers JB, Oyama S, Goerger BM, Rucinski TJ, Blackburn JT, Creighton RA (2009) Influence of humeral torsion on interpretation of posterior shoulder tightness measures in overhead athletes. Clin J Sports Med 19(5):366–371

    Article  Google Scholar 

  18. Myers JB, Oyama S, Clarke JP (2012) Ultrasonographic assessment of humeral retrotorsion in baseball players: a validation study. Am J Sports Med 40(5):1155–1160

    Article  Google Scholar 

  19. Myklebust G, Hasslan L, Bahr R, Steffen K (2011) High prevalence of shoulder pain among elite Norwegian female handball players. Scand J Med Sci Sports 23(3):288–294

    Article  Google Scholar 

  20. Norton R, Honstad C, Joshi R (2019) Risk factors for elbow and shoulder injuries in adolescent baseball players: a systematic review. Am J Sports Med 47(4):982–990

    Article  Google Scholar 

  21. Oliveira VMA, Pitangui ACR, Gomes MRA, Silva HAD, Passos MHPD, Araujo RC (2017) Shoulder pain in adolescent athletes: prevalence, associated factors and its influence on upper limb function. Braz J Phys Ther 21(2):107–113

    Article  Google Scholar 

  22. Olsen SJ, Fleisig GS, Dun S, Loftice J, Andrews JR (2006) Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. Am J Sports Med 34(6):905–912

    Article  Google Scholar 

  23. Pieper HG (1998) Humeral torsion in the throwing arm of handball players. Am J Sports Med 26(2):247–253

    Article  CAS  Google Scholar 

  24. Reagan KM, Meister K, Horodyski MB, Werner DW, Carruthers C, Wilk K (2002) Humeral retroversion and its relationship to glenohumeral rotation in the shoulder of college baseball players. Am J Sports Med 30(3):354–3602

    Article  CAS  Google Scholar 

  25. Reuther KE, Sheridan S, Thomas SJ (2018) Differentiation of bony and soft-tissue adaptions of the shoulder in professional baseball pitchers. J Shoulder Elbow Surg 27(8):1491–1496

    Article  Google Scholar 

  26. Saka M, Yamauchi H, Yoshioka T, Hamada H, Gamada K (2015) Conventional humeral retroversion measurement using computed tomography slices or ultrasound images are not correlated with the 3-dimensional humeral retroversion angle. Orthop J Sports Med 3(3):2325967115573701

    Article  Google Scholar 

  27. Schorer J, Cobley S, Büsch D, Bräutigam H, Baker J (2009) Influences of competition level, gender, player nationality, career stage and playing position on relative age effect. Scand J Med Sci Sports 19(5):720–730

    Article  CAS  Google Scholar 

  28. Shanley E, Kissenberth MJ, Thigpen CA, Bailey LB, Hawkins RJ, Michener LA, Tokish JM, Rauh MJ (2015) Preseason shoulder range of motion screening as a predictor of injury among youth and adolescent baseball pitchers. J Shoulder Elbow Surg 24(7):1005–1013

    Article  Google Scholar 

  29. Whiteley RJ, Ginn K, Nicholson L, Adams R (2006) Indirect ultrasound measurement of humeral torsion in youth adolescent baseball players and non-athletic adults: reliability and significant. J Sci Med Sport 9(4):310–318

    Article  Google Scholar 

  30. Yamamoto N, Itoi E, Minagawa H, Urayama M, Saito H, Seki N, Iwase T, Kashiwaguchi S, Matsuura T (2006) Why is the humeral retroversion of throwing athletes greater in dominant shoulders than in non-dominant shoulders? J Shoulder Elbow Surg 15(5):571–575

    Article  Google Scholar 

  31. Yoshida M, Saho Y, Katayose M (2010) Reliability of measuring humeral retroversion using ultrasound imaging in a healthy nonthrowing population. J Sport Rehabil 19:149–160

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank all contributing coaches and athletes.

Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany

    Leonard Achenbach

  2. University Regensburg, Regensburg, Germany

    Annabelle Catherine Clément & Lukas Hufsky

  3. Sporthopaedicum Regensburg-Straubing, Regensburg, Germany

    Stefan Greiner

  4. Centre for Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany

    Florian Zeman

  5. Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany

    Sven Stephan Walter

Authors
  1. Leonard Achenbach
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  2. Annabelle Catherine Clément
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  3. Lukas Hufsky
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  4. Stefan Greiner
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  6. Sven Stephan Walter
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Correspondence to Leonard Achenbach.

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Ethical approval

Institutional Review Board (IRB) approval was obtained from the IRB (ID 17-895-101) prior to the initiation of this study.

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Informed written consent was obtained from all study participants and their parents.

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Achenbach, L., Clément, A.C., Hufsky, L. et al. The throwing shoulder in youth elite handball: soft-tissue adaptations but not humeral retrotorsion differ between the two sexes. Knee Surg Sports Traumatol Arthrosc 27, 3937–3943 (2019). https://doi.org/10.1007/s00167-019-05578-0

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  • DOI: https://doi.org/10.1007/s00167-019-05578-0

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