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Glenohumeral Internal Rotation Deficit (GIRD)


Glenohumeral internal rotation deficit (GIRD) often affects baseball pitchers and other athletes whose sports call for a lot of throwing or overhead motions. The glenohumeral joint is the ball-and-socket where the head of the upper arm fits into the cupped end of the shoulder blade. It is the main joint of the shoulder.

Making frequent and repeated overhead motions can gradually stretch the joint out allowing more external rotation (the "cocking" phase of a throw). However, this can cause tightness in internal rotation (the "follow through" phase of a throw).The resulting imbalance may affect your shoulder's range of motion and lead to other shoulder problems, including impingement, rotator cuff inflammation and labral tears. In most cases, we can treat these issues easily, without surgery.

Our approach to GIRD

We are committed to helping patients with GIRD and other shoulder problems recover function and return to their favorite activities. Our team includes orthopedic surgeons who specialize in the shoulder and physical therapists experienced in caring for patients with shoulder injuries.

Awards & recognition

  • One of the nation's best for orthopedic care

  • Among the top hospitals in the nation

Signs & symptoms

Signs of GIRD can be subtle and may include:

  • vague shoulder pain (though GIRD is sometimes painless)
  • a decrease in throwing strength and performance


GIRD is diagnosed through a physical exam. While you lie on your back, the doctor will rotate your arms one at a time internally and externally to check the range of motion in the shoulders. A difference in the range of motion between the throwing and non-throwing arm is a hallmark of GIRD.


In most cases, we can successfully treat GIRD with rest and a physical therapy plan that includes strengthening exercises and stretches to increase the shoulder joint's ability to rotate internally. Recovery typically takes several months. For the small number of patients who don't respond to conservative measures, surgery may be an option.

UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.

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