Document Type : Original Articles


1 Faculty of Sport Sciences, Shahid Bahonar University, Kerman, Iran.

2 Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.

3 Department of Physical Therapy, Faculty of Rehabilitation Sciences, Kerman University of Medical Sciences, Kerman, Iran.


Background: The shoulder complex is known as one of the most mobile joints of body whose frequently use for overhead movements causes changes in the shoulder joint range of motion. Sub-acromial impingement syndrome (SIS) is one of the most common causes of shoulder pain affecting shoulder joint range of motion. The purpose of this study was to compare shoulder joint functional range of motion in overhead athletes with and without Shoulder impingement syndrome. Methods: The current research is a cross-sectional study, in which 63 male overhead athletes (30 subjects without impingement syndrome (age: 28.12±6.13 y/o) and 33 subjects with impingement syndrome (age: 26.83±4.81 y/o)) threw a handball ball three times, while seating on a chair. A 6-camera Vicon Motion Capture system recorded the markers placed on the upper limb and trunk during each of the throwing conditions. To evaluate the range of motion, a whole-body kinematic model was used in OpenSim software, with inverse kinematics used to obtain adequate joint angles (shoulder joint abduction as well as internal and external rotation). Results: The results indicated that the external rotation and abduction range of motion were greater in the athletes with shoulder impingement syndrome in comparison to those without impingement syndrome (P <0/001 and p= 0.04, respectively), while their internal rotation range of motion were more limited than that of athletes without impingement syndrome (p<0/001). Conclusion: Overhead athletes with impingement syndrome have greater glenohumeral external rotation and abduction and less internal rotation in the throwing shoulder in comparison to athletes without impingement syndrome. These findings can be used to screen and identify high-risk athletes and help the therapists to make more appropriate therapeutic plans in order to assist the injured athlete to return to sports as soon as possible.


  1. Wilk KE, Meister K, Andrews IR. Current Concepts in the Rehabilitation of the Overhead Throwing Athlete. Am J Sports Med 2002;(30):136-51
  2. Cools AM., Johansson FR., Borms D & Maenhout A. Prevention of shoulder injuries in overhead athletes: a science-based approach. Braz J Phys Ther 2015;19(5), 331-339.
  3. Frisch KE, Clark J, Hanson C, Fagerness C, Conway A, Hoogendoorn L. High Prevalence of Nontraumatic Shoulder Pain in a Regional Sample of Female High School Volleyball Athletes. Orthop J Sports Med. 2017 ,23;5(6):2325967117712236.
  4. Saadatian A, Sahebozamani M, & Mohamadipour F. comparison of internal-to-external ratios of strength rotation and rom rotation in injured and healthy professional male handball players. J Res Rehabil Sci 2013;9(7):1232-1243
  5. Tyler TF, Nicholas SJ, Lee SJ, Mullaney M, McHugh MP. Correction of posterior shoulder tightness is associated with symptom resolution in patients with internal impingement. Am J Sports Med 2010; 38:114–19.
  6. Cools AM, Declercq G, Cagnie B, Cambier D, Witvrouw E. Internal impingement in the tennis player: rehabilitation guidelines. Br J Sports Med 2008; 42:165–71
  7. Cools AM, Johansson FR, Cagnie B, Cambier DC, Witvrouw EE. Stretching the posterior shoulder structures in subjects with internal rotation deficit: comparison of two stretching techniques. Shoulder Elbow 2012 ,1;4(1):56-63.
  8. Borsa PA, Laudner KG, Sauers EL. Mobility and stability adaptations in the shoulder of the overhead athlete: a theoretical and evidencebased perspective. Sports Med 2008; 38:17–36
  9. Keller RA, De Giacomo AF, Neumann JA, Limpisvasti, O & Tibone JE. Glenohumeral internal rotation deficit and risk of upper extremity injury in overhead athletes: a meta-analysis and systematic review. Sports health 2018;10(2), 125-132.
  10. Nodehi-Moghadam A, Nasrin N, Kharazmi A & Eskandari, Z. A comparative study on shoulder rotational strength, range of motion and proprioception between the throwing athletes and non-athletic persons. Asian J Sports Med 2013; 4(1), 34- 40.
  11. Szyluk K, jasinski A, Koczy B, Widuchowski W, Widuchowski J, Subacromial impingement syndrome most frequent reason of the painful shoulder syndrome. Pol merkur Lekarski 2008. 25(146): 179-83
  12. Lewis JS, Green AS, Dekel S. The etiology of subacromial impingement syndrome. Physiotherapy 2001; 87(9): 458-69.
  13. Michener LA, McClure PW, Karduna AR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech (Bristol, Avon) 2003;18(5): 369-39
  14. McConnell J, Donnelly C, Hamner S, Dunne J, & Besier T. Effect of shoulder taping on maximum shoulder external and internal rotation range in uninjured and previously injured overhead athletes during a seated throw. J Orthop Res 2011; 29(9), 1406-1411.
  15. Lewis JS, Wright C, Green A. Subacromial impingement syndrome: the effect of changing posture on shoulder range of movement. J Orthop Sports Phys Ther 2005;35(2):72-87.
  16. Mascarin NC, Vancini RL, Lira CA, Andrade MS. Stretch-induced reductions in throwing performance are attenuated by warm-up before exercise. J Strength Cond Res. 2015; 29:1393–8.
  17. McConnell J, Donnelly C, Hamner S, Dunne J, & Besier T.Passive and dynamic shoulder rotation range in uninjured and previously injured overhead throwing athletes and the effect of shoulder taping. PM&R 2012; 4(2), 111-116.
  18. Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart S M. Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med,2006; 34(3), 385-391.
  19. Almeida GPL, Silveira PF, Rosseto NP, Barbosa G, Ejnisman B, Cohen M. Glenohumeral range of motion in handball players with and without throwing-related shoulder pain. J Shoulder Elbow Surg 2013; 22(5), 602-607.
  20. Reinold MM, Wilk KE, Macrina LC, Sheheane C, Dun S, Fleisig GS, et al. Changes in shoulder and elbow passive range of motion after pitching in professional baseball players. Am J Sports Med 2008; 36:523-7.
  21. Dwelly PM, Tripp BL, Tripp PA, Eberman LE, Gorin S. Glenohumeral rotational range of motion in collegiate overhead-throwing athletes during an athletic season. J Athl Train 2009; 44:611-6.
  22. Kibler WB, Chandler TJ. Range of motion in junior tennis players participating in an injury risk modification program. J Sci Med Sport 2003; 6:51-62
  23. Scher S, Anderson K, Weber N, Bajorek J, Rand K, Bey MJ. Associations among hip and shoulder range of motion and shoulder injury in professional baseball players. J Athl Train 2010; 45:191-197
  24. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: Spectrum of pathology. Part I: Pathoanatomy and biomechanics. Arthroscopy 2003; 19:404-420.
  25. Trakis JE, McHugh MP, Caracciolo PA, Busciacco L, Mullaney M, Nicholas JS. Muscle strength and range of motion in adolescent pitchers with throwing-related pain: implications for injury prevention. Am J Sports Med 2008; 36(11), 2173-78
  26. Borsa PA, Laudner KG, Sauers EL. Mobility and stability adaptations in the shoulder of the overhead athlete: a theoretical and evidence-based perspective. Sports Med 2008; 38:17–36