Glenohumeral Internal Rotation Deficit After Operative Treatment of Mid- Shaft Clavicle Fractures: A Subclinical, Scapula-Related Phenomenon

Background Glenohumeral internal rotation deficit (GIRD) is a well-recognized component of shoulder dysfunction and has been extensively described in overhead athletes within the framework of scapular dyskinesis. However, the presence and characteristics of GIRD in patients following operative treatment of mid-shaft clavicle fractures remain insufficiently understood. This study aimed to evaluate the prevalence and features of GIRD in a post-traumatic population and to explore their potential relationship with scapular positioning. Methods This cross-sectional study included 62 patients who underwent open reduction and internal fixation (ORIF) for mid-shaft clavicle fractures. Clinical assessment was performed 14–22 months postoperatively at the time of elective implant removal. Glenohumeral internal rotation range of motion was measured bilaterally using a standardized protocol, and side-to-side differences were calculated to identify GIRD. Scapular dyskinesis was clinically assessed according to the SICK Scapula Rating Scale described by Kibler et al. Functional outcome was evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score. Scapular orientation was indirectly and exploratorily assessed by measuring the projected area of the glenoid on standard anteroposterior radiographs. Results A clinically relevant GIRD was identified in 45 of 62 patients (72.6%), with a median side-to-side difference of approximately 25°. No corresponding gain in external rotation was observed. Despite these objective findings, patients generally reported minimal symptoms, and DASH scores did not differ significantly between patients with and without internal rotation deficits. However, a small but statistically significant difference was observed in the SICK Scapula Rating Scale score. On radiographic evaluation, patients with GIRD demonstrated a larger projected glenoid area on standard anteroposterior views. This finding may reflect a tendency toward scapular protraction. Conclusion GIRD appears to be a common but largely subclinical finding after operative treatment of mid-shaft clavicle fractures. In contrast to the pattern described in overhead athletes, this post-traumatic internal rotation deficit was not accompanied by external rotation gain, suggesting a potentially distinct underlying mechanism. The observed association with a tendency toward scapular protraction may provide insight into this phenomenon. Awareness of this pattern may be relevant for postoperative assessment and for informing future studies aimed at optimizing rehabilitation strategies.