Elbow Topics

Patient Info


In the world of orthopaedic surgery, GIRD stands for Glenohumeral Internal Rotation Deficit. It is a condition whereby the shoulder loses its normal amount of rotation. GIRD is most often seen in athletes who compete year round and are not involved in a stretching program. It occurs from the repetitive microtrauma to the shoulder from throwing a softball/baseball, spiking a volleyball, or swimming. GIRD is significant for overhead athletes, because when an overhead athlete cannot follow through with his/her shot or throw or stroke it puts increased stress on the shoulder and often the elbow. If a thrower can not follow through normally, then often the thrower will change his/her mechanics (drop their slot, get their body in front of the pitch, etc) in a way that puts more stress on the elbow. The resulting elbow stress can lead to injury to the Ulnar Collateral Ligament or the Flexor Pronator Mass. Treating the loss of shoulder motion will often alleviate the symptoms at the elbow.

Little leaguer's elbow

Little Leaguer's elbow most often is used as a term to describe injury to the bone and cartilage of the 8 to 12 year old athlete's elbow. It can occur in throwing athletes such as baseball and softball players, but is also often seen in gymnasts, wrestlers, and motocross athletes. These impact athletes put high force loads through their immature joints. The injury we that occurs is a separation of the bone and cartilage from the lateral or outside of the elbow - the radiocapitellar joint. This injury produces an osteochondral lesion - meaning a lesion of bone (osteo) and cartilage (chondral). If untreated, the athlete will sometimes break off an osteochondral fragment or "loose body." Often these lesions, when diagnosed, can be treated with rest and correction of mechanics.


Arthrofibrosis is a term used to describe a stiff joint (arthro = joint, fibrosis = loss of motion). The elbow is the body's major joint most susceptible to stiffness. Arthrofibrosis can occur in response to a traumatic event (fracture, loose body), congenital deformity, arthritis, immobilization, or even a head injury. Arthrofibrosis can be treated with open or arthroscopic releases. Dr Shepard uses arthroscopic techniques to maximize a release of the joint and to minimize any additional trauma to the elbow.

Biceps rupture and Reconstruction

The biceps muscle originates from the humerus and scapula and inserts onto the radial head via the biceps tendon. The biceps tendon is the main supinator of the elbow and forearm. Supination is the motion by which we can turn our palm up towards the sky or ceiling. The biceps provides nearly 90% of the supination strength to the elbow. It is most often ruptured with a heavy, eccentric load (trying to lift or set down a TV, an air conditioner, or a couch). If the biceps ruptures completely, most people will notice a significant weakness in supination. Dr Shepard reconstructs the biceps attachment through a single small incision in the crease of elbow. The biceps is affixed with a small endobutton at the end of the tendon, a mollybolt type of device. A burr is then used to make a trough in the radius and the button and tendon is passed through thereby securing the tendon to its normal attachment and allowing it to heal.

The Tommy John Ligament

The Ulnar Collateral Ligament of the elbow is the primary stabilizer of valgus stress. The UCL or Tommy John Ligament comes under great stresses with throwing of a baseball, softball, or javelin. Likewise, the ligament sees stress from spiking a volleyball or performing a handstand. Very few people ever need or undergo a reconstruction of the ligament. The ligament is reconstructed to get athletes back to throwing at a high level. The surgery involves making drill tunnels in the ulna and humerus and then placing a tendon graft through these tunnels to recreate the ligament. The surgery itself takes about 90 minutes, but the recovery will take a minimum of 9 months to get back to throwing. Because of the long rehab time, very few athletes undergo this surgery except at the college or professional levels. Dr Shepard learned how to perform this surgery while working with world famous Dr James Andrews in Birmingham, AL. Dr Shepard prefers to perform this surgery in players at the College level or higher.