Research Podcast- Asymptomatic Shoulders and UE RTP criteria
Podcast Synopsis:
In this episode we discuss the evaluation and management of shoulder injuries in overhead athletes. They review and reflect on three key articles, including a study on asymptomatic elite volleyball players with MRI-confirmed shoulder pathologies, a scoping review of return-to-sport (RTS) criteria post-upper extremity surgery, and Kevin Wilk’s clinical commentary on functional shoulder testing. Their conversation emphasizes the need for objective, performance-based criteria in rehabilitation and highlights the disconnect between MRI findings and actual symptoms or function in athletes.
Cited Article (Primary Discussion Focus):
Reinig, J., Reinking, M. F., & Gallo, R. A. (2021). Shoulder MRI in asymptomatic elite volleyball athletes shows extensive pathology. Orthopaedic Journal of Sports Medicine, 9(5), 23259671211004825. https://doi.org/10.1177/23259671211004825
Wilk, K. E., Bagwell, M. S., Davies, G. J., & Arrigo, C. A. (2020). Return to Sport Participation Criteria Following Shoulder Injury: A Clinical Commentary. International Journal of Sports Physical Therapy, 15(4), 624–642. https://doi.org/10.26603/ijspt20200624
Trinh TQ, Naimark MB, Bedi A, Carpenter JE, Robbins CB, et al. Clinical outcomes after anterior shoulder stabilization in overhead athletes: an analysis of the MOON Shoulder Instability Consortium. Am J Sports Med. 2019;47(6):1404–1410. doi:10.1177/0363546519837666
5 Key Takeaways:
-
MRI Pathology ≠ Symptoms:
A high percentage of elite, asymptomatic volleyball players show structural abnormalities like tendinosis and partial cuff tears on MRI, suggesting that imaging findings alone shouldn't dictate treatment decisions. -
Functional Testing Should Drive RTS Decisions:
Current return-to-sport decisions are too often based on time since surgery rather than functional criteria. Only 12% of studies reviewed used sport-specific testing, highlighting a major gap in clinical practice. -
The Shoulder Needs Context-Specific Testing:
Unlike ACL rehab, the shoulder requires nuanced, sport-specific evaluation due to its complex, coordinated movement demands. Tests like ball drops, pull-ups, and fatigue-based assessments help fill this gap. -
Athletes Need Ongoing Performance Monitoring:
Returning to play should not signal the end of rehab. Continued check-ins help identify lingering deficits and guide progression back to full performance and durability in sport. -
Therapists Must Be Gatekeepers of Athletic Health:
Physical therapists should position themselves as long-term care providers for athletes, supporting them beyond initial recovery through performance optimization and injury prevention.
Couple Easy Take Away Test for UE shoulder strength and ROM assessment
- Total Arc ROM is within 5 deg of contralateral side
- 5% body weight one arm prone Table T for 20 reps
- Dynamometry ER by side and in 90 deg abd
