Webinar Upper Limb Testing For Return To Sport

What you'll learn

1. Chapter 1: Principles of Return-to-Sport Decision-Making for the Upper Limb

2. Chapter 2: Functional Anatomy, Kinetic Chain, and Sport Demands of the Shoulder, Elbow, and Wrist

   Return-to-sport (RTS) testing is only valid if it reflects the demands of the sport and the structures that meet them. The upper limb is a link system.

3. Chapter 3: Tissue Healing, Load Tolerance, and Injury Risk Factors in Upper Limb Athletes

4. Chapter 4: Clinical Screening: History, Pain Behavior, Red Flags, and Psychological Readiness (e.g., SIRSI, ASES, QuickDASH)

   Performance tests (isokinetic, closed-kinetic-chain upper-extremity stability, seated shot put, and similar) load a structure that may be irritable, unsafe, or psychologically unready. Screening decides whether, when, and how to test.

5. Chapter 5: Range of Motion and Mobility Testing: GIRD, Total Arc, Scapular Dyskinesis, and Thoracic Contribution

   Glenohumeral internal rotation deficit (GIRD) is a loss of internal rotation (IR) in the dominant shoulder relative to the non-dominant side.

6. Chapter 6: Strength Testing: Handheld Dynamometry, Isokinetics, Rotator Cuff Ratios, and Grip Strength

   By the end of this chapter you should be able to: - Select and standardise handheld dynamometry (HHD), isokinetic and grip tests for return to sport (RTS). - Interpret side-to-side differences and rotator cuff strength ratios.

7. Chapter 7: Power, Endurance, and Neuromuscular Control Testing: Plyometric Push-Up, Seated Shot Put, and Closed Chain Stability Tests

   Upper limb sport relies on the stretch-shortening cycle: a rapid eccentric load, a brief amortization phase and an explosive concentric action. Rate of force development often stays reduced after pain settles.

8. Chapter 8: Sport-Specific and Functional Testing: Y-Balance UQ, CKCUEST, Throwing Velocity, and Return-to-Throw Metrics

   Common pathologies in the returning thrower include: - Internal impingement (posterosuperior cuff against the glenoid in abduction/ER) - Partial articular-sided cuff tears - SLAP lesions with "peel-back" mechanism - Posterior capsular…

9. Chapter 9: Interpreting Test Results: Limb Symmetry, Normative Data, Test Batteries, and Clinical Reasoning

   By the end of this chapter you should be able to: - Explain why simple limb symmetry index (LSI) cut-offs are less valid in the upper limb than the lower limb.

10. Chapter 10: Designing Criterion-Based Progressions: Linking Test Deficits to Targeted Interventions and Load Management

11. Chapter 11: Special Situations: Post-Surgical Shoulder Stabilization, Rotator Cuff Repair, Elbow UCL, Adolescent Athletes, and Contact Sport Considerations

    Learning outcomes: By the end of this chapter you should be able to (1) explain why four populations need modified return-to-sport (RTS) criteria, (2) select tests and cut-offs for each, (3) apply staged progressions with realistic…

12. Chapter 12: Final Clearance and Long-Term Monitoring: Communication, Documentation, Reinjury Prevention, and Case Application

Practice questions

5 sample MCQs from this course. Tap a question to see the answer.

1. A 24-year-old male collegiate volleyball player has had posterior shoulder pain for three weeks after repetitive spiking. He reports that his dominant arm feels unstable and weak when he decelerates after the swing. Strength testing shows pain-limited eccentric control during the follow-through phase.

   1. Which muscle group is most active eccentrically during the deceleration phase of an overhead spike?

   • A. Rotator cuff external rotators (posterior cuff)
   • B. Pectoralis major in concentric shortening
   • C. Middle deltoid in isometric contraction
   • D. Triceps brachii in concentric elbow extension
   Show answer

   Answer: A. During the follow-through of an overhead throw or spike, the posterior rotator cuff eccentrically decelerates internal rotation of the humerus. Impaired eccentric control of these muscles is a common cause of posterior shoulder pain and instability in overhead athletes.

2. A 58-year-old man presents 3 weeks after falling onto an outstretched left hand and reports persistent shoulder pain that wakes him every night. He has lost about 8 kg unintentionally over 2 months and has a history of breast cancer treated 5 years ago. He cannot sleep on his left side or reach his back pocket.

   2. Which finding should prompt urgent medical referral before rehabilitation continues?

   • A. Constant night pain with unexplained weight loss and a cancer history
   • B. Pain that worsens with overhead reaching
   • C. Pain reproduced during resisted external rotation
   • D. Morning stiffness lasting about 20 minutes
   Show answer

   Answer: A. Night pain, unexplained weight loss, and a prior malignancy are red flags suggesting a possible systemic or neoplastic cause rather than a mechanical shoulder problem. These features require medical review and exclusion of pathology before any load-based rehabilitation is started.

3. A 34-year-old male tennis player reports lateral shoulder pain after his serve and weakness during forehand follow-through. Clinical testing shows painful resisted external rotation with a noticeable strength deficit on the dominant side. The clinician plans to quantify his shoulder external rotator strength using a handheld dynamometer.

   3. Which handheld dynamometry procedure involves the patient generating a maximal isometric force against a stationary device held by the examiner?

   • A. Make test
   • B. Break test
   • C. Isokinetic concentric test
   • D. Jamar grip test
   Show answer

   Answer: A. In the make test, the patient pushes or pulls against a fixed dynamometer that the examiner holds steady, producing a maximal isometric force value. It is the standard handheld approach for quantifying isometric strength in clinical settings, while the break test uses the examiner's force to overcome the patient's effort.

4. A 22-year-old female volleyball player is 4 months after arthroscopic labral repair of the right shoulder. She reports fear of overhead spiking and pain with repeated serves. Her therapist plans a Y-Balance Upper Quadrant test to compare reach performance between sides.

   4. Based on the YBT-UQ findings, which interpretation is most appropriate?

   • A. A side-to-side reach difference greater than 4 cm is associated with increased injury risk in overhead athletes
   • B. A composite score is calculated by adding the three reach distances without normalizing to arm length
   • C. Reach distances are recorded as shoulder abduction angles in degrees
   • D. The test is performed in standing with both feet fixed together on the floor
   Show answer

   Answer: A. Side-to-side asymmetry greater than 4 cm on the YBT-UQ is a commonly used threshold linked to increased injury risk in overhead athletes. Reach distances are normalized to arm length, and they are measured in centimetres rather than angles.

5. A 22-year-old male handball player is 5 months after arthroscopic stabilization of his right shoulder. During a seated medicine ball chest pass test, his right arm throws 4.2 m and his uninjured left arm throws 5.0 m. He reports no pain but feels weaker when attempting high-velocity throws.

   5. What is the limb symmetry index (LSI) for the operated right arm on this test?

   • A. 84%
   • B. 119%
   • C. 16%
   • D. 92%
   Show answer

   Answer: A. LSI is calculated as the involved limb result divided by the uninvolved limb result, multiplied by 100 (4.2 / 5.0 x 100 = 84%). Reporting the involved-over-uninvolved ratio, rather than the absolute difference, allows comparison across athletes and tests.

Flashcards

• Why is the glenohumeral joint described as having a high degree of mobility but low inherent stability?

  The glenoid fossa is shallow and covers only about a quarter to a third of the humeral head, so the bony architecture offers little constraint. Stability depends mainly on the labrum, joint capsule and ligaments, and the rotator cuff and scapular muscles that actively center the humeral head.

• What does the SIRSI measure, and what does a higher score indicate?

  The Shoulder Instability Return to Sport after Injury (SIRSI) is a 10-item patient-reported questionnaire that measures an athlete's confidence in returning to sport without recurrent shoulder instability. Scores range from 0 to 100, and higher scores indicate greater confidence and readiness to return.

• What is glenohumeral internal rotation deficit (GIRD), and how is it typically identified in overhead athletes?

  GIRD is a loss of shoulder internal rotation compared with the non-dominant or contralateral side. It is commonly identified when the side-to-side difference in internal rotation is about 20 degrees or more, measured with the scapula stabilized. It is often associated with posterior shoulder capsule tightness.

• What is the key difference between the 'make test' and the 'break test' when using handheld dynamometry?

  In the make test, the examiner holds the dynamometer steady while the patient pushes against it. In the break test, the patient generates maximal force and the examiner resists until the limb gives way. The break test is generally considered more reliable and better at capturing maximal strength, especially when the examiner is stronger than the patient or the limb is stabilized.

• What does the plyometric push-up test primarily assess in an athlete returning to sport?

  It assesses upper-body reactive power and the ability to rapidly switch from eccentric loading to concentric force production. The athlete lowers the chest under control and then pushes explosively enough for the hands to leave the ground. This reflects stretch-shortening cycle performance that is important for throwing and striking sports.

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