Throwing Programs and Return to Sport


Return to a throwing sport after elbow or shoulder injury can be a daunting task. Return to play rates after ulnar collateral ligament reconstruction have been favorable but lower than once thought ( ). Many studies show a high return rate to major league baseball, but return to similar performance and workload is not as high ( ). Return to throwing after surgical treatment for superior labral lesions is even more debilitating and sometimes unattainable ( ).

When helping guide patients back to throwing activities, a criteria-based algorithm should be followed that encompasses all aspects of the throwing motion and accounts for the physical characteristics of the athlete.

Phase 1

Progression Criteria

  • 0/10 pain Numeric Rating Pain Score (NRPS)

  • No joint swelling

  • Normalized range of motion (ROM)

    • Shoulder external rotation + internal rotation (total rotational motion)

      • 176 to 180 degrees ( ): within 5 degrees of uninvolved side

    • Shoulder horizontal adduction

      • 42 to 44 degrees ( )

    • Elbow ROM

      • 4 to 6 degrees lack of extension is within normal for throwing athletes ( )

  • Normalized strength

    • 5/5 strength of rotator cuff

    • 4/5 or > mid trap, low traps, and rhomboids

Phase 2

Progression Criteria

Isokinetic Shoulder Testing

  • 65% external rotation (ER)/internal rotation (IR) ratio at 180 degrees/sec, 61% ER/IR ratio at 300 degrees /sec ( )

  • 85% shoulder symmetry at both 180 and 300 degrees/sec

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