Rehabilitation and return to play of the athlete after an upper extremity injury

The takeaway

What are the return-to-play rates and rehabilitation principles for athletes after surgery for common upper extremity injuries including rotator cuff tears, SLAP tears, and shoulder instability?

Return-to-play rates after upper extremity surgery vary widely by injury type, sport, and athletic level. Overhead and throwing athletes consistently have lower return-to-play rates than non-overhead or recreational athletes, and sport-specific staged rehabilitation is essential for safe return to competition.

DescriptiveRead paper

Primary studyLimited evidence

Key points

Overhead throwing athletes face significantly lower return-to-play rates after shoulder surgery compared to recreational or non-overhead athletes
After rotator cuff repair, professional baseball pitchers return only 8-33% of the time, while recreational athletes return at rates of 85-100%
After SLAP repair, only 40-41% of baseball pitchers return to prior level, versus 74-88% of mixed or non-throwing athletes
Shoulder instability surgery yields more favorable results: 90.9-95% RTP after Bankart repair in collision and martial arts athletes
Rehabilitation progresses through four structured phases - acute, intermediate, advanced strengthening, and return to activity - with criteria-based advancement

How it was conducted

Design: Narrative review article
Topics covered: Rotator cuff tears, SLAP tears, anterior and posterior shoulder instability, and elbow UCL tears
Population: Overhead and throwing athletes at professional, collegiate, and recreational levels
Primary focus: Postoperative rehabilitation protocols and return-to-play rates after surgical intervention
Data sources: Multiple referenced studies and systematic reviews cited throughout

What they found

Rotator cuff repair in professional baseball players: only 33.3% returned to play (Erickson et al.); only 8% returned to competitive level after mini-open repair on professional pitchers
Rotator cuff repair in middle-aged and elderly swimmers: 97% returned to swimming at a mean of several months after surgery (Shimada et al.)
Rotator cuff repair in CrossFit athletes: 100% returned to training after a mean of 8.7 months
Rotator cuff repair in recreational athletes: 88% returned to sports activity at a similar level
Rotator cuff repair in athletes younger than a specified age: 85% RTP at a mean of 5.8 months after surgery
Rotator cuff repair in adolescent athletes (mean age not fully legible): 93% returned to same level or higher, though 64% of baseball/softball players had to switch positions
Partial rotator cuff tear repair (Rossi et al.): 87% (61/72) returned to sports, 80% at same level; overhead athletes took mean 6.4 months vs 3.6 months for non-overhead athletes
Meta-analysis of rotator cuff repair (Klouche et al., studies and patients not fully legible): overall RTP 84.7%, 65.9% returning to pre-injury level
SLAP repair in baseball pitchers (Gilliam et al.): only 41% felt able to return to same or better level; 73% of pitchers unable to return attributed it to the surgery
SLAP repair in major and minor league baseball pitchers: only 40% able to RTP, 22% returning to prior performance
SLAP repair in mixed professional athletes (volleyball, football, basketball, tennis): 88% (30/34) returned to pre-injury level at mean 6.4 months
SLAP repair across all athletic levels (Brockmeier et al.): 74% returned to pre-injury level of competition
Biceps tenodesis vs SLAP repair in patients younger than a specified age: similar RTP overall (76% tenodesis vs 85% repair), similar time to RTP (8.8 vs 9.4 months), similar overhead athlete RTP (84% tenodesis vs 83% repair)
Biceps tenodesis systematic review for overhead athletes: overall RTP 70%, ASES scores 81.7-97, athlete satisfaction 80-87%
Arthroscopic Bankart repair in collision athletes: 90.9% RTP
Arthroscopic Bankart repair in martial arts athletes: 95% RTP at mean 6.4 months
Arthroscopic posterior capsulolabral repair in American football players: 93% returned to play
Posterior shoulder stabilization systematic review: overall RTP range 62.7% to 100%

Limitations

The text is a narrative review without systematic literature search or quality assessment, limiting the strength of pooled conclusions
Many cited studies have heterogeneous designs, small samples, and varying definitions of return to play, making direct comparison unreliable
Specific numbers for some cited studies were not recoverable from the OCR text, including exact sample sizes for several key studies
The elbow UCL section and the conclusion were missing or truncated in the available text, leaving that portion of the review unassessed

Why it matters

For patients: Athletes considering shoulder surgery can expect highly variable return-to-play outcomes depending on their sport, position, and injury severity, with overhead throwers facing the toughest prognosis.
For clinicians: Rehabilitation after upper extremity surgery should follow criteria-based phase progression restoring ROM, strength, proprioception, and neuromuscular control before sport-specific loading, with RTP expectations tailored to injury type and athletic demand.
For readers: This review consolidates rehabilitation principles and outcome data across the most common surgically treated shoulder injuries, providing a practical framework for setting expectations and structuring postoperative care.

Source

doi:10.1016/j.asmr.2021.09.033

Read the original paper