Top Upper Extremity Return-to-Sport Tests

Return to sport (RTS) after an upper extremity injury shouldn’t be based on time alone — and it definitely shouldn’t stop at “it doesn’t hurt anymore.”

For athletes, especially those who lift, throw, grapple, strike, or collide, the shoulder, elbow, and wrist must demonstrate strength, stability, and power under load.

Below are some of the most useful upper extremity RTS tests we use in physical therapy to determine whether an athlete is truly prepared to return to training and competition.

1. Isometric Strength Testing

What it assesses: Maximal and side-to-side strength capacity

Rather than arbitrary resistance band exercises or "push into my hand so I can feel how strong you are," RTS should include quantified strength testing of key muscle groups:

• Shoulder internal and external rotation

• Shoulder abduction and adduction

• Elbow flexion/extension

• Grip strength (often overlooked, especially for throwing and combat athletes)

  
  

What we’re looking for:

• ≥90–95% limb symmetry (sport-dependent)

• Appropriate agonist/antagonist ratios (e.g., ER:IR for throwers)

• No pain or compensatory movement patterns under high effort

👉 Strength deficits often persist long after pain resolves — especially in overhead athletes.

2. Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST)

What it assesses: Shoulder girdle stability, force transfer, and fatigue tolerance. In a plank position, the athlete alternates touching each hand as many times as possible within a set time frame.

Why it matters for athletes:

• Mimics force transfer through the arm into the trunk

• Challenges scapular control under bodyweight load

• Highlights side-to-side asymmetry and endurance limitations

  
  

Benchmarks:

• Symmetry between sides

• Ability to maintain trunk and scapular control without “dumping” into the shoulder

• Scores adjusted based on sex, sport, and position

  
  

This test is particularly valuable for contact athletes, grapplers, and linemen, where closed-chain force acceptance is critical.

3. Upper Quarter Y-Balance Test

What it assesses: Dynamic stability, reach control, and shoulder endurance

The Upper Quarter Y-Balance test challenges an athlete’s ability to stabilize one arm while reaching in multiple directions with the other.

Why it matters:

• Exposes deficits in shoulder stability and trunk control

• Correlates well with injury risk and performance readiness

• Requires strength and motor control, not just brute force

  
  

Key considerations:

• Limb symmetry index

• Quality of movement (no trunk rotation, elbow collapse, or scapular winging)

• Fatigue effects across multiple trials

  
  

This is a great bridge between early strength testing and more explosive RTS tasks.

4. Medicine Ball Power Tests

What they assess: Explosive strength and force production

Upper extremity injuries often rob athletes of power, not just strength. Medicine ball testing allows us to measure whether that power has returned.

Common variations:

• Seated chest pass

• Rotational scoop toss

• Overhead throw (sport-specific)

  
  

What we’re looking for:

• Distance or velocity symmetry

• Efficient sequencing from trunk to arm

• No apprehension or “guarding” during explosive effort

  
  

These tests are especially valuable for throwing athletes, rotational sport athletes, and lifters returning to Olympic-style movements.

5. Sport-Specific Capacity Testing

What it assesses: Readiness under real-world demands

Ultimately, RTS testing must resemble the sport itself.

Examples:

• Repeated heavy carries or presses for strength athletes

• High-rep striking or grip fatigue drills for combat athletes

• Reactive catching or reaching for field sport athletes

  
  

This is where we move from clinical readiness to performance readiness.

Baseball-Specific Return-to-Sport Considerations ⚾

Throwing athletes deserve special attention due to the extreme forces involved.

Key RTS Metrics for Baseball Players:

• Shoulder ER strength and total rotational strength symmetry

• ER:IR strength ratios appropriate for throwing demands

• Grip strength endurance

• Medicine ball rotational power (not just straight-line throws)

  
  

Functional Throwing Readiness:

• Ability to tolerate progressive long toss programs

• No loss of velocity or accuracy with fatigue

• No next-day soreness that alters mechanics

  
  

Importantly, a pitcher can “feel fine” but still lack the rotational power or deceleration capacity required to safely throw at full intensity.

Final Thoughts

Strength, stability, and power testing gives us objective answers and help athletes return with confidence rather than hesitation.

If you’re an athlete coming back from an upper extremity injury, or a coach looking to protect your players long-term, RTS testing should be a process, not an afterthought.