Proposed clinical decision-support framework

Shoulder Return-to-Sport Index

A sport-weighted framework for shoulder-dominant athletes that combines mobility, strength, power, dynamic stability, and endurance.

Developed for an in-service presentation by Benjamin Blackstone

01

Athlete Profile

02

Sport Weighting

Use the preset or customize the relative importance of each domain. Custom values are normalized to 100% automatically.

Mobility
Strength
Power
Dynamic stability
Endurance
Normalized total: 100%

03

Enter Test Results

Scores are calculated from the proposed rubric below. Use “N/A” by leaving optional tests blank.

How to administer these tests →

Mobility

0–100

Overhead-thrower note: greater dominant-side ER with less IR is commonly expected; interpret total arc and humeral retrotorsion before labeling the shift abnormal. Henry et al., 2026; Vasquez et al., 2025.

Domain score—

Strength

0–100

Modified long-lever test: use the prone lift-off / isometric I-Y-T variation. This is not the original ASH push-down force-plate test.

Evidence anchor: ASH research supports long-lever shoulder force testing, but the lift-off variation should be treated as a standardized local measure rather than borrowing original ASH cutoffs. Ashworth et al., 2018; Ulupınar et al., 2025.

Domain score—

Power

0–100
SMBT scoringRecorded only — excluded from Power score

If no defensible baseline or matched reference exists, record SMBT descriptively and exclude it from scoring. The remaining scored Power test automatically carries the domain.

Evidence anchor: SASP has strong reliability/validity support in current UE RTS literature; SMBT reference values exist, but matching by protocol and population matters. Pontillo et al., 2026; Borms & Cools, 2018.

Domain score—

Dynamic Stability

0 or 100
Scapular neuromuscular control

Standardize qualitative observation

  • Use the same task, load, view, and number of repetitions between raters.
  • Observe elevation and lowering for smooth scapulohumeral rhythm and controlled upward rotation.
  • Note reproducible medial-border/inferior-angle prominence, early shrug, dysrhythmia, or loss of control with repetition.
  • Use light tactile palpation when needed to confirm scapular border motion rather than relying on visual impression alone.
  • Rate not appropriate only when the deviation is clear, repeatable, and clinically meaningful.

This is intentionally a zero-sum clinical judgment domain: appropriate = 100; not appropriate = 0.

Evidence anchor: current shoulder RTS guidance supports combining qualitative movement assessment with objective testing; the binary score itself is proposed. Schwank et al., 2022.

Domain score—

Endurance

0–100
Modified Prone T Endurance Test

Local Prone T protocol

  • Men: 5% body weight in each hand; women: 3% body weight in each hand.
  • Prone with chest supported on a Swiss ball or bench.
  • Complete 10 full T raises → 10 T-raise pulses → 10-second T hold.

The Modified Prone T Test is a locally developed pass/fail endurance screen that combines elements of published posterior-shoulder endurance testing with repeated dynamic loading, short-range pulses, and a terminal isometric hold. The exact 10 + 10 + 10 protocol has not been independently validated.

Evidence anchor: posterior-shoulder endurance testing supports the underlying endurance construct; CKCUEST has stronger published reliability and validity as an upper-extremity performance test. Moore et al., 2013; Powell et al., 2021; Pontillo et al., 2026.

Domain score—

04

RTS Summary

—/100
Enter test data to calculate a score

The composite score is only shown when at least one test is entered in every weighted domain.

Open Test Guide

05

Scoring Notes

What is evidence-supported?

  • Use of objective shoulder strength, ROM, power, stability, and endurance testing.
  • Reliability of long-lever shoulder force testing in I/Y/T positions.
  • CKCUEST and SASP as reliable upper-extremity performance tests.
  • Posterior shoulder endurance testing as a repeatable clinical construct.
  • Published SMBT reference data exist, but comparability depends on population and protocol; unmatched SMBT results are recorded rather than forced into the score.

What is proposed?

  • The 100-point composite score.
  • Sport-specific domain weights.
  • Overall readiness bands and domain gates.
  • The binary dynamic-stability scoring rule.
  • Any use of this score as a reinjury prediction tool.
Core evidence: Bern Consensus 2022 Pontillo 2026 systematic review Henry 2026 humeral retrotorsion More reading →

Important: This is a proposed clinical decision-support framework created for an in-service presentation and has not been prospectively validated. It should complement, not replace, clinical reasoning and graded sport-specific exposure.