Shoulder RTS Index
A focused reading list for the concepts and tests used in this in-service prototype. Priority is given to consensus guidance, systematic reviews, and clinically relevant measurement studies.
The individual tests below have varying levels of measurement support. The composite 100-point score, sport-specific weighting, readiness bands, and binary dynamic-stability rule remain proposed and are not prospectively validated.
Start here for the larger decision-making philosophy.
Schwank A, Blazey P, Asker M, et al. J Orthop Sports Phys Ther. 2022;52(1):11–28.
Best-practice, principle-based guidance for shoulder injury prevention, rehabilitation, load management, and RTS across sports.
Read on PubMed →Otley T, et al. Arthrosc Sports Med Rehabil. 2022.
Useful clinical framework for combining qualitative assessment, objective performance testing, and graded sport exposure after stabilization procedures.
Open access →Measurement evidence supporting the test battery.
Pontillo M, Bellm E, Barber P, et al. Sports Med Open. 2026;12:13.
Systematic review of upper-extremity functional testing; especially useful for CKCUEST, single-arm shot put, and the limitations of current RTS evidence.
Open access →Ashworth B, Hogben P, Singh N, Tulloch L, Cohen DD. 2018.
Foundational paper establishing strong reliability for long-lever I/Y/T shoulder force testing. Note that this site uses a modified lift-off variation, not the original push-down protocol.
Open access →Ulupınar S, et al. 2025.
Summarizes current validity and reliability evidence for the ASH/AST construct and highlights heterogeneity in protocols and measurement precision.
Open access →Intelangelo L, et al. Sports Health. 2025.
Large overhead-athlete cohort examining isometric strength, rotational ROM, scapular control, and the commonly used ER:IR ratio threshold around 0.75.
Read on PubMed →Important context for interpreting dominant-side ER/IR asymmetry in throwing athletes.
Henry KM, Arnold AJ, Kennedy SM, et al. Int J Sports Phys Ther. 2026;21(2):124–134.
Shows that correcting rotational ROM for relative humeral retrotorsion can substantially change whether apparent IR or ER deficits are identified.
Open article →Vasquez JE, McCauley F-A, Reynolds CM, et al. JSES Int. 2025;10(1):101398.
The article linked in this presentation: HRT-corrected ER deficits were more prevalent than HRT-corrected IR deficits, reinforcing the need to account for osseous adaptation.
Read on PubMed →Kay J, et al. Arthroscopy. 2018;34(4):1308–1318.
Systematic review showing greater dominant-arm humeral retroversion in overhead throwers, commonly accompanied by less IR and more ER.
Read on PubMed →References for performance context and repeated shoulder capacity.
Borms D, Cools A. Int J Sports Med. 2018;39(6):433–441.
Provides reference values for several upper-extremity functional tests, including SMBT, while demonstrating important sex/age/sport effects.
Open DOI →Powell A, Levy E, Heneghan NR, Horsley I. Phys Ther Sport. 2021;49:62–67.
Supports posterior-shoulder endurance as a measurable clinical construct. It informs the rationale for the local Modified Prone T Test, but does not validate the exact 10 + 10 + 10 protocol or its loading.
Read on PubMed →Declève P, et al. Phys Ther Sport. 2021;47:201–207.
Supports shoulder endurance as a distinct, reliable construct in overhead athletes rather than assuming maximal strength represents repeated capacity.
Open article →Moore SD, Uhl TL, Kibler WB. Sports Health. 2013;5(3):233–238.
Uses a loaded prone posterior-shoulder endurance task and supports the clinical rationale for testing repeated T-position capacity.
Read article →Evidence informing the structured sport-movement module. The combined website checklist is proposed; these papers support the feasibility or relevance of specific observational approaches and movement features.
DeFroda SF, Sugimoto D, Staffa SJ, et al. Int J Sports Phys Ther. 2021;16(6):1523–1531.
A 20-item 2D observational pitching tool with excellent total-score interrater reliability (ICC 0.91). Individual-item agreement was more variable, which supports using clearly defined, repeatable observation criteria.
Open access →Pollen TR, Ebaugh D, Mohring J, Hutchinson D, Silfies SP. J Sport Rehabil. 2023;32(2):183–189.
Evaluated seven upper-limb freestyle technique errors in real time. Reliability and live-vs-video validity were moderate for most items, supporting structured poolside observation while highlighting rater variability.
Read on PubMed →Pollen TR, et al. J Athl Train. 2023;58(2):185–194.
In collegiate swimmers, crossover hand entry was associated with higher subsequent injury odds (OR 8.50). The total freestyle-technique score itself was not associated with injury.
Open access →Shih YF, Wang YC. J Athl Train. 2019;54(1):90–98.
Players with shoulder pain demonstrated less scapular posterior tilt and greater GH horizontal abduction and scapular internal rotation at ball contact during cross-body spikes. These are 3D findings; the website translates only clearly observable consequences into qualitative 2D cues.
Open access →McClure P, Tate AR, Kareha S, Irwin D, Zlupko E. J Athl Train. 2009;44(2):160–164.
Standardized definitions of winging and dysrhythmia produced 75–82% agreement with weighted kappa values of 0.48–0.61 in overhead athletes.
Open access →These papers support the clinical concepts and measurement properties of individual components to different degrees. They do not validate this website’s composite score or sport-specific weighting. Those remain hypotheses for future validation.