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Return to Sport Criteria for Tennis Players: Understanding return to play decision making following an upper extremity injury --What does the evidence say?

In the rehabilitation world, return to sport (RTS) testing is a hot topic.  Athletes are always asking their support team, “When can I start running?”, “When can I go back to practice?”, “When can I start competing again?”.  Fortunately, sport science medicine has progressed immensely in the past decade with the establishment of evidence based criteria and functional testing for return to play decision making, especially following lower extremity injuries and ACL reconstruction.  Functional tests like the Landing Error Scoring System (LESS), Y-Balance Test, and Hop Testing all have validated cutoff scores that are predictive of future injury. There are even a multitude of patient reported outcome measures related to RTS following a lower extremity injury including the IKDC-10, ACL-RSI, KOOS, HAGOS, and more.  Yet, for an overhead athlete or upper extremity injury, there is only one patient reported outcome measure that is specifically related to return to sporting activity, the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Questionnaire (KJOC).  Return to running programs have been researched and validated, as well as return to throwing programs.  Although, when it comes to return to play decision making following an upper extremity injury, there is very little data to support the few “functional tests” described in the literature.  I say “functional” because the available functional tests of the shoulder are in closed chain, plank positions that do not mimic a sports specific movement pattern. There has yet to be a truly functional, open chain, rotational test, or shoulder endurance test created specifically for overhead athletes, such as tennis players.  So how do we manage these athletes and create a successful approach to RTS, particularly, return to tennis following an upper extremity injury?

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