Shoulder injuries are among the most difficult conditions to manage in Sport Medicine. They vary greatly in severity, mechanism and their impact on performance.
Athletes dealing with shoulder pain often ask:
Why does my shoulder hurt?
What can be done?
When I can play again?
The answers are not always straightforward. Delivering the best possible care requires a deep understanding of: anatomy, biomechanics, careful planning and a personalized approach to each individual case.
In this special edition, we aim to provide a well-rounded blend of surgical and rehabilitation insights that you can draw upon to support your management of these often challenging issues.
With contributions from experts around the world, our aim is to highlight the key factors that shape clinical decision-making: how we navigate treatment pathways, structure rehabilitation, support injury prevention and performance enhancement, incorporate technology and make those all-important decisions.
This special edition begins with our own reflections at Aspetar, sharing how our surgical and rehabilitation teams are evolving their approach to treating shoulder injuries in elite athletes. We hope these contributions help guide your own practice and spark further conversation in this challenging and evolving field.
From my perspective as an orthopedic surgeon, collaborating with such a dynamic and highly skilled interdisciplinary team has been an exceptional opportunity. In young athletes, shoulder instability is commonly encountered with high prevalence that requires a truly individualized approach. At Aspetar, we design customized treatment protocols that incorporate anthropometric evaluation, clinical assessments and the athlete’s unique functional and personal characteristics. These personalized strategies, supported by a collaborative environment, have significantly accelerated recovery timelines and improved return-to-sport outcomes.
In this edition, I had the pleasure to work together with my colleague surgeon Dr Khalid Alkhelaifi to explore the decision-making process behind high-stakes shoulder surgery in “Million-Dollar Shoulders: The Aspetar Approach to Surgical Decision-Making in the Athletic Shoulder”. In another paper, we addressed a critical question frequently encountered in clinical practice: Rotator Cuff at the Crossroads: Repair, Regeneration or Retirement? written in collaboration with Professor Atay.
This issue also brings together a truly global perspective. From Dr Nikolas Garbis' reflections on the breaking points in elite shoulders in the USA, to Prof. Sae Hoon Kim’s in-depth analysis of shoulder instability in Korean athletes, these contributions illustrate the diversity of clinical challenges across sports and regions.
Looking toward the future, Dr. Bruno Gobbato presents fascinating applications of virtual and augmented reality in shoulder surgery. Radiological perspectives from Dr. Marcello and colleagues, alongside Prof. Mahmut Nedim Doral’s reflections on four decades in sports surgery, provide invaluable context and depth to this edition.
The diversity of insights from North America to Asia to Europe not only enriches our understanding but also elevates the standards of our shared practices. Bringing these voices together in one publication reflects the very spirit of international collaboration that drives innovation and excellence in sports medicine.
As the edition transitions into rehabilitation, we’re excited to showcase the outstanding contributions from our colleagues here at Aspetar. We begin by exploring the foundation of our rehabilitation approach: the importance of Motor Control. It’s the first step in helping our post- surgical athletes regain strength and power, and it serves as the backbone for a successful rehabilitation pathway.
Moving forward, we dive into Return to Play, a critical decision in the rehabilitation process. Dr. Edel Fanning and Dr. Margie Olds share their expertise on return-to-play testing for contact and collision athletes, offering valuable insights from both the Northern and Southern hemispheres.
In closing the rehabilitation section, we’re fortunate to benefit from the wealth of experience shared by Dr. Craig Boetcher, Andrew Delbridge, and Britt Calling. Their clinical pearls on managing competitive swimmers with shoulder pain are not only practical but offer evidence-based strategies that can be applied across a variety of sports.
Our colleague Rod Whitely has spearheaded two critical articles. The first broadens our understanding of biomechanical assessment in identifying injury risk factors in elite baseball players, with contributions from practitioners working in Major League Baseball. The second article challenges the conventional view of load management—not just as an injury risk monitoring tool but as a means to enhance performance.
From their experiences of developing the “Shoulder Instability Return to Sport after Injury”, Dr Alexandre Hardy and colleagues in France share their contribution on why psychological factors may be the missing piece of the puzzle when it comes to our return to sport decision-making processes.
Despite all the advancements, we still face a challenge: the lack of high-quality, consistent research to guide our decisions in practice. Many of us draw on experiences from specific athletic populations or from our own training, which often leads to differing views, even when the outcomes we achieve are quite similar. It’s a reminder of how much we still need more targeted, high-quality research to support and align our clinical approaches.
As we continue to evolve, our goal is to not only treat injuries effectively but to anticipate and reduce them, helping athletes stay healthy, perform better, and return stronger. Looking ahead, there’s a growing belief that data should play a much greater role in how we manage injuries. When we bring together clinical expertise with imaging, objective testing, and long-term outcome tracking, we put ourselves in a stronger position to make more informed decisions. This not being limited to treatment decisions, but also in injury prevention and performance optimisation. The integration of artificial intelligence and machine learning into our decision-making processes is no longer a distant concept—it’s already here. The larger and more diverse our data sets become, the greater our potential to strengthen the quality of evidence that underpins our practice.
Moving forward, it’s clear that expanding collaborations and sharing knowledge across disciplines will be key to advancing our field. We need to work together to improve proposed solutions for complex problems. This complexity is why no single research group has found the best way forward which is a challenge that excites us both. With the best way not being clear, we recognise that the real value lies in how we work collaboratively across disciplines to make informed and effective decisions that support each athlete’s recovery and long-term performance.
We hope this edition not only adds to your knowledge but also sparks new thinking and inspiration as you navigate the complexities of managing athletic shoulder injuries.
Gazi Huri, MD
Shoulder and Elbow Orthopaedics Surgeon
Aspetar Sports Orthopaedics Fellowship Programme Coordinator
Aspetar
Matthew Rees, PT
Senior Physiotherapist
Aspetar