UNDERSTANDING SHOULDER INJURIES IN ELITE ATHLETES
– Written by Samuel Mircoff, Nickolas Garbis, United States of America
INTRODUCTION
Shoulder injuries are a significant concern in professional sports. With a wide range of pathologies resulting in impaired performance, threatened longevity, and considerable recovery demand, injuries to the shoulder can have a substantial impact on an athlete’s career1. These injuries pose particular challenges to the orthopedic surgeon, as presentations are often vague, diagnostic exams are commonly misleading, and treatment options are not always as reliable as we’d like2. A clear understanding of underlying anatomy and biomechanics is essential for orthopedic surgeons to appropriately diagnose and treat shoulder injuries so that athletes can return to their sport with minimal burden.
While common causes for shoulder pain in the professional athlete are mechanical in nature, with overuse resulting in tendinopathies, ligamentous tears, and neurovascular injury, athletes might also endure acute trauma, resulting in instability and fracture that cannot be ignored2,3. This review will explore (1) anatomical and biomechanical principles relevant to shoulder function in athletes, (2) risk factors that might contribute to injury, and (3) common shoulder pathologies seen in professional athletes, with considerations for treatment and recovery.
ANATOMY & BIOMECHANICS
The shoulder is a complex joint consisting of four articulations - the glenohumeral, acromioclavicular, sternoclavicular, and scapulothoracic joints - with a plethora of surrounding soft tissues which work in concert to generate extreme functional mobility seen nowhere else in the body3 (Figure 1). The spheroidal glenohumeral joint is shallow and relies on both static and dynamic stabilizers to confer stability4. The glenoid has been described as a pear-shaped golf tee that is notably mismatched in size to the humeral head. With only 30% maximum contact between articular surfaces, even small defects in bony architecture can disrupt joint stability despite constraining soft tissues.
The glenoid labrum is a fibrocartilaginous sleeve that deepens the socket by up to 50%, and works with the glenohumeral ligaments to prevent translation of the humeral head. The inferior glenohumeral ligament is most commonly injured and consists of anterior and posterior bands that resist anterior-inferior translation in abduction and external rotation, and posterior translation in flexion and internal rotation, respectively. The superior glenohumeral ligament, along with the coracohumeral ligament, resists inferior translation in the adducted arm. The long head of the biceps tendon fuses superiorly with the labrum and acts as a humeral head depressor, and has also been shown to prevent anterior-posterior translation4.
The rotator cuff muscles provide dynamic stability, compressing the humeral head into the glenoid to maintain joint centricity while participating in active constraint during force-coupled motion. The supraspinatus and infraspinatus insert on the greater tuberosity, positioning the two to block posterior-superior translation while contributing to abduction and external rotation. The teres minor also provides posterior constraint and aids in external rotation. The subscapularis inserts anteriorly, allowing it to resist anterior-inferior translation while assisting with internal rotation. Glenohumeral range of motion depends on scapulothoracic cooperation, with the two typically participating in a 2:1 ratio known as the scapulohumeral rhythm. Strength imbalances in the periscapular musculature, particularly the serratus anterior and trapezius muscles, can disrupt shoulder kinematics and predispose glenohumeral injury, especially in the overhead athlete4.
The biomechanical demands of overhead throwing place extraordinary stress on the shoulder2,3, requiring a delicate balance of both mobility and stability referred to as the “thrower’s paradox.” The throwing motion is well documented (Figure 2), with critical phases testing the shoulder’s functional limits, especially at the professional level. During the transition from late cocking to acceleration, external rotation can reach up to 165°-175°, far exceeding the normal range of motion in non-athletes and generating enough torque to enable extreme internal rotation velocities up to 7000° per second5. In professional athletes, the resulting distraction forces during this phase have been recorded to reach 108% of body weight, which is substantially greater than the 81% observed in collegiate players, putting heightened strain on soft tissue stabilizers to maintain joint integrity. The deceleration phase additionally puts particular stress on the deltoid and rotator cuff, as they eccentrically contract to counteract these forces to safely slow the arm. Both bony and muscular adaptations have been reported among overhead athletes, though it isn’t known whether these contribute or protect from injury.
COMMON CONDITIONS
While injury prevalence varies widely by sport, those involved in overhead activities and those exposed to contact and collisions are at significant risk. It is important to recognize the unique risk factors as well as common mechanisms of injury across domains of sport in order to accurately identify shoulder injuries in professional players. Athletic injuries can be broadly categorized into two groups: overuse and direct trauma. In the following sections, we will first outline the known risk factors among each group, followed by an overview of common injuries seen within each.
Overuse Injuries
The unique demands of overhead athletes put extreme stress on the shoulder, making overuse a primary offender of tendinopathies and ligamentous wear within this population. It has been reported that 18-90% of overhead athletes experience some form of pain or injury, with incidence increasing by level of competition5. A systematic review by Salamh et al. identified both modifiable and non-modifiable risk factors of athletic shoulder injuries, with training load, range of motion, and strength imbalance being key modifiable risk factors5. At the elite level, athletes required to train 5-6 days a week, sometimes even twice a day, are at elevated risk for overuse injuries. Deficiencies in external rotation range of motion, as well as imbalance between internal-external rotation strength, have both been linked to increased risk of shoulder injury and surgery6. Prior histories of shoulder pain or injury are non-modifiable risk factors that should be additionally considered in this population. Though baseball players have been extensively studied as the prototypical overhead athlete, these principles apply broadly across overhead sports such as volleyball, handball, water polo, cricket, swimming, and tennis1.
Rotator Cuff Tears
Description
Rotator cuff pathology comprises a broad spectrum of conditions including tendinopathy, partial-thickness tears, and more rarely, full-thickness tears of one or more of the rotator cuff muscles. In the throwing athlete, the posterior half of the supraspinatus is most commonly affected followed by the anterosuperior half of the infraspinatus2. The physical demands of throwing results in the accumulation of microtrauma as the cuff endures repetitive strain, extreme angular velocities, and remarkable distraction forces3. Throwers typically report pain with overhead activity during the late cocking phase, and in some cases, will experience night pain with radiation into the elbow or hand. Diagnosis can be a major challenge, as many provocative maneuvers are better at detecting full-thickness than partial-thickness tears, and concomitant injury is also common. MRI and ultrasonography are particularly useful in characterizing tear extent, and assessing repair integrity following treatment2.
Treatment
Initial management is nonoperative, emphasizing rest and physical therapy focused on range of motion, rotator cuff, and periscapular strengthening. NSAIDs and corticosteroid injections can be useful for symptomatic relief, but can impede postoperative healing3. Surgical intervention is only considered in athletes with persistent symptoms, or those with full-thickness tears and significant functional deficit7. In partial thickness tears, arthroscopic debridement is the surgical treatment of choice while direct repair is reserved for full-thickness tears.
Recovery
For the nonoperative athlete, targeted physical therapy can achieve meaningful symptomatic improvement within 3-6 months, at which point players can return to activity. Depending on the extent of injury, the in-sport athlete should focus on activity modification and targeted exercises to maintain participation7. Unfortunately, prognosis is poor if nonoperative treatment fails, as only 33-50% of operative players return to their prior level of competition with lower rates for full-thickness repairs compared to arthroscopic debridement8. The typical recovery timeline is 8-10 months, and precautions should be made to avoid rapid activity progression, stiffness, or reinjury.
SLAP Tears & LHB Tendinopathy
Description
Due to the constellation of vulnerable positioning, repetitive torsional force, and poor vascularity, the superior labrum and long head of the biceps tendon (LHB) are susceptible to injury in the overhead athlete. Extreme external rotation during the late cocking phase causes posterosuperior migration of the humeral head, putting heightened torque on the superior labrum from the LHB tendon where almost half of its footprint originates. In combination with posterior capsule contracture and glenohumeral internal rotation deficit (GIRD), the humeral head shifts posterosuperiorly resulting in a peel-back mechanism that causes a superior labral anterior to posterior (SLAP) tear9. Type II SLAP tears (Figure 3) are most commonly seen, and athletes often present with functional shoulder pain, reports of catching or popping, and loss of throwing velocity2,3.
As with rotator cuff tears, there is no single physical exam maneuver that reliably detects SLAP tears, though the active compression (O’Brien) test is commonly used2. Concomitant LHB pathology can further complicate diagnosis without advanced imaging. MRA is more sensitive to labral pathology than MRI, and diagnostic arthroscopy is the standard for definitive diagnosis following failed nonoperative therapy2,9.
Treatment
The best treatment for SLAP lesions remains controversial. As with other overuse injuries, the initial treatment is nonoperative with a focus on rest, frequent icing, NSAIDs, and addressing any underlying mechanical causes. Targeted rehabilitation to address GIRD, posterior capsular contracture, and scapular imbalances should be the primary focus. When therapy proves unsuccessful after 3 months, arthroscopic repair is recommended for tears greater than grade I with biceps tenotomy or tenodesis to address concomitant LHB pathology9. There is no clear consensus on the ideal treatment of LHB in professional athletes, though tenodesis may be preferred.
Recovery
The nonoperative athlete with a SLAP tear is usually allowed to complete the season under strict symptomatic monitoring. However, significant postoperative precautions are imperative to protect the integrity of the repair. Overhead activity is restricted for 6-12 weeks to avoid “peel back” and torsional stress on the repair. Full return to unrestricted throwing typically doesn’t occur for 8-9 months postoperatively. Unfortunately, though clinical results are generally good following surgical repair, return-to-sport in overhead athletes is reported around 60%, and return to pre-injury level of competition is less consistent9.
Scapular Dyskinesis
Description
Scapular asymmetry is often seen in overhead athletes, with bilateral differences noted in scapulothoracic range of motion. This condition is seen in the dominant shoulder with inferior positioning of the arm, a protracted scapula, and better developed musculature2. It is thought that a tight posterior capsule can lead to inferior positioning and decreased clearance of the supraspinatus through the coracoacromial arch, leading to impingement-type symptoms3. Diagnosis is clinical and relies on careful comparison of the bilateral scapulae through active range of motion in flexion, abduction, and external rotation. The constellation of scapular malpositioning, inferior medial border prominence, coracoid pain and malposition, and kinetic abnormalities are commonly referred to as SICK scapula syndrome2.
Treatment
There are discrepant reports whether scapular dyskinesis is a primary pathology or a secondary consequence of throwing mechanics. Regardless, rehabilitation is effective in relieving symptoms2,10. Therapy focuses on restoring coordination of periscapular musculature and restoring normal biomechanics of the scapulohumeral rhythm. Surgical therapy is rarely indicated and is reserved only for cases with structural lesions causing nerve injury or snapping scapula10.
Recovery
Fortunately, prognosis is generally good, and a majority of athletes experience symptomatic and functional improvement in 6-12 weeks10. While complete resolution may take several months, most in-season athletes are able to maintain participation while undergoing targeted therapy and activity modification. Ongoing monitoring is recommended, as recurrence is possible if underlying kinetic or technique deficits are not addressed.
Traumatic Injuries
Contact and collision sports such as rugby, football, American football, hockey, wrestling, cycling, and gymnastics can expose athletes to acute shoulder trauma following a fall or direct blow. Arm position matters, as impact subjects already taut stabilizers to harmful impulse forces, heightening risk for tear and instability11. An adducted and internally rotated arm is acutely susceptible to posterior injury, and a blow to the abducted and externally rotated arm makes the anterior tissues particularly vulnerable. Direct trauma to the apex of the shoulder imposes extreme forces to the acromion and clavicle, posing risk for bony injury12. A systematic review by Wright et al. identified several key risks associated with collision injuries among athletes, with male sex, increased glenoid height-to-width ratio, and prior injury being notable non-modifiable risk factors for injury and recurrence11. Interestingly, modifiable factors including strength, range-of-motion, and joint laxity were not found to be significant.
Shoulder Instability
Description
The shoulder is the most dislocated joint in the body13; however not all instability events result in frank dislocation. Rather, subluxation and incomplete dislocations comprise a large majority of traumatic events, making instability of heightened concern in at-risk professional athletes. Up to 95% of instability cases are anterior, which can result in various soft-tissue injuries of the anterior inferior glenohumeral joint3. Compromise of the anteroinferior labrum, known as a soft-tissue Bankart, is common, as are lesions resulting from glenolabral articular disruption (GLAD), and humeral or glenoid avulsion of the glenohumeral ligament (HAGL or GAGL, respectively)13. Bony injury can also occur either due to acute impaction from dislocation events or chronic erosion from recurrent instability14. Posterior humeral head impaction, referred to as Hill-Sachs lesions, is more common than anteroinferior glenoid fracture, known as bony Bankart lesions (Figure 4)13. Posterior dislocations comprise only 5-10% of shoulder instability and are almost always associated with posterior labral compromise13.
Frankly dislocated shoulders should be manually reduced as soon as possible, followed by post-reduction radiographs to confirm joint congruency and to assess associated injury3. In lieu of complete dislocation, provocative maneuvers including apprehension, relocation, and load-and-shift tests can be useful in detecting joint laxity as compared to the contralateral side2. Advanced imaging with MRI and CT is essential to detect labral and osseous injury, respectively, as these findings have major implications for treatment.
Treatment
Initial treatment of first-time instability for in-season athletes remains controversial, but is largely non-operative with brief immobilization and early rehabilitation. In the absence of major glenohumeral injury, therapy focused on regaining motion, strengthening the rotator cuff, and stabilizing the scapula has reported positive outcomes in helping players return to sport without pain or apprehension14. However, with significant injury to the joint, surgical intervention is typically necessary to minimize recurrence. Surgery can usually be delayed until off-season; however, evidence increasingly supports immediate repair in the young and athletic population3. Arthroscopic labral repair is preferred for athletes with Bankart lesions and minimal bone loss. Adjunctive procedures such as remplissage and bone blocking (Latarjet) are indicated after a loss of 20% bony architecture, as soft-tissue stabilizers can no longer compensate beyond this threshold14.
Recovery
In the non-operative athlete, regimented therapy often allows return to play in 2-6 weeks, but recurrence rates are high14. Operative athletes are usually withheld from sport for 4-6 months with strict postoperative precautions. Unfortunately, surgical outcomes vary by procedure and typically lead to lower return-to-play rates and performance decline14, with 80% of players returning to pre-injury level of competition after capsulolabral repair and remplissage, and only 75% after Latarjet.
AC Separation
Description
Injuries to the acromioclavicular (AC) joint account for nearly 10% of all shoulder injuries, spanning from minor sprains to severe displacement15. Injuries commonly result from direct trauma to the adducted arm, or a fall on the outstretched hand driving the humeral head into the acromion. Athletes will typically have point tenderness over the joint and exacerbated pain with shoulder elevation and provocative maneuvers3. The Rockwood classification categorizes AC injuries based on sequential disruption of the AC and coracoclavicular (CC) ligament and subsequent displacement of the joint (Figure 5). It’s crucial to identify the extent of injury with adequate radiographs as treatment depends on appropriately identifying the classification of injury15.
Treatment
Types I and II injuries are treated conservatively with non-operative management including brief immobilization and progressive rehabilitation following resolution of pain. In high-performance athletes, direct injection of long-acting anesthetic can be considered to expedite symptomatic improvement15. Types IV through VI injuries are treated operatively and various techniques have been described. Though there is little consensus on technique, surgical objectives aim to restore anatomic alignment of the AC joint and to repair or reconstruct the CC ligaments (Figure 6). Treatment of Type III injuries falls in uncertain territory, and surgical intervention is typically avoided until 3-6 months of failed conservative treatment15.
Recovery
Players with low-grade AC injuries can typically return to sport after 2-3 weeks once they are no longer symptomatic. Off-season athletes can undergo a more gradual progression of activity focusing on painless range of motion and strengthening exercises. Operative repair largely depends on the chosen procedure; however, full return to peak strength may take up to 9-12 months15. In the meantime, players are usually able to engage in strengthening exercise and full contact-activity by 3 and 6 months, respectively.
Clavicular Fracture
Description
Direct contact to the clavicle is much more likely to result in clavicular fracture than AC separation, as the clavicle is susceptible to fracture at only one-sixth3 the forces necessary to disrupt the joint. Clavicular fractures are the most prevalent fracture among athletes, contributing close to 10% of all sports-related fractures16. More broadly, it has been reported that up to 50% of all clavicular fractures are attributed to sports participation16. With such remarkable prevalence, these injuries demand recognition and awareness of appropriate management.
Several classification systems have been proposed that describe patterns of clavicular injury based on location and prevalence16. Nuances and subclassifications differentiate the Allman, Neer, and Robinson systems; however, Type 1 injury generally involves the middle third of the clavicle, representing 80% of fractures, and Types 2 and 3 involve the distal and medial ends, representing 15% and 5%, respectively (Figure 7). Upright radiographs are useful in revealing fracture displacement which might not be apparent on gross examination16. A careful investigation of neurovascular injury, particularly with Type 1 and 3 fractures, is imperative given the close proximity of the brachial plexus and subclavian artery3.
Treatment
As with other traumatic pathologies described, management typically depends on the classification and severity of injury. In the non-athlete, nonoperative management with immobilization in a figure-8 split has been reportedly successful in minimally displaced fractures3. However, the activity requirements of professional athletes put them in their own category of treatment consideration. Surgical fixation is generally recommended in this population, and has shown higher rates of radiographic union in both Type 1 and 2 fractures, making it a more reliable and expeditious option than conservative treatment16.
Recovery
Even with early surgical intervention, recovery rates after clavicular fracture vary depending on both injury severity and activity demand. Depending on pain, the non-contact athlete can sometimes return to activity in as soon as 3 weeks. In the contact athlete, stringent postoperative precautions should be taken until clinical and radiographic healing is confirmed, typically around 6-8 weeks. Despite generally reliable return to sport rates, unfortunately only 80% of athletes tend to return to their pre-injury level of competition16.
PREVENTION STRATEGIES
Given the apparent challenges and consequences of shoulder injury among athletes, perhaps the greatest intervention for career longevity is prevention. Several prevention programs have demonstrated effectiveness in mitigating the occurrence of shoulder injuries, particularly in athletes17,18. These programs, including the FIFA 11+ injury prevention program19, the Oslo Sports Trauma Center (OSTRC) shoulder injury prevention program20, as well as sport-specific functional training and strengthening programs each incorporate strategies to address risk factors associated with shoulder injuries17.
The FIFA 11+ program (Figure 8), designed specifically for soccer goalkeepers, has shown an almost 70% reduction in overall upper extremity when routinely implemented before training sessions19. The OSTRC program similarly resulted in nearly 30% reduction in the odds of shoulder injuries among professional handball players when performed during warm-ups over a seven-month timeframe20. Functional training programs have also shown favorable results with decreased pain in swimmers, lower injury rates in baseball players, and even enhanced performance in overhead athletes1,17. Clearly, implementing strategies like these at the team-wide level can significantly lessen the burden of the shoulder injuries described in this review.
CONCLUSIONS
Shoulder injuries in professional athletes are complex and pose significant challenges due to the joint’s intricate anatomy, biomechanical demands of professional sports, and vast spectrum of pathologies encountered. Pathologies are broadly categorized into overuse injuries including rotator cuff disease, SLAP and LHB tears, and scapular dyskinesis, and traumatic injury including instability, AC separation, and clavicular fracture. Given the considerable recovery demand, career disruption, and lifestyle burden, a thorough understanding of the detection and management of these conditions is crucial to the high-performance population. Ultimately, injury prevention plays a pivotal role in preserving athletic performance in the highest levels of competition.
Samuel Mircoff BS
Orthopaedic Research Fellow
Shoulder & Elbow Surgery
Nickolas Garbis MD
Chief, Shoulder & Elbow Division
Associate Professor of Orthopaedic Surgery
Department of Orthopaedic Surgery and Rehabilitation
Loyola University Medical Center
Maywood, IL, USA
Contact: samuel.mircoff@luhs.org
References
1. Schwank A, Blazey P, Asker M, Møller M, Hägglund M, Gard S, Skazalski C, Haugsbø Andersson S, Horsley I, Whiteley R, Cools AM, Bizzini M, Ardern CL. 2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels. J Orthop Sports Phys Ther. 2022 Jan;52(1):11-28. doi: 10.2519/jospt.2022.10952. PMID: 34972489.
2. Garbis NG, McFarland EG. Understanding and evaluating shoulder pain in the throwing athlete. Phys Med Rehabil Clin N Am. 2014 Nov;25(4):735-61. doi: 10.1016/j.pmr.2014.06.009. Epub 2014 Aug 22. PMID: 25442157.
3. Hudson VJ. Evaluation, diagnosis, and treatment of shoulder injuries in athletes. Clin Sports Med. 2010 Jan;29(1):19-32, table of contents. doi: 10.1016/j.csm.2009.09.003. PMID: 19945585.
4. Lugo R, Kung P, Ma CB. Shoulder biomechanics. Eur J Radiol. 2008 Oct;68(1):16-24. doi: 10.1016/j.ejrad.2008.02.051. Epub 2008 Jun 3. PMID: 18511227.
a. Shoulder Biomechanics: https://pubmed.ncbi.nlm.nih.gov/18511227/
5. Salamh P, Bullock G, Chester R, Daniell H, Cook C, DeLang M, Tucker HR, Walker D, Lewis J. Risk Factors Associated with New Onset of Shoulder Pain and Injury Among the Athletic Population: A Systematic Review of the Literature. Int J Sports Phys Ther. 2025 Mar 1;20(3):315-332. doi: 10.26603/001c.129462. PMID: 40041538; PMCID: PMC11872537.
6. Intelangelo L, Lassaga I, Gonzalo E, Mendoza C, Manuel Ormazabal J, Roulet I, Bevacqua N, Jerez-Mayorga D. Is Strength the Main Risk Factor of Overuse Shoulder Injuries? A Cohort Study of 296 Amateur Overhead Athletes. Sports Health. 2024 Dec 23:19417381241298287. doi: 10.1177/19417381241298287. Epub ahead of print. PMID: 39711152; PMCID: PMC11664554.
7. Reinholz AK, Till SE, Arguello AM, Barlow JD, Okoroha KR, Camp CL. Advances in the Treatment of Rotator Cuff Tears: Management of Rotator Cuff Tears in the Athlete. Clin Sports Med. 2023 Jan;42(1):69-79. doi: 10.1016/j.csm.2022.08.003. PMID: 36375871; PMCID: PMC10009818.
8. Erickson BJ, Chalmers PN, D'Angelo J, Ma K, Romeo AA. Performance and return to sport following rotator cuff surgery in professional baseball players. J Shoulder Elbow Surg. 2019 Dec;28(12):2326-2333. doi: 10.1016/j.jse.2019.01.029. Epub 2019 Jul 13. PMID: 31311750.
9. LeVasseur MR, Mancini MR, Hawthorne BC, Romeo AA, Calvo E, Mazzocca AD. SLAP tears and return to sport and work: current concepts. J ISAKOS. 2021 Jul;6(4):204-211. doi: 10.1136/jisakos-2020-000537. Epub 2021 Mar 11. PMID: 34272296.
10. Cools AM, Struyf F, De Mey K, Maenhout A, Castelein B, Cagnie B. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med. 2014 Apr;48(8):692-7. doi: 10.1136/bjsports-2013-092148. Epub 2013 May 18. PMID: 23687006.
11. Wright A, Ness B, Spontelli-Gisselman A, Gosselin D, Cleland J, Wassinger C. Risk Factors Associated with First Time and Recurrent Shoulder Instability: A Systematic Review. Int J Sports Phys Ther. 2024 May 1;19(5):522-534. doi: 10.26603/001c.116278. PMID: 38707855; PMCID: PMC11065770.
12. Twomey-Kozak J, Whitlock KG, O'Donnell JA, Klifto CS, Anakwenze O. Epidemiology of Sports-Related Clavicle Fractures in the United States: Injuries From 2015 to 2019. Orthop J Sports Med. 2022 Oct 20;10(10):23259671221126553. doi: 10.1177/23259671221126553. PMID: 36313007; PMCID: PMC9597028.
13. Ladd LM, Crews M, Maertz NA. Glenohumeral Joint Instability: A Review of Anatomy, Clinical Presentation, and Imaging. Clin Sports Med. 2021 Oct;40(4):585-599. doi: 10.1016/j.csm.2021.05.001. PMID: 34509200.
14. Glover MA, Fiegen AP, Bullock GS, Nicholson KF, Trasolini NA, Waterman BR. Management of Shoulder Instability in the Overhead Athletes. Clin Sports Med. 2024 Oct;43(4):683-703. doi: 10.1016/j.csm.2024.03.024. Epub 2024 May 3. PMID: 39232574.
15. Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med. 2007 Feb;35(2):316-29. doi: 10.1177/0363546506298022. PMID: 17251175.
16. Gobbell W, Edwards CM, Engel SR, Coyner KJ. Getting Athletes Back on the Field: Management of Clavicle Fractures and Return to Play. Clin Sports Med. 2023 Oct;42(4):649-661. doi: 10.1016/j.csm.2023.05.006. PMID: 37716728.
17. Liaghat B, Pedersen JR, Husted RS, Pedersen LL, Thorborg K, Juhl CB. Diagnosis, prevention and treatment of common shoulder injuries in sport: grading the evidence - a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). Br J Sports Med. 2023 Apr;57(7):408-416. doi: 10.1136/bjsports-2022-105674. Epub 2022 Oct 19. PMID: 36261251; PMCID: PMC10086287.
18. Hadjisavvas S. Shoulder Injury Prevention Exercise Programs in Overhead Athletes: A Brief Review. J Phys Ther Rehabil. 2024 May;1(1):1002
19. Al Attar WSA, Faude O, Bizzini M, Alarifi S, Alzahrani H, Almalki RS, Banjar RG, Sanders RH. The FIFA 11+ Shoulder Injury Prevention Program Was Effective in Reducing Upper Extremity Injuries Among Soccer Goalkeepers: A Randomized Controlled Trial. Am J Sports Med. 2021 Jul;49(9):2293-2300. doi: 10.1177/03635465211021828. Epub 2021 Jun 17. PMID: 34138672.
20. Andersson SH, Bahr R, Clarsen B, Myklebust G. Preventing overuse shoulder injuries among throwing athletes: a cluster-randomised controlled trial in 660 elite handball players. Br J Sports Med. 2017 Jul;51(14):1073-1080. doi: 10.1136/bjsports-2016-096226. Epub 2016 Jun 16. PMID: 27313171.
21. Zhou L, Raybin SG, Bottoni CR. The athlete’s shoulder. Aspetar Sports Med J [Internet]. 2016 May; 5(1). Available from: https://journal.aspetar.com/en/archive/volume-5-issue-1/the-athletes-shoulder
22. Bahr R, Hassanmirzaei B, Tabben M, Chaabane M, Chebbi S, Nader R, et al. Injury prevention in football. Aspetar Sports Med J [Internet]. 2012 Nov; 12(Targeted topic—Sports Medicine in Padel). Available from: https://journal.aspetar.com/en/archive/volume-12-targeted-topic-sports-medicine-in-padel/injury-prevention-in-football#.ZCFNihVBwqs
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