Skip to main content

Evaluation of the Shoulder and Elbow in the Elite Tennis Player

  • Chapter
  • First Online:

Abstract

The evaluation of the shoulder and elbow in the elite tennis player is of extreme importance to determine the ultimate cause of the injury/pathology and prepares the foundation for the development of evidence-based rehabilitation and treatment programs. The high interplay and close association of the shoulder, scapulothoracic, and elbow articulations in the upper extremity kinetic chain make a thorough evaluation of all three regions of paramount importance regardless of the specific area of injury in the elite tennis player. The purpose of this chapter is to overview key evaluation methods for the shoulder and elbow of particular relevance to the elite tennis player to provide this foundation. Reference to descriptive findings contained in Chap. 10 will also be provided to highlight specific anatomic adaptations and musculoskeletal strength and range of motion profiling inherent in elite-level players.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Ellenbecker TS. Clinical examination of the shoulder. St Louis, MO: Elsevier Saunders; 2004.

    Book  Google Scholar 

  2. Ellenbecker TS, Wilk KE. Sport therapy for the shoulder. Champaign, IL: Human Kinetics Publishers; 2017.

    Google Scholar 

  3. Priest JD, Nagel DA. Tennis shoulder. Am J Sports Med. 1976;4(1):28–42.

    CAS  PubMed  Google Scholar 

  4. Ellenbecker TS. Chap. 10 Musculoskeletal screening for the elite and developing tennis player. In: DiGiacomo G, Ellenbecker T, Kibler WB, editors. Tennis medicine. Cham: Springer; 2018.

  5. Young SW, Dakic J, Stroia K, Nguyen ML, Harris AH, Safran MR. High incidence of infraspinatus muscle atrophy in elite professional female tennis players. Am J Sports Med. 2015;43(8):1989–93.

    Article  PubMed  Google Scholar 

  6. Piatt BE, Hawkins RJ, Fritz RC, Ho CP, Wolf E, Schickendantz M. Clinical evaluation and treatment of spinoglenoid notch ganglion cysts. J Shoulder Elb Surg. 2002;11:600–4.

    Article  Google Scholar 

  7. Kibler WB. Role of the scapula in the overhead throwing motion. Contemp Orthop. 1991;22:525.

    Google Scholar 

  8. Bourne DA, Choo AM, Regan WD, MacIntyre DL, Oxland TR. Three-dimensional rotation of the scapula during functional movements: an in-vivo study in healthy volunteers. J Shoulder Elb Surg. 2007;16(2):150–62.

    Article  Google Scholar 

  9. Kibler WB, Uhl TL, Maddux JW, Brooks PV, Zeller B, McMullen J. Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Shoulder Elb Surg. 2002;11:550–6.

    Article  Google Scholar 

  10. Ellenbecker TS, Kibler WB, Bailie DS, Caplinger R, Davies GJ, Riemann BL. Reliability of scapular evaluation in professional baseball players. Clin Orthop Relat Res. 2012;470:1540–4.

    Article  PubMed  Google Scholar 

  11. McClure PW, Tate AR, Kareha S, Irwin D, Zlupko E. A clinical method for identifying scapular dyskinesis, Part 1: Reliability. J Athl Train. 2009;44:160–4.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Tate AR, McClure P, Kareha S, Irwin D, Barbe MF. A clinical method for identifying scapular dyskinesis, Part 2: Validity. J Athl Train. 2009;44:165–73.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tate AR, McClure P, Kareha S, Irwin D, Barbe MF. A clinical method for identifying scapular dyskinesis, Part 1. J Athl Train. 2009;44:165–73.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med. 1998;26:325–37.

    Article  CAS  PubMed  Google Scholar 

  15. Kelley MJ, Kane TE, Leggin BG. Spinal accessory nerve palsy: associated signs and symptoms. J Orthop Sports Phys Ther. 2008;38(2):78–86.

    Article  PubMed  Google Scholar 

  16. Ellenbecker TS. Shoulder internal and external rotation strength and range of motion of highly skilled junior tennis players. Isokinet Exerc Sci. 1992;2:1–8.

    Google Scholar 

  17. Ellenbecker TS, Roetert EP, Bailie DS, Davies GJ, Brown SW. Glenohumeral joint total rotation range of motion in elite tennis players and baseball pitchers. Med Sci Sports Exerc. 2002;34(12):2052–6.

    Article  PubMed  Google Scholar 

  18. Chandler TJ, Kibler WB, Uhl TL, Wooten B, Kiser A, Stone E. Flexibility comparisons of elite junior tennis players to other athletes. Am J Sports Med. 1990;18:134–6.

    Article  CAS  PubMed  Google Scholar 

  19. Wilk KE, Macrina LC, Arrigo C. Passive range of motion characteristics in the overhead baseball pitcher and their implications for rehabilitation. Clin Orthop Relat Res. 2012;470:1586–94.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wilk KE, Macrina LC, Fleisig GS, Porterfield R, Simpson CD II, Harker P, Paparesta N, Andrews JR. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011;39:329–35.

    Article  PubMed  Google Scholar 

  21. Shanley E, Rauh MJ, Michener LA, Ellenbecker TS, Garrison JC, Thigpen CA. Shoulder range of motion measures as risk factors for shoulder and elbow injuries in high school softball and baseball players. Am J Sports Med. 2011;39:1997–2006.

    Article  PubMed  Google Scholar 

  22. Ellenbecker TS, Roetert EP, Piorkowski P. Shoulder internal and external rotation range of motion of elite junior tennis players: a comparison of two protocols (abstract). J Orthop Sports Phys Ther. 1993;17:A65.

    Article  Google Scholar 

  23. Wilk KE, Reinold MM, Macrina LC, Porterfield R, Devine KM, Suarez K, Andrews JR. Glenohumeral internal rotation measurements differ depending on stabilization techniques. Sports Health. 2009;1(2):131–6.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Tyler TF, Roy T, Nicholas SJ, Gleim GW. Reliability and validity of a new method of measuring posterior shoulder tightness. J Orthop Sports Phys Ther. 1999;29(5):262–74.

    Article  CAS  PubMed  Google Scholar 

  25. Tyler TF, Nicholas SJ, Lee SJ, Mullaney M, McHugh MP. Correction of posterior shoulder tightness is associated with symptom resolution in patients with internal impingement. Am J Sports Med. 2010;38(1):114–9.

    Article  PubMed  Google Scholar 

  26. Laudner KG, Stanek JM, Meister K. Assessing posterior shoulder contracture: the reliability and validity of measuring glenohumeral joint horizontal adduction. J Athl Train. 2006;41(4):375–80.

    PubMed  PubMed Central  Google Scholar 

  27. Kelly BT, Kadrmas WH, Speer KP. The manual muscle examination for rotator cuff strength. An electromyographic investigation. Am J Sports Med. 1996;24:581–8.

    Article  CAS  PubMed  Google Scholar 

  28. Daniels L, Worthingham C. Muscle testing: techniques of manual examination. 4th ed. Philadelphia, PA: WB Saunders; 1980.

    Google Scholar 

  29. Kendall FD, McCreary EK. Muscle testing and function. 3rd ed. Baltimore, MD: Williams and Wilkins; 1983.

    Google Scholar 

  30. Jobe FW, Bradley JP. The diagnosis and nonoperative treatment of shoulder injuries in athletes. Clin Sports Med. 1989;8:419–37.

    CAS  PubMed  Google Scholar 

  31. Malanga GA, Jemp YN, Growney E, An K. EMG analysis of shoulder positioning in testing and strengthening the supraspinatus. Med Sci Sports Exerc. 1996;28:661–4.

    Article  CAS  PubMed  Google Scholar 

  32. Chalmers PN, Cvetanovich GL, Kupfer N, Wimmer MA, Verma NN, Cole BJ, Romeo AA, Nicholson GP. The champagne toast position isolates the supraspinatus better than the Jobe test: an electromyographic study of shoulder physical examination tests. J Shoulder Elb Surg. 2016;25(2):322–9.

    Article  Google Scholar 

  33. Jenp YN, Malanga BA, Gowney ES, An KN. Activation of the rotator cuff in generating isometric shoulder rotation torque. Am J Sports Med. 1996;24:477–85.

    Article  CAS  PubMed  Google Scholar 

  34. Walch F, Boulahia A, Calderone S, Robinson AH. The ‘dropping’ and ‘hornblower’s’ signs in evaluation of rotator cuff tears. J Bone Joint Surg Br. 1998;80(4):624–8.

    Article  CAS  PubMed  Google Scholar 

  35. Leroux JL, Codine P, Thomas E, Pocholle M, Mailhe D, Flotman F. Isokinetic evaluation of rotational strength in normal shoulders and shoulders with impingement syndrome. Clin Orthop. 1994;304:108–15.

    Google Scholar 

  36. Patte D, Goutallier D, Monpierre H, Debeyre J. Over-extension lesions. Rev Chir Orthop. 1988;74:314–8.

    CAS  PubMed  Google Scholar 

  37. Kurokawa D, Sano H, Nagamoto H, Omi R, Shinozaki N, Watanuki S, Kishimoto KN, Yamamoto N, Hiraoka K, Tashiro M, Itoi E. Muscle activity pattern of the shoulder external rotators differs in adduction an abduction: an analysis using positron emission tomography. J Shoulder Elb Surg. 2014;23:658–64.

    Article  Google Scholar 

  38. Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br. 1991;73:389–94.

    Article  CAS  PubMed  Google Scholar 

  39. Stefko JM, Jobe FW, Vander Wilde RS, Carden E, Pink M. Electromyographic and nerve block analysis of the subscapularis liftoff test. J Shoulder Elb Surg. 1997;6:347–55.

    Article  CAS  Google Scholar 

  40. Neer CS, Welsh RP. The shoulder in sports. Orthop Clin North Am. 1977;8:583–91.

    PubMed  Google Scholar 

  41. Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med. 1980;8:151–8.

    Article  CAS  PubMed  Google Scholar 

  42. Davies GJ, DeCarlo MS. Examination of the shoulder complex, Current concepts in rehabilitation of the shoulder. La Crosse, WI: Sports Physical Therapy Association; 1995.

    Google Scholar 

  43. Yocum LA. Assessing the shoulder. Clin Sports Med. 1983;2:281–9.

    CAS  PubMed  Google Scholar 

  44. Valadie AL III, Jobe CM, Pink MM, Ekman EF, Jobe FW. Anatomy of provocative tests for impingement syndrome of the shoulder. J Shoulder Elb Surg. 2000;9(1):36–46.

    Article  Google Scholar 

  45. McFarland EG, Torpey BM, Carl LA. Evaluation of shoulder laxity. Sports Med. 1996;22:264–72.

    Article  CAS  PubMed  Google Scholar 

  46. Gerber C, Ganz R. Clinical assessment of instability of the shoulder with special reference to anterior and posterior drawer tests. J Bone Joint Surg Br. 1984;66(4):551–6.

    Article  CAS  PubMed  Google Scholar 

  47. Pagnani MJ, Warren RF. Stabilizers of the glenohumeral joint. J Shoulder Elb Surg. 1994;3:73–90.

    Article  Google Scholar 

  48. O’Brien SJ, Neves MC, Arnvoczky SP, et al. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med. 1990;18:449–56.

    Article  PubMed  Google Scholar 

  49. Hawkins RJ, Mohtadi NGH. Clinical evaluation of shoulder instability. Clin J Sports Med. 1991;1:59–64.

    Article  Google Scholar 

  50. Saha AK. Mechanism of shoulder movements and a plea for the recognition of “zero position” of the glenohumeral joint. Clin Orthop. 1983;(173):3–10.

    Google Scholar 

  51. Altchek DW, Dines DW. The surgical treatment of anterior instability: selective capsular repair. Oper Tech Sports Med. 1993;1:285–92.

    Google Scholar 

  52. Hawkins RJ, Schulte JP, Janda DH, Huckell GH. Translation of the glenohumeral joint with the patient under anesthesia. J Shoulder Elb Surg. 1996;5:286–92.

    Article  CAS  Google Scholar 

  53. Carter C, Wilkinson J. Persistent joint laxity and congenital dislocation of the hip. J Bone Joint Surg Br. 1964;46:40–5.

    Article  CAS  PubMed  Google Scholar 

  54. Beighton P, Horan F. Orthopaedic aspects of the Ehlers-Danlos syndrome. J Bone Joint Surg Br. 1969;51(3):444–53.

    Article  CAS  PubMed  Google Scholar 

  55. Juul-Kristensen B, Rogind H, Jensen DV, Remvig L. Inter-examiner reproducibility of tests and critera for generalized joint hypermobility and benign joint hypermobility syndrome. Rheumatology (Oxford). 2007;46(12):1835–41.

    Article  CAS  Google Scholar 

  56. Cameron KL, Duffey ML, DeBerardino TM, Stoneman PD, Jones CJ, Owens BD. Association of generalized joint hypermobility with a history of glenohumeral joint instability. J Athl Train. 2010;45(3):253–8.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Itoi E, Kido T, Sano A, Urayama M, Sato K. Which is more useful, the “full can test” or the “empty can test” in detecting the torn supraspinatus tendon? Am J Sports Med. 1999;27(1):65–8.

    Article  CAS  PubMed  Google Scholar 

  58. Pennock AT, Pennington WW, Torry MR, Decker MJ, Vaishnav SB, Provencher MT, Millet PJ, Hackett TR. The influence of arm and shoulder position on the bear-hug, belly-press, and lift-off tests: an electromyographic study. Am J Sports Med. 2011;39:2338–46.

    Article  PubMed  Google Scholar 

  59. Pandya NK, Colton A, Webner D, Sennett B, Huffman GR. Physical examination and magnetic resonance imaging in the diagnosis of superior labrum anterior-posterior lesions of the shoulder: a sensitivity analysis. Arthroscopy. 2008;24(3):311–7.

    Article  PubMed  Google Scholar 

  60. Hegedus EJ, Goode A, Campbell S, et al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med. 2008;42:80–92.

    Article  CAS  PubMed  Google Scholar 

  61. Hegedus EJ. Which physical examination tests provide clinicians with the most value when examining the shoulder ? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012. https://doi.org/10.1136/bjsports-2012-091066.

    Article  PubMed  Google Scholar 

  62. Cook C, Beaty S, Kissenberth MJ, Siffri P, Pill SG, Hawkins RJ. Diagnostic accuracy of five orthopedic clinical tests for diagnosis of superior labrum anterior posterior (SLAP) lesions. J Shoulder Elb Surg. 2012;21(1):13–22.

    Article  Google Scholar 

  63. Michener LA, Doukas WC, Murphy KP, Walsworth MK. Diagnostic accuracy of history and physical examination of superior labrum anterior-posterior lesions. J Athl Train. 2011;46(6):343–8.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Andrews JR, Gillogly S. Physical examination of the shoulder in throwing athletes. In: Zarins B, Andrews JR, Carson WG, editors. Injuries to the throwing arm. Philadelphia, PA: WB Saunders; 1985.

    Google Scholar 

  65. Ellenbecker TS. Etiology and evaluation of rotator cuff pathologic conditions and rehabilitation. In: Donatelli RA, editor. Physical therapy of the shoulder. 4th ed. Philadelphia, PA: Churchill Livingstone; 2004. p. 337–58.

    Chapter  Google Scholar 

  66. Liu SH, Henry MH, Nuccion S. A prospective evaluation of a new physical examination in predicting glenoid labrum tears. Am J Sports Med. 1996;24(6):721–5.

    Article  CAS  PubMed  Google Scholar 

  67. Stetson WB, Templin K. The crank test, the O’Brien test, and routine magnetic resonance imaging scans in the diagnosis of labral tears. Am J Sports Med. 2002;30(6):806–9.

    Article  PubMed  Google Scholar 

  68. O’Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26(5):610–3.

    Article  PubMed  Google Scholar 

  69. Magee DJ. Orthopaedic physical assessment. 3rd ed. Philadelphia, PA: WB Saunders; 1997.

    Google Scholar 

  70. Kibler BW, Sciascia AD, Hester P, Dome D, Jacobs C. Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. Am J Sports Med. 2009;37(9):1840–7.

    Article  PubMed  Google Scholar 

  71. Kibler WB. Specificity and sensitivity of the anterior slide test in throwing athletes with superior glenoid labral tears. Arthroscopy. 1995;11(3):296–300.

    Article  CAS  PubMed  Google Scholar 

  72. Morrey BF, Tanaka S, An KN. Valgus stability of the elbow: a definition of primary and secondary constraints. Clin Orthop Relat Res. 1991;(265):187–95.

    Google Scholar 

  73. Regan WD, Korinek S, Morrey BF, An KN. Biomechanical study of ligaments around the elbow joint. Clin Orthop Relat Res. 1991;(271):170–9.

    Google Scholar 

  74. Kibler WB. Clinical biomechanics of the elbow in tennis: implications for evaluation and diagnosis. Med Sci Sports Exerc. 1994;26:1203–6.

    Article  CAS  PubMed  Google Scholar 

  75. Elliott B, Fleisig G, Nicholls R, Escamilia R. Technique effects on upper limb loading in the tennis serve. J Sci Med Sport. 2003;6(1):76–87.

    Article  CAS  PubMed  Google Scholar 

  76. Strukel RJ, Garrick JG. Thoracic outlet compression in athletes. Am J Sports Med. 2016;6(2):35–9.

    Article  Google Scholar 

  77. Churchill RW, Munoz J, Ahmad CS. Osteochondritis dissecans of the elbow. Curr Rev Musculoskelet Med. 2016;9(2):232–9.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Antuna SA, O’Driscoll SW. Snapping plicae associated with radiocapitellar chondromalacia. Arthroscopy. 2001;17(5):491–5.

    Article  CAS  PubMed  Google Scholar 

  79. Kim DH, Gambardella RA, Elattrache NS, Yocum LA, Jobe FW. Arthroscopic treatment of posterolateral elbow impingement from lateral synovial plicae in throwing athletes and golfers. Am J Sports Med. 2006;34(3):438–44.

    Article  PubMed  Google Scholar 

  80. Nirschl RP. Elbow tendinosis/tennis elbow. Clin Sports Med. 1992;11:851–70.

    CAS  PubMed  Google Scholar 

  81. Hamilton CD, Glousman RE, Jobe FW, et al. Dynamic stability of the elbow: electromyographic analysis of the flexor pronator group and the extensor group in pitchers with valgus instability. J Shoulder Elb Surg. 1996;5:347–54.

    Article  CAS  Google Scholar 

  82. Bruce JR, Andrews JR. Ulnar collateral ligament injuries in the throwing athlete. J Am Acad Orthop Surg. 2014;22(5):315–25.

    Article  PubMed  Google Scholar 

  83. Dines J, Altchek D, Dines DM. Medial collateral ligament reconstruction of elbow; current concepts in surgical technique. J Shoulder Elb Surg. 2010;19:110–7.

    Article  Google Scholar 

  84. Safran M, Ahmad C, Elattrache N. Ulnar collateral ligament of the elbow. Arthroscopy. 2005;21(11):1381–95.

    Article  PubMed  Google Scholar 

  85. Cain EL Jr, Dugas J, Wolf R, Andrews J. Elbow injuries in the throwing athletes; a current review. Am J Sports Med. 2005;33(2):231–9.

    Article  Google Scholar 

  86. O’Driscoll SW, Lawton RL, Smith AM. The “moving valgus stress test” for medial collateral ligament tears of the elbow. Am J Sports Med. 2005;33(2):231–9.

    Article  PubMed  Google Scholar 

  87. Calfee RP, et al. Clinical assessment of the ulnar nerve at the elbow: reliability of instability testing and the association of hypermobility with clinical symptoms. J Bone Joint Surg Am. 2010;92(17):2801–8.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Lasecki M, et al. The snapping elbow syndrome as a reason for chronic elbow neuralgia in a tennis player - MR, US and sonoelastography evaluation. Pol J Radiol. 2014;79:467–71.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Brucker J, Sahu N, Sandella B. Olecranon stress injury in an adolescent overhand pitcher: a case report and analysis of the literature. Sports Health. 2015;7(4):308–11.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Park JY, Yoo HY, Chung SW, Lee SJ, Kim NR, Ki SY, Oh KS. Valgus extension overload syndrome in adolescent baseball players: clinical characteristics and surgical outcomes. J Shoulder Elb Surg. 2016;25(12):2048–56.

    Article  Google Scholar 

  91. Paulino FE, Villacis DC, Ahmad CS. Valgus extension overload in baseball players. Am J Orthop (Belle Mead NJ). 2016;45(3):144–51.

    Google Scholar 

  92. O’Driscoll S, Goncalves L, Dietz P. The Hook test for distal biceps tendon avulsion. Am J Sports Med. 2007;35(11):1865–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David Dines .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Dines, D., Ellenbecker, T.S., Berkowitz, J. (2018). Evaluation of the Shoulder and Elbow in the Elite Tennis Player. In: Di Giacomo, G., Ellenbecker, T., Kibler, W. (eds) Tennis Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-71498-1_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-71498-1_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-71497-4

  • Online ISBN: 978-3-319-71498-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics