# Return to Sport After Shoulder Arthroplasty: A Scoping Review

## TL;DR

This review examines how athletes return to sports after shoulder surgery, finding high success rates but a lack of objective criteria for clearance.

## Contribution

The study identifies gaps in evidence-based protocols for return-to-sport after TSA, highlighting the need for standardized testing criteria.

## Key findings

- RTS rates were high overall, with anatomical TSA showing better outcomes than other procedures.
- Most protocols rely on time-based restrictions and subjective assessments, lacking objective testing criteria.
- There is a critical need for standardized strength testing and sport-specific assessments.

## Abstract

This scoping review synthesized existing literature on return-to-sport (RTS) protocols and testing criteria following total shoulder arthroplasty (TSA) to identify gaps in evidence-based practice and inform future research priorities for clinicians. A comprehensive literature search was performed using PubMed and Google Scholar from January 2015 to September 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Inclusion criteria comprised studies involving adults who underwent TSA and reported RTS protocols or testing criteria. Twenty-three studies published between January 2015 and September 2025 met the inclusion criteria. RTS rates were high (85.1% overall, 72.3% at equivalent or improved levels), with anatomical TSA (aTSA) demonstrating superior rates (92.6%) compared to hemiarthroplasty (HSA; 71.1%) or reverse TSA (rTSA; 74.9%). Average return time ranged from four to nine months across sports. However, objective testing criteria for clearance were notably absent. Most studies relied on time-based restrictions and subjective physician assessment without standardized measurement protocols or operational definitions for range of motion (ROM) and strength requirements. Despite encouraging RTS rates, a significant gap exists between successful outcomes and available evidence-based clearance criteria. Current protocols rely on arbitrary time-based restrictions rather than objective functional measures. Critical deficiencies include the absence of standardized strength testing, sport-specific assessments, validated outcome measures, and long-term implant survival data.