Upper limb functional testing: does age, gender, and sport influence performance?

Background: Musculoskeletal adaptations are common in overhead athletes. As they also are involved in injury prevention, there has been an increase in their evaluation through shoulder screening over the last years. However, for some evaluations, and especially for functional testing, there is a lack of normative values, which limits the interpretation of the values measured. Moreover, the influence of age, gender, and sport on upper limb functional tests remains underexplored.

Methods: Five hundred eighty seven athletes (handball players, rugby players, swimmers, tennis players, and volleyball players) performed a battery of upper limb functional tests between 2018 and 2023, including the Modified-Athletic Shoulder Test, the Single Arm Medicine Ball Throw, the Seated Single Arm Shot Put Test, the Upper Limb Rotation Test, the Upper Quarter Y Balance Test, the Modified Closed Kinetic Chain Upper Extremity Stability Test, and the Posterior Shoulder Endurance Test. In total, normative values as well as the influence of age, gender, and sport on upper limb functional performance were obtained for 496 of them.

Results: The Modified-Athletic Shoulder Test revealed sport-specific adaptations, with dominant arms significantly outperforming nondominant arms, notably in handball, rugby, and tennis. The Single Arm Medicine Ball Throw and Seated Single Arm Shot Put Test highlighted the influence of age and gender on upper limb power, with males consistently outperforming females. The Upper Limb Rotation Test demonstrated similar rotation in both arms across sports, while gender disparities were still observed. The Upper Quarter Y Balance Test exhibited surprising consistency in upper-quarter balance across sports and age groups ( > .05). The Modified Closed Kinetic Chain Upper Extremity Stability Test showed age-related improvements in stability, while the Posterior Shoulder Endurance Test demonstrated age-related differences in posterior shoulder endurance in swimmers.

Conclusion: This study contributes to advances in sports medicine by better understanding functional shoulder performances in upper limb athletes. The differences observed according to the sport, gender, or age underscore the importance of sport-specific assessments and interventions. Moreover, the normative values provided will be essential for primary prevention as well as for determining return-to-play capacity after an injury or surgery.