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Sports medicine for the shoulder

«I can train, but I am not performing and I feel my shoulder when I serve or smash»

Shoulder injuries in athletes: diagnosis, treatment and return to competition. Trained at St George Hospital in Sydney, a leading sports medicine centre.

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Treated by Dr. Ricardo Aveledo, shoulder subspecialist certified by the Royal College of Surgeons. Consultation and surgery in Tenerife · Hospital Quirónsalud View CV

Do any of these sound familiar?

If two or three sound familiar, this fits the picture.

  • Loss of power in the sporting movement without clear pain at rest
  • Pain that appears once you reach a certain training volume
  • The shoulder is fine at the start and complains in the second half of the session
  • Loss of internal rotation compared with the other shoulder
  • Discomfort serving, smashing, swimming or throwing, but not in daily life
  • A sense of giving way, or that the shoulder does not respond in one specific movement

Worth having it assessed soon if you also notice

  • An episode of dislocation or subluxation during sport.
  • Sudden loss of strength after an explosive movement: this may be an acute tear.
  • Pain that no longer settles with rest between sessions.
The shoulder is not one joint but four working together, held mostly by soft tissue. Hence its mobility, and hence its fragility. Clavicle Acromion Rotator cuff Glenoid Humerus
The shoulder is not one joint but four working together, held mostly by soft tissue. Hence its mobility, and hence its fragility.

An athlete’s shoulder is not just any shoulder

A shoulder that swims 4,000 metres, serves 80 times in a match or absorbs a fall from a bike has different demands from one that opens cupboards. That difference changes three things: what gets injured, what counts as ‘normal’ on examination, and above all what recovered means.

For someone sedentary, recovery means no longer having pain in everyday activities. For an athlete, recovery means performing again in the very movement that caused the injury. Those are very different goals and they demand different processes.

Trained at one of Australia’s leading centres

Dr. Aveledo completed his training as a Fellow in Sports Medicine and Shoulder Surgery at St George University Hospital in Sydney, one of Australia’s most prestigious sports medicine centres, alongside Dr. George Murrell, director of its Orthopaedic Research Institute.

There he worked with elite athletes and with complex shoulder surgery, including reconstruction techniques for massive irreparable rotator cuff tears. He remains connected to that centre: he has been invited to the St George Shoulder Conference and is an examiner of research projects for the University of Sydney.

The commonest injuries by sport

Racquet and throwing sports (padel, tennis, handball, volleyball). Overload injuries predominate: cuff tendinopathy, impingement and superior labral injuries. The problem is almost never one movement, but accumulation.

Swimming. The classic swimmer’s shoulder, a tendinopathy from the volume of overhead strokes, closely tied to technique and to the use of paddles.

Contact sports (rugby, judo, football, skiing). Acute injuries predominate: dislocations, acromioclavicular injuries and fractures.

Cycling. Falls onto the shoulder, with clavicle fracture and acromioclavicular dislocation as the headline injuries.

Gym and CrossFit. Overload in overhead movements and injuries from poor technique under heavy loads.

Returning to competition is decided by criteria, not dates

A date in the calendar says nothing about whether a shoulder is ready. What does say so is measured strength compared with the healthy side, full range of movement, and the ability to perform the competitive movement without pain and without compensating with the rest of the body.

When those three criteria are met, returning is safe even if it is earlier than planned. When they are not, returning is a gamble, even if the date has passed. Most of the recurrences seen in clinic come from having decided by calendar.

How the diagnosis is confirmed

  1. 01

    Analysis of the movement and the load

    Which sport, which movement hurts, at what point in the training cycle it appeared and what changed before it did. In athletes, the why usually lies in the load and not only in the tissue.

  2. 02

    Comparative examination

    Always compared with the other shoulder. In throwing athletes it is normal to find adaptations — more external and less internal rotation — that are not pathological, and mistaking them for injury is a common error.

  3. 03

    Targeted imaging

    Dynamic ultrasound for tendons and MRI where labral or cuff injury is suspected. Imaging confirms the clinical suspicion; it does not replace examination.

What can be done, and in what order

Surgery is not the starting point. It is proposed when it beats not operating, and the reasoning is explained.

First option

Treatment without surgery

In athletes the first intervention is almost never surgical: it is correcting the load, the movement and the strength deficit that caused the injury.

When: Almost always the first step, except in acute structural injuries such as a dislocation or a complete tear.

What it involves
  • Retraining the training load, with measured progression rather than absolute rest
  • Specific work on the rotators and scapular control, where the real deficit usually lies
  • Correcting technique where the movement pattern is the cause, with guidance you can pass on to your coach
  • Ultrasound-guided injection only where pain prevents progress in retraining
If needed

Sports surgery

Where there is a structural injury preventing a return to previous level, it is dealt with arthroscopically, with a return-to-sport plan defined before operating.

When: Recurrent instability, structural injury with loss of performance, or failure of properly conducted retraining.

What it involves
  • Arthroscopic stabilisation in recurrent instability
  • Labral or rotator cuff repair according to the injury
  • Acromioclavicular reconstruction in cycling and contact sport injuries
  • Discharge criteria based on strength and control targets, not a date in the calendar

How long will this take?

The return to sport is not decided by date but by criteria: strength symmetrical with the healthy side, full range of movement, and control of the movement without pain. These timings are approximate for an arthroscopic stabilisation or repair.

  1. Protection First 4 weeks

    Protecting the repair while working the rest of the body: legs, core and aerobic capacity. Losing general fitness is not part of the treatment.

  2. Movement and base Weeks 4–12

    Full range restored and strength progressively reintroduced. Continuous running and lower-body work without restriction.

  3. Specific strength Weeks 12–20

    Shoulder strengthening with increasing load and power work. Technical movement without opposition or speed.

  4. Return to competition Weeks 20–36

    The competitive movement is reintroduced, first in training and then in matches. Contact and throwing sports come last.

Frequently asked questions

Do I have to stop training completely?

Almost never. Complete rest usually makes things worse: strength, control and fitness are lost, and on returning the shoulder is less prepared than before. The usual approach is to adapt volume and movement, keep everything that does not hurt and work specifically on the deficit. Stopping altogether is the last option, not the first.

When can I compete again?

When the criteria are met, not when a date arrives. The three that matter most are: strength symmetrical with the healthy side, full range of movement, and the ability to perform the competitive movement without pain and without compensating. Returning before meeting them is the main cause of recurrence.

I have less internal rotation in my throwing shoulder — is that an injury?

Not necessarily. In throwing and racquet athletes it is an expected adaptation: the dominant shoulder gains external and loses internal rotation over years of practice. It is considered a problem when the deficit is large and accompanied by pain or loss of performance. Treating a normal adaptation as an injury is a common error.

Will surgery end my sporting career?

In most cases, no. Arthroscopic stabilisation data show high rates of return to previous level where rehabilitation is completed. What does compromise the result is cutting the timeline short: surgery is one part of the process, and the part that takes least time.

Can my coach or physiotherapist know which phase I am in?

Yes, and they should. You leave the consultation with the specific guidance — which phase you are in, which movements are allowed and which are not — to pass on to whoever trains or treats you day to day. Dr Aveledo follows your progress with you at your reviews; there is no separate coordination with them.

Often confused with

An assessment with Dr. Aveledo

Consultations at Hospital Quirónsalud Tenerife, Vida Puerto de la Cruz and Quirónsalud Santa Cruz.

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Dr. Ricardo Aveledo

Orthopaedic surgeon and traumatologist with a PhD in Physics Applied to Traumatology and an international subspecialty in Sports Medicine and Shoulder Surgery. He practises across several medical centres in Tenerife and remains research-active as an examiner of undergraduate projects at the University of Sydney.

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Spain OMC 36/08/46635
Australia AHPRA MED0002120123