Shoulder Overuse Injuries in Tennis Players: Biomechanics, Risk Factors, Prevention and Return to Sport - A Narrative Review

Abstract

Background. Repetitive overhead loading places substantial demands on the shoulder in tennis, particularly when players are exposed to high volumes of serving. Aim. To review current evidence concerning tennis-related shoulder biomechanics, risk factors, prevention, rehabilitation, and return to sport (RTS). Materials and methods. A targeted narrative review of PubMed-indexed literature was conducted and supplemented by reference chaining from relevant reviews and consensus statements. Priority was given to systematic reviews, prospective cohorts, biomechanical studies, intervention trials, and clinical guidance. Results. The tennis serve requires extreme glenohumeral rotation and exposes the shoulder to substantial mechanical loading. Dominant-arm internal-rotation loss and structural abnormalities are common, although they may reflect sport-specific adaptation rather than pathology. In adolescent competitive players, repeated workload spikes have been prospectively associated with higher rates of shoulder complaints and injury. Isolated ROM and strength measures, however, remain insufficient as stand-alone predictors of individual injury risk. Prevention and rehabilitation should combine progressive exposure, development of shoulder and kinetic-chain capacity, and gradual reintroduction of tennis-specific loading. Conclusions. Tennis-related shoulder overuse injury is best considered a multifactorial problem in which mechanical demand interacts with exposure, physical capacity, and recovery.