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TRI Testing Notes & Instructions

These are the official testing notes and instructions for the Thrower’s Readiness Inventory (TRI), from the 2026 Ready to Throw TRI document (pages 4-5). Use them alongside the online TRI tool.

Special Tests/Observation:

  • Observe for any visible effusion/edema, ask about recent trends
  • Note quality and location of pain with any special testing
  • Thoracic mobility should be observed in transverse and sagittal planes

Functional Tests:

  1. Single leg step down: have the patient on a box/step (8-10″) and instruct them to reach down and tap their contralateral heel to the ground in a rhythmic pattern (~2 sec per rep; metronome can be used).
    • Keep hips back and head up. Patient should maintain a consistent cadence without loss of knee alignment or balance.
  2. One-arm ball throws against wall: patient uses 1kg ball and is placed in throwing slot. Tester should palpate scapula and observe arm height over 30sec while patient actively dribbles the ball on the wall.
    • Assess for loss of arm height or scapular position for compensatory patterns secondary to fatigue.
  3. Low-intensity towel throws: tie a knot in the end of a towel or pillowcase. Patient performs their entire throwing motion at an instructed “25% effort”.
    • Observe for mechanical faults or apprehension. Any pain should be noted and at what point in the throwing motion (i.e. lay-back vs acceleration vs follow-through).
  4. CKCUEST: patient is in “push-up” position with hands ~36in (1m) apart (use tape or other visual markers).
    • Patient instructed to tap contralateral hand (alternating) as many times as they can in 15sec without loss of balance. Terminate test if pain is present in weight-bearing.
  5. Side plank: patient instructed to hold a “stacked foot” side plank x45sec on affected side without loss of frontal-plane height. Terminate test if pain is present in weight-bearing.
  6. Prone Shoulder Endurance Test (PSET): patient is positioned in prone at the edge of a table with adequate height for their arm to hang without obstruction (test only dominant UE)
    • Patient is provided a dumbbell (see below) and instructed to horizontally abduct their arm to 90° with thumb up towards ceiling – hold as long as possible for time
    • Test is concluded once scapula loses retraction or patient unable to maintain 90° elevation
    • Reference weight can be selected based on patient size/age: Males = 3-5lbs; Females = 2-3lbs

ROM:

  • Tester should assess for end-feel and potential soft-tissue limitations, note as necessary
  • ER/IR should be measured consistently with appropriate support to ensure true neutral plane; ensure anterior support during IR to mitigate scapular movement
  • Cross-body adduction requires a firm lateral border block of the scapula

Strength:

  • All strength tests measured with hand-held dynamometer should be performed via “make test”
  • Ensure proper stabilization and a firm block for the patient to perform maximum effort isometric contraction – consider body mechanics while testing to maximize leverage and reduce variability
    • For IR at 0°, block against their humerus to avoid being overpowered, see figure below
  • Each contraction should last ~3 seconds
  • Note any pain
Strength testing figure: for IR at 0 degrees, block against the patient's humerus

References:

  1. Wilk KE, Meister K, Andrews JR. Current concepts in the rehabilitation of the overhead throwing athlete. Am J Sports Med. 2002;30:136-151.
  2. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: Spectrum of pathology. Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003;19:641-661.
  3. Roush JR, Kitamura J, Waits MC. Reference values for the closed kinetic chain upper extremity stability test (CKCUEST) for collegiate baseball players. N Am J Sports Phys Ther. 2007;2(3):159-163.
  4. Wilk KE, Macrina LC, Fleisig GS, et al. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011;39:329-335.
  5. 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;470:1586-1594.
  6. Kibler WB, Wilkes T, Sciascia A. Mechanics and pathomechanics in the overhead athlete. Clin Sports Med. 2013;32:637-651.
  7. Franz JO, McCulloch PC, Kneip CJ, Noble PC, Lintner DM. The utility of the KJOC score in professional baseball in the United States. Am J Sports Med. 2013;41(9):2167-2173. doi:10.1177/0363546513495177
  8. McCulloch PC, Patel JK, Ramkumar PN, Noble PC, Lintner DM. Asymmetric Hip Rotation in Professional Baseball Pitchers. Orthop J Sports Med. 2014;2(2):2325967114521575. doi:10.1177/2325967114521575
  9. Camp CL, Zajac JM, Pearson DB, et al. Decreased shoulder external rotation and flexion are greater predictors of injury than internal rotation deficits: analysis of 132 pitcher-seasons in professional baseball. Arthroscopy. 2017;33(9):1629-1636.
  10. Mathew CJ, Lintner DM. Superior Labral Anterior to Posterior Tear Management in Athletes. Open Orthop J. 2018;12:303-313. doi:10.2174/1874325001812010303
  11. Wilk KE, Arrigo CA, Bagwell MS, et al. Repair of the ulnar collateral ligament of the elbow: rehabilitation following internal brace surgery. JOSPT. 2019;49(4):253-261.
  12. Pontillo M, Sennett BJ. Profile of upper extremity strength and function in division 1 collegiate athletes. Phys Ther Sport. 2020;44:8-13.
  13. Schilling DT, Elazzazi AM. Shoulder strength and closed kinetic chain upper extremity stability test performance in division III collegiate baseball and softball players. Int J Sports Phys Ther. 2021;16(3):844-853.
  14. Evans NA, Konz S, Nitz A, Uhl TL. Reproducibility and discriminant validity of the Posterior Shoulder Endurance Test in healthy and painful populations. Phys Ther Sport. 2021;47:66-71.
  15. Michener LA, Barrack AJ, Liebeskind BY, et al. Professional baseball player type and geographic region of origin impacts shoulder external and internal rotation strength. Int J Sports Phys Ther. 2021;16(4):1126-1134.