Return-to-play (RTP) decisions often represent a challenge to physicians caring for athletes. The multifaceted and unique nature of each RTP decision makes standardization of the decision-making process impossible and demands of the physician thoughtful consideration of all competing interests and variables. Such difficult medical decisions are further complicated by unique ethical and legal considerations. Although no concrete RTP recommendations are available, the consensus of experienced team physicians and knowledge of the rules and regulations that apply to RTP are helpful guides to treating the various upper extremity injuries that occur in elite athletes.