Shoulder Injuries in Pediatric Athletes

Shoulder injuries in pediatric athletes are typically caused by acute or overuse injuries. The developing structures of the shoulder lead to injury patterns that are distinct from those of adult athletes. Overuse injuries often affect the physeal structures of the proximal humerus and can lead to pain and loss of sports participation. Shoulder instability is common in pediatric athletes, and recurrence is also a concern in this population. Fractures of the proximal humerus and clavicle are typically treated with conservative management, but there is a trend toward surgical intervention.

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Chronic overuse injuries tend to occur in overhead athletes. Baseball pitchers who have high pitch counts are at highest risk.

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Chronic overuse injuries tend to occur in overhead athletes. Baseball pitchers who have high pitch counts are at highest risk.

Youth pitchers show several changes compared with mature pitchers. Younger pitchers tend to begin trunk rotation earlier in the throwing process. There is also a trend toward more open pelvic position during throwing. Both of these mechanisms have been proposed to increase the likelihood of injury to the developing physis because of higher rotational stress at the proximal humerus.

For patients with SLAP lesions, a short period of physical therapy and rest may help to resolve symptoms. However, when there is continued pain and MRI consistent with labral injury, surgical repair may be indicated ( Fig. 3 ).

Results of arthroscopic treatment have been encouraging. Recurrence rates of instability have been reported from 2% to 12%. Return to sports, range of motion, and pain scores have also been good to excellent for most patients.

Many of these injuries are treated nonoperatively with a sling and rest. Although some investigators recommend nonoperative treatment of all pediatric AC injuries, operative management is frequently advocated for athletes or patients with more severe injuries.

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