Sports Shoulder Injuries in Children

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Epidemiology

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Common Sports Associated

• Football (especially defensive players)
• Wrestling
• Basketball (males)
• Softball, gymnastics, cross-country (females)
• Extreme sports:
  • Skateboarding
  • Skydiving

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Key Point

• Limited high-quality epidemiological data
• Need for:
  • Registries and better tracking systems

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Common Injury Patterns

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1. Medial Clavicle Epiphyseal Injury

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Population

• Adolescents

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Key Concept

• Often a physeal fracture, not a true dislocation

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Displacement Types

Anterior Displacement

• Relatively safe

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Posterior Displacement

• Dangerous
• Risk to:
  • Mediastinal structures

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Treatment

• Usually non-operative

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Outcome

• Good functional recovery
• Cosmetic deformity may persist

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2. Proximal Humerus Fractures

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Includes

• Salter–Harris injuries

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Key Feature

• Excellent remodeling potential

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Management

• Mostly conservative
• Surgery rarely required

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3. Little League Shoulder

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Definition

• Proximal humeral stress fracture

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Cause

• Repetitive overhead throwing

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Clinical Features

• Shoulder pain during throwing
• Reduced performance

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Radiographic Finding

• Physeal widening

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Diagnosis Tip

• Compare with:
  • Contralateral shoulder

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Treatment

• Rest (~3 months)
• Gradual return to sport

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Prognosis

• Good
• Most athletes return to play

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Biomechanics and Adaptations

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Changes Due to Repetitive Throwing

• Increased external rotation
• Decreased internal rotation
• Humeral head retroversion

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Concept

• Adaptive remodeling due to repetitive stress

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Important Clinical Insight

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Diaphyseal Humerus Fracture in Throwers

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Key Rule

• Always suspect:
  • Pathological fracture

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Common Cause

• Simple bone cyst

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Clinical Note

• May be asymptomatic
• Fracture may lead to:
  • Healing of cyst

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Overuse Injuries and Prevention

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Risk Factors

• Early sports specialization
• High pitching load
• Poor technique
• Rapid growth phase

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Prevention Strategies

• Limit pitching volume
• Avoid excessive competitive exposure
• Encourage multi-sport participation
• Educate:
  • Parents
  • Coaches

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Key Message

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• Early overuse can lead to:
  • Long-term shoulder damage

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Clinical Insight

• High training intensity at a young age:
  • Does not guarantee elite performance
  • Increases injury risk

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Final Takeaways

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• Most pediatric shoulder injuries:
  • Respond well to conservative treatment

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• Early diagnosis helps prevent:
  • Deformity
  • Abnormal rotational changes

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• Prevention is essential:
  • Protect young athletes from overuse

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Final Message

• Focus should be on safe training, early recognition, and conservative management to ensure long-term shoulder health in young athletes

Courtesy: Mary Lloyd Ireland M.D. Associate Professor University of Ketucky Lexington, KY, USA www.MaryLloydIreland.com http://orthopaedics.med.uky.edu/