Traumatic causes of acute shoulder pain and injury in children and adolescents
- Joseph Chorley, MD
Joseph Chorley, MD
- Section Editor — Pediatric Sports Medicine; Adolescent Sports Medicine
- Associate Professor of Pediatrics, Adolescent Medicine, and Sports Medicine
- Baylor College of Medicine
- Gabriel P Brooks, PT, DPT, SCS, MTC
Gabriel P Brooks, PT, DPT, SCS, MTC
- Doctor of Physical Therapy
- Texas Children's Hospital
- Section Editor
- George A Woodward, MD
George A Woodward, MD
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics
- University of Washington School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Diagnosis and treatment for shoulder injuries in the young athlete is different from treating adults because of the higher likelihood of fracture and anterior shoulder dislocations [1,2]. During the teenage years participation in many sports put the young athlete at risk for acute (eg, football, hockey) and repetitive overuse injuries (eg, swimming, baseball, tennis) . Understanding the anatomy and applicable biomechanics of the shoulder is essential to identifying these injuries.
The causes of acute shoulder injury in the young athlete will be reviewed here. The physical examination of the shoulder is reviewed separately. (See "Physical examination of the shoulder".)
A complex network of anatomic structures endows the human shoulder with tremendous mobility, greater than any other joint in the body. The shoulder girdle is composed of three bones (the clavicle, scapula, and proximal humerus) and four articular surfaces (sternoclavicular, acromioclavicular, glenohumeral, and scapulothoracic) (figure 1A-C). The glenohumeral joint, commonly referred to as the shoulder joint, is the principal articulation. The shoulder is an inherently unstable joint that relies on several delicate interactions to minimize the risk for injury. The shape and interaction of the bones and soft tissues of the shoulder girdle are essential to understanding the factors leading to shoulder stability.
●Glenohumeral structures – The glenohumeral joint is loosely constrained within a thin capsule bounded by surrounding muscles and ligaments (figure 1A-C and table 1). The shoulder's great mobility is due in large part to the shallow depth of the glenoid and the limited contact between the glenoid and the humeral head. Only 25 percent of the humeral head surface makes contact with the glenoid. The labrum, a fibrocartilaginous ring attached to the outer rim of the glenoid, provides some additional depth and stability [1,4]. It also serves as a bumper to decrease the potential for humeral head subluxation. The shallowness and small surface area of the glenohumeral joint make it susceptible to instability and injury and require that stability be provided primarily by extrinsic supports.
Surrounding muscles and ligaments provide these supports:
•The glenohumeral ligaments are collagenous reinforcement of the capsule and quite variable in their thickness, anatomic position, and their contribution to shoulder stability (figure 1B). The glenohumeral ligaments serve as the primary static stabilizer [5-7].
The inferior glenohumeral ligament complex (IGHL) is made up of the anterior and posterior bands and the posterior axillary pouch that form a hammock like structure. In abduction and external rotation, the anterior band is the primary restraint to anterior translation of the humeral head [5,6].
In the absence of the anterior IGHL, the middle glenohumeral ligament may provide some restraint to anterior humeral translation .
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- CLINICAL ANATOMY
- LIFE-THREATENING AND SERIOUS CONDITIONS
- Sternoclavicular injury
- - Diagnosis
- - Management
- - Reduction of posterior sternoclavicular dislocation
- Referred pain
- Pathologic fracture
- COMMON CONDITIONS
- Superficial contusion
- Clavicle injuries
- - Distal clavicle contusion (shoulder pointer)
- - Clavicle fractures
- Proximal humeral fractures
- Shoulder dislocation
- Acromioclavicular injuries
- Burners (stingers)
- OTHER CONDITIONS
- Scapula fractures