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Evaluation of acute traumatic shoulder injury in children and adolescents

Authors
Kristin Ernest, MD
Marc Baskin, MD
Section Editor
Gary R Fleisher, MD
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

The evaluation of traumatic shoulder injury in children and adolescents will be discussed here. The traumatic causes of shoulder pain and injury in children and adolescents and the physical examination of the shoulder are reviewed separately. (See "Traumatic causes of acute shoulder pain and injury in children and adolescents" and "Physical examination of the shoulder".)

BACKGROUND

Pediatric shoulder injuries are very common, accounting for approximately one million outpatients visits annually in the United States [1]. Among active children and adolescents, the incidence of shoulder injuries increases as the participation in overhead activities such as baseball and volleyball rises. Despite the risk for traumatic shoulder injury during any competitive activity, the largest risk for shoulder injury remains during contact sports such as football and rugby [2].

CLINICAL ANATOMY

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 [AC], 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 and to identify injury.

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 [3,4]. 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:

                
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Literature review current through: Nov 2017. | This topic last updated: Oct 30, 2017.
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