Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Evaluation of acute traumatic shoulder injury in children and adolescents

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


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".)


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].


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:

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Oct 30, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Department of Research & Scientific Affairs, American Academy of Orthopaedic Surgeons. Physician Visits for Musculoskeletal Symptoms and Complaints. Updated November 2013. http://www.aaos.org/research/stats/patientstats.asp (Accessed on September 11, 2017).
  2. Moyer JE, Brey JM. Shoulder Injuries in Pediatric Athletes. Orthop Clin North Am 2016; 47:749.
  3. Lippitt SB, Vanderhooft JE, Harris SL, et al. Glenohumeral stability from concavity-compression: A quantitative analysis. J Shoulder Elbow Surg 1993; 2:27.
  4. Howell SM, Galinat BJ. The glenoid-labral socket. A constrained articular surface. Clin Orthop Relat Res 1989; :122.
  5. O'Brien SJ, Neves MC, Arnoczky SP, et al. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med 1990; 18:449.
  6. Urayama M, Itoi E, Hatakeyama Y, et al. Function of the 3 portions of the inferior glenohumeral ligament: a cadaveric study. J Shoulder Elbow Surg 2001; 10:589.
  7. Schwartz E, Warren RF, O'Brien SJ, Fronek J. Posterior shoulder instability. Orthop Clin North Am 1987; 18:409.
  8. Szilvássy J. [Estimation of age by the sternal articular surfaces of the clavicle]. Beitr Gerichtl Med 1977; 35:343.
  9. Cmap JD, Cilley EIL. Diagrammatic chart showing time of appearnce of the various centers of ossification and period of union. Am J Roentgenol Radium Ther 1931; 26:905.
  10. McClure JG, Raney RB. Anomalies of the scapula. Clin Orthop Relat Res 1975; :22.
  11. Samilson RL. Congenital and developmental anomalies of the shoulder girdle. Orthop Clin North Am 1980; 11:219.
  12. Rockwood CA. The Shoulder, Saunders Elsevier, Philadelphia 2009.
  13. Mudge MK, Wood VE, Frykman GK. Rotator cuff tears associated with os acromiale. J Bone Joint Surg Am 1984; 66:427.
  14. Bigliani LU, Morrison DS, April EW. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans 1986; 10:228.
  15. Boehm TD, Rolf O, Martetschlaeger F, et al. Rotator cuff tears associated with os acromiale. Acta Orthop 2005; 76:241.
  16. Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med 2007; 35:316.
  17. Kim W, McKee MD. Management of acute clavicle fractures. Orthop Clin North Am 2008; 39:491.
  18. Willick SE, Sanders RK. Radiologic evaluation of the shoulder girdle. Phys Med Rehabil Clin N Am 2004; 15:373.