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Shoulder

The shoulder is the portion of the body that joins the arm to the chest and back. As the most mobile joint in the body, it has the largest range of movement and helps control the arm. Our shoulders allow us to reach overhead and in front of and behind us.

Shoulder anatomy:

  • The upper arm bone (humerus) rests in a cup-like bone called the glenoid.
  • The shoulder blade (scapula) sits behind the glenoid, and the collarbone comes over the top.
  • The point where all these bones come together, along with the surrounding muscles, is the shoulder.

There are several components that help stabilize the shoulder, including:

  • Rotator cuff: The rotator cuff is a group of muscles and tendons that surround the shoulder. These muscles help stabilize your shoulder during activities like throwing.
  • Labrum: The labrum is a thin rim of cartilage that helps secure the ball at the top of the arm bone (humeral head) in the glenoid socket. This fence-like tissue provides depth to the glenoid, helping keep the humeral head in the center of the socket.
  • Shoulder capsule: The shoulder capsule is a thin sheet of connective tissue that surrounds the humeral head and attaches to the glenoid rim. There are four major ligaments in the capsule that work to keep the humeral head centered on the glenoid while making overhead motions.
  • Dynamic stabilizers: Dynamic stabilizers are a group of muscles that include the rotator cuff, biceps and scapular stabilizers. These muscles move the shoulder through elevation and rotation and help the labrum and capsule stabilize the humeral head in the center of the socket. They also keep the shoulder blade moving smoothly during overhead motions. In other words, dynamic stabilizers allow you to move your arm in an overhead motion quickly, such as when you throw a ball, and keep you from dislocating your shoulder during the process.

Collarbone (clavicle)

Better known as the collarbone, the clavicle is the bone in your chest just below the skin that connects your breastbone to your shoulder and arm.

Collarbone anatomy

The collarbone is surrounded by several muscles and important structures. The shoulder, including the deltoid and trapezius, surround the clavicle on the outside and behind it. The important connective structures, known as the coracoid and trapezoid ligaments, attach the collarbone to the coracoid (a bone that helps stabilize the shoulder joint).

Underneath the collarbone, there are vital blood vessels that supply the rest of the upper body. The lungs are also below the collarbone.

There are several types of fractures and joint injuries that can affect shoulders and cause pain for kids and teens. Some of the common injuries we see include:

A broken shoulder typically refers to a broken bone in the upper portion of the arm (humerus). These fractures tend to heal quickly on their own. A specialized sling is worn to keep the arm in a steady position. Rarely, surgery is required to repair a humeral fracture.

There are three types of broken shoulder injuries, including:

Acromioclavicular (AC) joint injuries

The AC joint has two key groups of ligaments that help support it. The AC ligament runs side to side, and a pair of coracoclavicular (CC) ligaments help stabilize the joint from top to bottom. AC joint injuries are usually caused by direct trauma to the shoulder.

Treatment depends on the severity of the injury. Your child’s doctor will usually take an X-ray to see if the collarbone is displaced. Most of the time, AC joint injuries do not require surgery, except in severe cases.

Proximal humeral physeal fractures

Injuries to the growth plate of the humerus (upper arm bone) can happen from overuse or after a traumatic event. But since children’s bones grow quickly, children can usually fully recover without surgery. Breaks can be located through, above, below, or both above and below the growth plate. If your child has a severe fracture in which the bones are now far apart, your doctor may recommend surgery using pins, plates and screws, or a rod that goes into the arm bone to stabilize the break until it heals.

Humeral shaft fractures

Breaks in the middle of the upper arm bone are often due to trauma, such as car accidents or falls. And with this type of fracture, there is also a risk of injury to one of the nerves in the arm. Your doctor will perform a thorough physical exam during the initial evaluation and throughout the course of your child’s treatment to determine whether this is present. These breaks often don’t require surgery and can be treated with immobilization. Initially, the injured arm is placed in a splint and a sling. Typically, one to two weeks later, and once the initial swelling has gone down, your child can be transitioned into a Sarmiento brace, which secures the arm and compresses the soft tissues.

Dislocated shoulders happen when your child’s arm is pulled up or backward and forced out of the socket. They may also occur when falling on the shoulder or an outstretched hand.

The upper arm bone (humerus) fits into the shoulder socket (glenoid). The joint is held in place by soft tissue, which includes cartilage attached to the shoulder socket (labral cartilage), connective tissue and rotator cuff muscles. In a dislocated shoulder injury, these tissues are stretched or torn.

What are symptoms of a dislocated shoulder?

The main symptom of this injury is severe pain that gets worse with movement, but there are others, including an appearance of a lump sitting outside the shoulder joint and numbness in the upper arm caused by stretching of nerves.

How is a dislocated shoulder treated?

Treatment for a dislocated shoulder involves a doctor putting the arm back in the joint. Your child’s pain should then mostly subside, but you can continue to apply ice as needed for pain and swelling. The injured shoulder will be placed in a sling to prevent movement and promote healing during a period of rest. After that, physical therapy exercises will be prescribed to stabilize the shoulder and hopefully prevent reinjury. If the shoulder continues to dislocate, surgery may be necessary.

The rotator cuff is a group of four muscles that surround the shoulder and help stabilize it during overhead activities. Rotator cuff tendonitis causes pain and inflammation in the tendons of the rotator cuff and is typically caused by repetitive activities like throwing. It can usually be treated with rest, along with ice and anti-inflammatory medication. If your child continues to use his shoulder with rotator cuff tendonitis, there’s a risk of a rotator cuff tear.

Shoulder impingement, sometimes called subacromial impingement, is the most common cause of shoulder pain and is usually most noticeable during overhead activities like throwing.

How is shoulder impingement diagnosed?

A doctor trained to treat shoulder problems, such as an orthopedic surgeon, will test your child’s range of motion, strength and stability during a physical exam. An X-ray may be ordered to see if there are other bone problems, such as fractures or growth plate injuries. An MRI can also help pinpoint injuries to the shoulder joint or tears in the cartilage.

How is shoulder impingement treated?

Your child will participate in modified workouts and rest the shoulder until the pain is gone. Ice and anti-inflammatory medication can help ease the pain. Physical therapy for six to eight weeks to help improve strength, range of motion and stability may also be ordered by your child’s doctor. If your child’s shoulder is not showing improvement within four to six months, your doctor may recommend surgery.

How can you prevent shoulder impingement?

If your child is playing sports, he needs to stop playing or practicing if he has shoulder pain. Here are some tips to prevent shoulder impingement for specific sports:

  • Baseball or softball o Change positions for easier throws.
    • Avoid overuse.
    • Have an expert assess your child’s throwing motion.
    • Hit only if it doesn’t make the pain worse.
  • Tennis
    • Reduce overhead motion because it can cause more stress on the shoulder than ground strokes.
    • Reduce serves and overhead shots.
  • Swimming
    • Train in the slower lane to help reduce pain.
    • Stop land workouts or exercises if they overwork your child’s painful shoulder.
    • Don’t use aids like kickboards if they cause pain.
    • Avoid stretching with a partner because this can overstretch the shoulder and cause injury.
    • Have a coach evaluate stroke mechanics.
  • Volleyball
    • Avoid hitting, serving and repetitive setting if it causes pain.
  • Gymnastics and cheerleading
    • Avoid handsprings, tumbling passes, walkovers or other weight-bearing stunts.
    • Avoid handstands, pushups, punches and giants if they cause pain.

When rotator cuff muscles are overused, they may not be able to effectively stabilize the shoulder—leading to pain and inflammation. This condition, called glenohumeral instability, is common in baseball and volleyball players.

How is glenohumeral instability diagnosed?

Young athletes with glenohumeral instability will complain of pain in the front, back, top or inside of the shoulder during overhead activities like throwing a ball. There may also be a sense of “shifting” or “popping.”

How is glenohumeral instability treated?

Treatment of glenohumeral instability may include:

  • Reducing or eliminating painful activities until the pain is gone.
  • Using ice and anti-inflammatory medication can help control pain.
  • Physical therapy to provide the best chance for a full recovery. Your physical therapist will help you regain strength and evaluate your throwing motion to identify and correct any issues that may be straining your shoulder. Physical therapy typically lasts six to eight weeks.
  • Surgery; in extreme cases, surgery may be needed.

Little League shoulder is an overuse injury seen often in growing athletes, especially young pitchers. Repetitive overhead motions like throwing can cause pain and damage to a child’s growth plate. Sometimes, there will also be swelling near the shoulder.

Little League shoulder is typically diagnosed during a physical exam, and an X-ray may be ordered to check for widening of the growth plate.

How is Little League shoulder treated?

The best way to treat this condition is with rest, ice and anti-inflammatory medication. Throwing and batting are typically limited for six to eight weeks, and a sling may be used to limit motion. Once the growth plate has healed and the pain is gone, physical therapy may be required to help restore your child’s strength and range of motion and to help guide a gradual return to full throwing.

How can you prevent Little League shoulder?

You can help your child prevent Little League shoulder by teaching the proper mechanics, limiting the number of pitches and throws, and making sure not to throw breaking pitches until the bones are mature enough for it—usually around age 13 or 14.

Because the collarbone (clavicle) is just below the skin’s surface, injuries are common. Fractures often occur after a fall off a bicycle or similar impact. Since the body begins to heal fractures very quickly, an orthopedic specialist should examine your child within seven days if you suspect a broken collarbone. If you allow the bone to begin healing improperly, it can create lasting problems.

How is a broken collarbone treated?

Treatment for a broken collarbone depends on the location and severity of the break. Fractures in younger children often heal in a few weeks with the use of a sling. In adolescents, if the bones are separated far from each other or are coming through the skin, your doctor may recommend surgery to bring the bones together. Athletes who do not require surgery will likely wear a sling to support their arm. Most collarbone injuries are treated without surgery, but sometimes surgery is needed to give the best chance for a full recovery.

Is a broken collarbone painful?

It’s common to have pain and discomfort for the first seven to 10 days after a collarbone injury.

To relieve pain, you can:

  • Apply an ice pack to your child’s shoulder. Make sure it’s not too heavy, and place a towel between the skin and ice pack to avoid irritation.
  • Have your child rest in an upright position (for example, in a reclining chair or propped up with multiple pillows).
  • Ask your child’s doctor about over-the-counter or prescription pain medication.

Will the bump on my child’s healed collarbone go away?

When a bone heals, new bone (callous) forms around the area of the break. This usually creates a bump that shrinks over time, but it will most likely always be there. Callouses rarely cause problems.

This content is general information and is not specific medical advice. Always consult with a doctor or healthcare provider if you have any questions or concerns about the health of a child. In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away. Some physicians and affiliated healthcare professionals on the Children’s Healthcare of Atlanta team are independent providers and are not our employees.