In time, most overhead athletes will experience shoulder pain. In the pediatric populations, the younger the child and the more aggressive the pursuit, the more likely there is to be an episode of shoulder pain. We're not just talking about pitchers -- we're talking about pitchers, volleyball players, swimmers, track and field participants, and gymnasts.

Unlike their adult counterparts, children rarely suffer from a rotator cuff problem. At this age, the injuries we typically see are stress fractures or stress reactions of the growth plate and chronic repetitive stress injuries to the ligaments around the shoulder, leading to instability. Instability can be very subtle. The shoulder doesn't need to dislocate for instability to be present. Subtle instability, which leads to subluxation of the joint, can lead to pain that is often misinterpreted by the untrained observer to be a rotator cuff strain. Gross instability, where the shoulder dislocates, is usually associated with a significant traumatic event or a unique form of instability known as multi-directinal instability, where all the ligaments around the shoulder are loose. Most chronic repetitive stress related episodes of instability are not associated with labral tears. The ligaments have simply stretched out.

As you observe your junior athletes ... if they appear to be suffering every time they use their shoulder, it may be time to visit an orthopedist. Many children will recover uneventfully from many overuse shoulder injuries, IF the injured athlete is examined and treated by an appropriately trained professional within a reasonable period of time.