Shoulder Pain in the Overhead Athlete

Shoulder pain in overhead athletes is fairly common.  This is especially true for our young athletes.  Young children who participate in overhead sports are at risk for overuse injuries resulting in shoulder pain.   The shoulder of a child or young adult is at risk because they are still growing.   Shoulder pain in young overhead athletes will often respond to rest or physical therapy.

In time, many adolescent overhead athletes will experience shoulder pain. In the pediatric populations, the younger the child and the more aggressive the pursuit, the more likely there will be an episode of shoulder pain. These days it’s not uncommon for a young thrower to pitch for their town team and travel team, but also with their pitching coach or parent. Growing bones and ligaments are not always ready to handle that much stress.  When we discuss overhead athletes,  we’re not just talking about pitchers — we’re talking about pitchers, volleyball players, swimmers, track and field participants (javelin throwers), and gymnasts.

Shoulder Pain in Young Athletes

Most young athletes with shoulder pain fit into one of two broad category.  They can stress their bones and have stress fractures, or they can stress their soft tissues such as ligaments.

Unlike their adult counterparts, children rarely suffer from a rotator cuff problem.  After a long workout or a long game a child may have soreness due to inflammation of the rotator cuff- but that should subside over a day or two.

At this age, the injuries we typically see include stress fractures or stress reactions of the growth plate.  The growth plate at the top of the arm bone or humerus is the weakest point in the arm until your child finishes growing.   Identifying and treating(rest) these stress fractures is critical.  If the stress fracture heals there is a very good chance that your child will return to sports within a few months.  If this injury is missed it can result in chronic long term shoulder issues and pain. Any overhead athlete with shoulder pain for more than 7-10 days should have x-rays to look for a stress reaction or stress fracture.

Chronic repetitive stress injuries to the ligaments or labrum around the shoulder can lead to shoulder micro instability. This 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.  These athletes with shoulder pain due to subtle instability may also respond to physical therapy and then a guided throwing program.  Surgery to repair a labral tear or to tighten the ligaments in the shoulder may be necessary if the athlete does not respond to physical therapy.

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.