Symptoms are always unilateral and should resolve within 15 minutes. It is paramount to assess the cervical spine for serious injury. Bilateral symptoms, lower extremity symptoms, persistent symptoms, or recurrent injury are all signs of more serious disease and may need a more extensive workup and cervical spine stabilization. Athletes may return to activity if there are no red flags on history or physical examination and the athlete has full pain-free range of motion and strength in the neck and affected extremity.
Shoulder dislocation is uncommon in childhood but becomes more frequent in adolescence. The younger the patient is at presentation, the more likely it is that the patient will have recurrent dislocation. Anterior dislocation is the most common. If assessment of the neurovascular status of the affected extremity reveals any compromise, urgent reduction is needed to prevent further complications. Patients will need radiographs to assess for fractures of the glenoid (Bankhart lesion) and humeral head (Hill-Sachs lesion). Most patients will require a brief period of protection in a sling or shoulder immobilizer, as well as pain control. As symptoms resolve, a gentle range-of-motion program, followed by an aggressive strengthening program, should be done. Recurrence occurs in nearly 90% of athletes participating in contact sports, so orthopedists consider surgical intervention early rather than awaiting further dislocation.
The incidence of overuse injuries is increasing because of increased opportunities for athletic participation as well as higher levels of intensity during sports. Overuse injuries are inflammatory responses in tendons and bursae that are subjected to repetitive motions and trauma (e.g., rotator cufftendinopathy in swimmers). These injuries are uncommon in children but may be seen in adolescents. Bony injury, such as physeal fractures and apophysitis, must be ruled out before making the diagnosis of a soft tissue overuse injury. Many overuse injuries in the shoulder, such as rotator cuff tendinopathy, are secondary to joint laxity.
The patient will often present with discomfort over the affected area that worsens with activity. Physical examination usually reveals tenderness to palpation and often weakness of the associated muscles due to pain. It is important to assess for glenohumeral stability. Radiographs may be indicated for acute trauma or when symptoms are not improving. Treatment consists of activity modification, icing, anti-inflammatory medication, and a physical therapy program aimed at strengthening, increasing flexibility, and improving posture.
Proximal humeral epiphysiolysis is commonly referred to as Little Leaguer’s shoulder. It most commonly occurs in 9to 14-year-olds who participate in overhead (tennis, volleyball) and throwing sports, particularly baseball pitchers. It is a stress injury that potentially can be a fracture (epiphysiolysis) of the proximal humeral physis. Most patients present with pain during or after throwing. There may be tenderness to palpation over the proximal humerus; if the athlete has been resting for a few days, examination may be normal. Radiographs should include comparison views to assess the physis. There may be widening of the proximal humeral physis in the affected arm, but the films may be normal. Treatment is rest from the offending activity, followed by a rehabilitation program designed to improve strength in the shoulder muscles. Pitchers should also be encouraged to follow youth pitching guidelines published by Little League baseball.
The elbow consists of three articulations: Ulnar-humeral jointRadial-humeral jointProximal radioulnar jointCollectively, these joints produce a hinge-type joint that allows for supination (palm up) and pronation (palm down) positioning of the hand. The elbow has excellent geometric stability, and the musculature around the elbow primarily produces flexion and extension.
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