Adolescent Shoulder Injuries: Consensus and Controversies
Dean C. Taylor, MD, Col (Ret); Kevin L. Krasinski, MD

Participation in athletics by adolescents continues to increase. Annually, approximately 45 million children and adolescents in the U.S. participate in organized youth athletics1. More than 7.3 million high-school athletes, representing >50% of the U.S. high-school population, participated in sports during the 2006-2007 school year. This was the eighteenth consecutive year in which participation had increased2. Little League Baseball recorded more than 2.6 million participants in 20073, and Pop Warner Football tallied 380,000 participants4. The increased involvement in athletics and the demands of sports on teenagers have been accompanied by a rise in injuries. High-school athletes sustain an estimated 2 million injuries annually, resulting in approximately 500,000 physician visits and 30,000 hospitalizations each year1.

There is a continuing trend for many young athletes to focus on a single sport and to subspecialize in that sport earlier in their careers. Countless athletes play on multiple teams, year-round, in a given sport with limited rest. This can place exceptional demands on the musculoskeletal system of these young athletes, especially the shoulders of athletes who perform overhead activities such as baseball pitchers.

In this lecture, we discuss the spectrum of traumatic and overuse shoulder injuries in adolescent athletes. The management of these injuries in this population requires special considerations and is not without debate. The current consensus and controversies will be explored.


Clavicular Fractures

The s-shaped clavicle is a strut connecting the shoulder girdle to the axial skeleton, and its superficial location makes it susceptible to injury. Clavicular fractures are common in children, accounting for 10% to 15% of fractures in that population. Up to 90% of these fractures occur in the midpart of the shaft of the bone. The vast majority of fractures are caused by a direct fall onto the lateral aspect of the …

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