Shoulder instability can affect children and teens who participate in sports, particularly activities that involve throwing, serving, swimming, or other repetitive overhead movements. The shoulder is one of the most mobile joints in the body, which allows young athletes to move their arms through a wide range of motion. That mobility also makes the shoulder more susceptible to instability and injury.
Shoulder instability can occur after an acute injury, such as a fall, direct contact, or forceful twisting of the arm. It can also develop from repetitive stress in athletes who repeatedly place high demands on the shoulder. In some cases, an injury may cause the shoulder to partially or completely slip out of its socket.
Because children and teens are still growing, shoulder injuries require careful evaluation of the developing musculoskeletal system. Identifying the cause of shoulder instability can help determine the appropriate treatment and support a safe return to sports.
What Is Shoulder Instability?
The shoulder joint is a ball-and-socket joint formed by the head of the humerus, or upper arm bone, and the glenoid, which is part of the shoulder blade. The shoulder has a very large range of motion, but it is also one of the more unstable joints in the body. Several structures work together to keep the shoulder stable. Strong ligaments help hold the ball in the socket, while the rotator cuff and other shoulder muscles help center the ball in the joint and assist with movement. The labrum is a rim of strong tissue around the socket that helps deepen the joint and improve stability.
When the shoulder is injured, the joint can dislocate or sublux. A shoulder dislocation occurs when the head of the humerus completely disengages from the socket. A subluxation occurs when the head of the humerus partially slips out of the socket and then returns on its own.
Shoulder instability may also occur when repetitive stress affects the structures that help stabilize the shoulder. This can be seen in young athletes involved in overhead sports, particularly throwing athletes.
What Causes Shoulder Instability in Young Athletes?
There is not one single cause of instability in young athletes. Shoulder instability can develop following an acute injury or as a result of repetitive stress. A shoulder may dislocate or sublux after a direct contact injury or a wrenching or twisting motion of the arm. In sports, this can happen when an athlete falls, is struck, or forcefully moves the upper arm.
Repetitive overhead activity can also place significant stress on the structures that stabilize the shoulder. Overhand throwing, for example, places extremely high stresses on the shoulder, particularly on the ligaments that help keep the shoulder stable in the socket. When these movements are repeated many times, they can contribute to a range of shoulder injuries, including instability.
Labral injuries can also be associated with instability. A labral injury may occur after an acute traumatic event such as a dislocation or from repetitive stress, as can occur in overhead athletes. Some people are also very flexible and may experience multiple episodes of shoulder dislocations or subluxations, even with relatively minor activities, because their ligaments are too loose.
Signs and Symptoms of Shoulder Instability
Symptoms can vary depending on how the instability developed and whether there has been an acute injury. A young athlete with a shoulder dislocation may experience severe pain, deformity, and an inability to move the arm. Numbness or weakness may also occur. With other forms of shoulder instability, symptoms may be less dramatic.
Young athletes may experience:
- Shoulder pain, particularly with overhead activities
- A feeling that the shoulder is unstable or loose
- A shoulder that slips partially or completely out of place
- Weakness or loss of strength
- Decreased range of motion
- In some cases, increased shoulder motion
- Catching, locking, or popping in the shoulder
- Pain with throwing or other sports activities
- A decline in athletic performance
A young athlete may also experience symptoms associated with an underlying labral injury. Labral tears can cause pain, particularly with overhead activities, along with feelings of instability, catching, locking, popping, loss of strength, or decreased range of motion. Pain with throwing is a primary symptom of many shoulder throwing injuries. In some cases, that pain can progress from occurring only during sports to interfering with activities of daily living.
Which Sports Put Young Athletes at Risk for Shoulder Instability?
Sports that require frequent overhead movement can place significant demands on the shoulder. These include:
- Baseball and softball
- Tennis
- Swimming
- Volleyball
- Gymnastics
- Cricket
- Other throwing and overhead sports
Throwing athletes are particularly susceptible because the shoulder is repeatedly moved through demanding positions at high speed. The forces involved in throwing place significant stress on the structures that help stabilize the shoulder.
Tennis players can experience similar stress from repeated serves and overhead strokes, while swimmers perform thousands of repetitive shoulder movements during training. Young athletes may also develop shoulder and elbow problems because the forces generated during throwing or serving travel through the entire upper extremity.
How is Shoulder Instability Diagnosed?
Diagnosis typically begins with a medical history and physical examination. A pediatric orthopedic specialist may ask how the injury occurred, when symptoms began, which activities cause pain, and whether the athlete participates in throwing or other repetitive overhead sports.
The physical examination may evaluate shoulder strength, stability, flexibility, and range of motion. The physician may also assess the movement of the shoulder blade and other areas of the upper extremity when appropriate.
Imaging may be used to further evaluate the shoulder. X-rays can help evaluate the shoulder’s bony structures and anatomy. Following a shoulder dislocation, X-rays may be taken after the joint has been put back into position to confirm that it has been properly relocated and to check for fractures. X-rays can also help determine whether a growth plate is involved.
Magnetic resonance imaging (MRI) may be recommended when additional information is needed. MRI can provide a more detailed look at soft tissue that may not be visible on X-rays alone. This can be particularly useful when a physician is evaluating for injuries involving the labrum or rotator cuff. A labral tear can often be suspected based on the history and physical examination and may be confirmed with an MRI or MRI arthrogram, which provides greater detail of the soft tissues.
How Is Shoulder Instability Treated in Children and Teens?
Treatment depends on the cause and severity of the injury and the individual needs of the young athlete. Treatment may begin without surgery. Depending on the injury, this can include temporary rest from the activity that causes pain, anti-inflammatory medication, immobilization with a sling or shoulder immobilizer, and physical therapy. After a shoulder dislocation, the shoulder is typically immobilized while it begins to heal. Physical therapy can then help the shoulder regain mobility, strength, and stability.
For shoulder throwing injuries, treatment often begins with temporarily avoiding the throwing motion. Physical therapy may be used to improve strength and stretch tight muscles, while evaluation of throwing mechanics can help address factors that may contribute to the problem.
When there is significant soft-tissue damage or conservative treatment is unsuccessful and the athlete continues to experience repeat episodes of instability, including subluxations or dislocations, surgery may be recommended to help stabilize the shoulder.
When surgery is appropriate, shoulder arthroscopy may be used for certain injuries. Shoulder arthroscopy is a minimally invasive procedure that uses a small camera and specialized instruments to examine and treat structures inside the joint. For labral injuries, the labrum can be repaired arthroscopically to help stabilize the shoulder.
Can Physical Therapy Help with Shoulder Instability?
Physical therapy can be an important part of treatment for instability in young athletes. After a shoulder dislocation, therapy can help restore mobility, strength, and stability. Rehabilitation may focus on strengthening the shoulder muscles that help stabilize the joint.
For athletes with throwing-related shoulder injuries, physical therapy can also address tight or weak muscles and help improve movement. Strengthening and stretching can help reduce the risk of recurrence when the athlete returns to throwing. Physical therapists may also evaluate throwing or movement mechanics. Addressing weaknesses, muscle imbalances, or changes in mechanics can help young athletes return to their sport with improved function. The specific therapy program depends on the athlete’s injury, symptoms, sport, and individual needs.
When Can Young Athletes Return to Sports?
Returning to sports should be based on the athlete’s recovery, treatment, and ability to safely perform the movements required by their sport. For throwing injuries, treatment may begin with temporary avoidance of the throwing motion. Physical therapy can help improve strength and flexibility before the athlete returns to throwing. The goal is not simply to have the pain disappear. The athlete should also regain appropriate strength, mobility, and shoulder stability before returning to the activities that place stress on the joint.
For athletes who require surgery, the recovery period depends on the specific injury and procedure. For example, athletes who undergo surgery for a labral tear are typically restricted from sports for a minimum of three to four months. Physical therapy follows the initial period of immobilization and focuses on restoring range of motion and strength. A pediatric orthopedic specialist can help determine when a young athlete is ready to progress back to sports based on the individual injury and recovery.
Can Shoulder Instability Lead to Repeated Dislocations?
In some young athletes, shoulder instability can become recurrent. Some people who are very flexible may experience multiple episodes of shoulder dislocations or subluxations because their ligaments are too loose. An athlete who has experienced a shoulder dislocation may also have soft-tissue damage involving structures such as the ligaments, cartilage, or rotator cuff.
Labral injuries can also be associated with shoulder instability. A Bankart tear, for example, is an injury to the front and lower portion of the labrum that is commonly seen following a shoulder dislocation. When significant soft-tissue damage is present, or when an athlete does not improve with conservative treatment and continues to have repeat episodes of instability, surgery may be recommended to help stabilize the shoulder. The goal of treatment is to restore stability and function so that the young athlete can safely return to activity.
When to See a Pediatric Orthopedic Specialist for Shoulder Instability
Shoulder symptoms should not simply be played through when they persist, repeatedly return, or interfere with sports or everyday activities. An orthopedic evaluation may be appropriate if a child or teen has:
- Persistent or recurring shoulder pain
- A feeling that the shoulder is unstable
- A shoulder that repeatedly slips out of place
- Weakness or loss of strength
- Loss of normal range of motion
- Catching, locking, or popping
- Difficulty moving the arm
- A decline in throwing or athletic performance
- Symptoms that continue despite rest
- Repeated shoulder dislocations or subluxations
Children and teens are not simply smaller adults. Their bones, joints, and growth plates are still developing, and pediatric orthopedic specialists consider growth and skeletal development when evaluating and treating injuries. Early evaluation can help identify the source of shoulder instability and determine whether rest, physical therapy, or other treatment is appropriate.
Schedule a Consultation with The Pediatric Orthopedic Center
At The Pediatric Orthopedic Center, our pediatric orthopedic specialists evaluate and treat shoulder injuries and instability in children, teens, and young athletes. Our approach considers the child’s age, growth, activity level, sport, symptoms, and the structures involved in the injury.
Treatment is individualized, with non-operative care emphasized whenever appropriate. When additional treatment is necessary, our team can evaluate the injury and develop a plan to help restore function and support a safe return to activity.
If your child has persistent or recurring shoulder pain, weakness, loss of motion, a feeling of instability, or repeated shoulder dislocations or subluxations, an evaluation can help identify the cause and determine the appropriate next steps.
To schedule an appointment at The Pediatric Orthopedic Center, contact our office or request an appointment online.
This page is for general educational purposes and is not intended to replace professional medical advice, diagnosis, or treatment.
