Identifying Acute and Overuse Injuries of the Shoulder in Pediatric Sports

Abstract Acute and overuse shoulder injuries in pediatric sports have become more prevalent (seen in almost 40% of baseball pitchers) due to multiple factors such as increased participation in athletic events and games played, less recovery time, and sport specialization (i.e., intense year-round focus on a single sport). The differential is broad when approaching a pediatric athlete with shoulder pain. To complicate things, pediatric athletes are prone to conditions that are not typical in adults, such as proximal humeral epiphysiolysis or Little League shoulder (LLS). It is important to include brachial plexopathy and thoracic outlet syndrome in this differential due to different management strategies. Overall, this age group has a predilection for fractures and sprains as opposed to ligamentous or tendinous damage when insults to the shoulder occur owing to skeletal immaturity. The search was conducted on PubMed (from January 2010 to July 2025) and Scopus (from January 2023 to September 2025) producing a total of 178 reference (82 were included in this review); additional relevant references published before 2010 were also included. Although each shoulder injury presenting in an athlete may be distinct, this narrative review will demonstrate how these pathologies are closely related, how to approach diagnosis, and discuss the evidence and expectations for return to play.