Journal of the Pediatric Orthopaedic Society of North America · Published 2026-03-17 · DOI 10.1016/j.jposna.2026.100361
In addition to a thorough history, a systematic approach to the shoulder exam is critical to understanding dysfunction in the shoulder in an adolescent athlete. Similar to other orthopaedic joint exams, a progression through inspection, palpation, strength, range of motion, and special testing can make a complex exam more efficient and reproducible. Specific to adolescents, shoulder complaints often result from physeal stress injuries, apophysitis, or hyperlaxity-related instability, conditions that are absent in skeletally mature patients. It is essential to recognize specific characteristics of the adolescent shoulder to distinguish them from pathologies commonly seen in adults. Familiarity with these diagnoses and appropriate tests can help the practitioner determine a reliable diagnosis and an optimal treatment plan. Key Concepts: (1) History and mechanism of injury will direct a more focused exam. (2) In adolescents, injuries involving the physis or apophysis are common, so clinical signs like physeal tenderness or pain caused by rotational movement should take priority over diagnoses usually found in adults. (3) The apprehension and relocation tests serve as the principal assessments for anterior traumatic unidirectional shoulder instability, whereas the load and shift test is particularly valuable in the evaluation of patients presenting with multidirectional instability. (4) Examination of throwing-shoulder pathology should not be limited to the shoulder alone as etiologies may stem from poor throwing mechanics, imbalances in the kinetic chain, or underlying scapular dysfunction. (5) Proper understanding and evaluation of scapular dysfunction are critical in a growing athlete to prevent recurrence of shoulder pain.
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