Uncommon in young children, common in teenagersStrong evidence
Few children see a doctor for shoulder pain, especially when they're young. In 12 English general practices, shoulder problems were the least common of 12 body areas that children aged 3 to 17 consulted for: 13 consultations per 10,000 children a year, against about 100 each for the foot, the knee and the back. In boys the rate rose from none at 3 to 5 to 13 per 10,000 at 10 to 13. Most broken bones are seen in A&E rather than general practice, so these figures undercount injuries.
By the teens it is common. In 2,953 Danish 12 to 19 year olds, 13.3% had shoulder pain when asked, third after the knee and the back, and over a quarter of those had it almost every day. In a UK study of 2,901 young people, 9.5% had at least moderately troublesome shoulder pain at nearly 18, second only to the lower back. Figures vary widely with how pain is counted, from 6% to 63% across studies of 10 to 19 year olds, and some "shoulder" pain may really be the neck or upper back. In children up to about 12, wrist, hand and finger complaints outnumber shoulder ones, and most arm complaints at that age follow an injury.
Sources 1, 2, 3, 4
Overhead sport and swimming raise itStrong evidence
Shoulder pain is common in young athletes who throw, serve or swim. Surveys found it in 43.5% of 310 Brazilian athletes aged 10 to 19, and shoulder overuse injuries in 31.3% of 434 young athletes in Singapore, more often in older teenagers. Over a season, 23% of 471 Swedish elite handball players aged 15 to 18 had shoulder problems that cut their training or performance, more girls than boys, and half of 476 US pitchers aged 9 to 14 had elbow or shoulder pain during one season.
Swimmers report it most. Across 12 studies of 1,460 competitive swimmers, 91.3% of 15 to 17 year olds had had shoulder pain, and they trained the most, about 17 hours a week. About 1 in 5 female competitive swimmers had shoulder pain with disability, whether aged 8 to 11, 12 to 14 or of high school age. In 80 young elite swimmers aged 13 to 25, 91% had shoulder pain, and scans showed an overloaded tendon at the top of the shoulder in 69% of those scanned, linked to how much they swam. Most teenage club swimmers thought mild to moderate shoulder pain was normal, and 73% used painkillers to keep swimming.
These are links, not proven causes: being an older teenager, training more, specialising in one sport (1.81 times the risk of an overuse injury in highly specialised young athletes, pooling studies), throwing with arm pain or when tired, and very flexible joints, which went with 1.68 times the odds of troublesome shoulder pain at nearly 18 in the UK study.
Sources 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 3
The usual causes change with ageEmerging evidence
Babies: a collarbone broken at birth affected 0.23% of 1,224,709 Swedish babies born at full term between 2010 and 2022, and a stretched nerve in the neck and shoulder (a brachial plexus birth injury, or Erb's palsy) 0.13%, both becoming less common over that time. Most collarbones broken at birth heal without long-term problems, and about 85 in 100 babies with Erb's palsy recover fully, mild cases within 1 to 8 weeks, an NHS trust leaflet says.
Toddlers and young children: falls cause most broken bones, most often from below bed height (under 1 metre). A young child who won't use an arm after a pull on the hand may have a pulled elbow, which our children's elbow guide covers. Rarely, a young child stops using an arm because of a bone or joint infection: bone infection affects about 13 in 100,000 children a year in Norway, about 3 times as often under 3, and the shoulder is an uncommon site.
School-age children: a broken collarbone is one of the commonest breaks, 11% of all fractures in Swedish 0 to 19 year olds, second only to the wrist end of the forearm (26%). Breaks at the top of the arm bone are about 2% to 3%, and the growth plate there makes most of the bone's growth, so these breaks remodel strongly.
Teenagers: sport takes over. Little League shoulder, a stress injury of the growth plate at the top of the arm bone, mostly affects young pitchers around 12 to 13; swimmers and other overhead athletes overload the rotator cuff, the muscles that hold and turn the shoulder; and a shoulder can dislocate in a fall or a tackle (2.5 in 100,000 children aged 14 and under a year in Edinburgh, average age 12, mostly boys). A shoulder that slips without an injury, mostly in people under 25 and often with very flexible joints, is a different problem with a different treatment.
Sources 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25
A dislocated shoulder often comes out again in teenagers, though figures varyMixed evidence
How often a shoulder dislocates again after the first time depends on age, and studies give different figures. Pooling 6 retrospective studies of mixed quality in children aged 18 and under, 73% dislocated again: 93% of those aged 14 to 18, against 40% of those aged 13 and under. In 41 children aged 14 and under seen in Edinburgh over 11 years, 18 (43.9%) dislocated again, a median of 14.7 months later, more often once their growth plates had closed (12 of 17, against 6 of 24 whose growth plates were still open), and 1 in 5 had an operation to stabilise the shoulder.
The UK care pathway from the British Elbow and Shoulder Society and the British Orthopaedic Association gives estimated chances from a modelled table: 86% for a 15 year old boy and 54% for a 15 year old girl within 2 years of a first dislocation, and it says almost 90% of repeat dislocations happen within 2 years. So a teenager's shoulder may well come out again, especially an older teenage boy's. Physiotherapy, then a specialist's view if it keeps happening, is what matters, and the NHS says surgery is sometimes needed to reduce the risk.
Sources 26, 24, 27, 28
Pain from somewhere else: uncommon, with clear cluesEmerging evidence
A burning, electric or dead arm straight after a tackle or a fall is usually a stinger, a stretched or pinched nerve in the neck, which often lasts seconds to minutes. A trapped nerve in the neck causing arm pain and pins and needles is uncommon in teenagers: in a US population study, the average age was about 48.
Rarely, pain is felt in the shoulder from the chest or the tummy. A collapsed lung (pneumothorax) brings a sudden, sharp, stabbing chest or shoulder pain that is worse breathing in, with breathlessness; fewer than 1 in 2,000 people aged 15 and over go to hospital with one each year, and it is more common at 15 to 34, in people who smoke and in tall, thin people. In a teenage girl who could be pregnant, shoulder tip pain with sudden tummy pain or fainting can mean bleeding from an ectopic pregnancy, the only shoulder tip pain the NHS describes. Severe tummy pain, or pain behind the left ribs after a blow, needs 999 or A&E. The NHS pneumonia and spleen pages don't mention shoulder pain, and pneumonia showing as tummy pain in children appears only in case reports, so these links are rare.
Sources 29, 30, 31, 32, 33, 34, 35, 36
Infection, arthritis and bone tumours: rare, and the signs that matterStrong evidence
Bone and joint infections are rare, and the shoulder is an uncommon site. In 22 children with an infected shoulder joint, using the arm less was the commonest sign (59%), and the first X-rays were often normal; a small series found it from 1 month to 15 years old. The NHS says take a child to a GP if they don't want to use an arm or leg and seem irritable, because young children don't always get a high temperature with a bone infection.
Juvenile arthritis affects at least 10,000 under 16s in the UK, more often girls, often starting between 2 and 10, with swollen, stiff joints that are worse in the morning or after rest; Arthritis UK's list of joints starts with the hands, wrists and elbows.
Bone tumours are rare: about 35 children under 15 in the UK develop osteosarcoma each year, most often around the knee and shoulder, and about 30 develop Ewing sarcoma. The pain comes and goes at first, then becomes constant and is often worse at night, sometimes with swelling, or a break after a minor fall. A harmless bone cyst, mostly found in children and almost 90% in the top of the arm or thigh bone, is usually painless until it breaks, and most go by the end of growth. Leukaemia can start with limb pain (43% of children at diagnosis, in a review of 33 studies), often alongside looking pale, tiredness, fevers or bruising easily. The National Institute for Health and Care Excellence (NICE) asks GPs to arrange a very urgent blood test for persistent or unexplained bone pain in a child, and to consider a very urgent X-ray.
Growing pains are leg pains in 3 to 12 year olds, in both legs, in the evening or at night; the NHS doesn't describe them in the arms, so shoulder pain shouldn't be put down to growing pains.
Sources 19, 20, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47
When a scan or test helpsStrong evidence
Usually not at all: ordinary shoulder pain without an injury or warning signs is recognised from the story and an examination, and NHS inform says new shoulder pain often settles within 6 weeks (advice written for adults).
After a fall, an X-ray checks for a broken collarbone or upper arm, and usually a dislocation; the NHS says a broken collarbone needs to be treated in hospital. A young thrower's growth plate is checked with X-rays of both shoulders, used in 20 of 23 studies, but a widened growth plate also shows in throwers without pain, so the X-ray is read alongside the symptoms. A magnetic resonance imaging (MRI) scan helps if a shoulder keeps dislocating; for a shoulder that slips without an injury, the UK pathway says scans aren't needed in primary care, as X-rays are often unhelpful.
A suspected infection is checked in hospital with blood tests and an X-ray, then an MRI scan, ideally within 48 hours, and an infected joint is washed out, ideally within 24 hours; the first X-ray was normal in 12 of 22 children with an infected shoulder. Unexplained bone pain or swelling needs a very urgent X-ray, NICE says.
Sources 48, 49, 50, 28, 23, 51, 25, 52, 20, 46
How it usually goesEmerging evidence
A broken collarbone: children often recover in 3 to 4 weeks, the NHS says. Children's leaflets expect good movement by 2 to 4 weeks and usual sport at about 6 weeks, with a small risk of injury for up to 12 weeks; the bump over the break usually goes within a year in young children, while over 10 some thickening may last. In teenagers with completely displaced breaks, the bone failed to join in 0.4% and broke again in 2.6% over 2 years. A break at the top of the arm bone remodels strongly as children grow, and treatment without surgery rarely leaves lasting problems.
Little League shoulder: symptoms settled at about 2.6 months, and children were back competing at about 3 to 4 months in US and Japanese series; pain came back in 7% to 25%. A dislocation takes 6 to 12 weeks to recover, and up to 16 weeks before some sports, the NHS says, and a teenager's shoulder may come out again. A shoulder that slips without an injury usually improves with physiotherapy, though it can take up to 6 months.
Most babies with Erb's palsy recover fully, a bone infection treated within 3 to 5 days often clears up completely, and harmless bone cysts mostly go by the end of growth. No one can promise a timescale.
Sources 49, 53, 54, 55, 21, 22, 56, 23, 28, 25, 16, 38, 43
