Shoulder pain in children

Overview

Shoulder pain in children is discomfort, aching, or soreness around the shoulder joint or the muscles and tendons that support it. It can happen suddenly after an injury or come on slowly from overuse.

Yes, shoulder pain is quite common in children, especially those who are active in sports or playground activities.

It can affect children of any age, but it happens most often in school-age children and teenagers who play contact sports, do throwing sports, or use climbing equipment.

Symptoms

Common symptoms

• Pain or ache in the shoulder, arm, or upper back
• Swelling or redness around the shoulder joint
• Stiffness or difficulty moving the arm
• Tenderness when touching the shoulder

Symptoms in children

• Not wanting to use the affected arm (known as 'pseudoparalysis')
• Crying or fussing when the arm is moved
• Holding the arm close to the body
• Avoiding activities they normally enjoy

Causes

Main causes

• Injury from falls, sports collisions, or playground accidents (e.g., landing on an outstretched hand)
• Overuse from repetitive activities like throwing, swimming, or climbing
• Infection of the shoulder joint or surrounding tissue (septic arthritis or osteomyelitis)
• Referred pain from the neck, such as a neck muscle strain or spine issue

Risk factors

• Playing contact sports (e.g., rugby, football, wrestling)
• Repetitive overhead motions (e.g., baseball pitching, tennis, swimming)
• Recent illness that may weaken the immune system
• Young age – young children have weaker shoulder structures and may fall more often

When to see a doctor

See a doctor urgently if:

• If the child has a fever with shoulder pain or swelling
• If the child cannot move the arm at all
• If the pain is severe or follows a bad injury
• If the shoulder looks deformed or out of place

Book a routine appointment if:

• If the pain lasts more than a week with home care
• If the child continues to avoid using the arm after a few days
• If you are worried about a possible injury that is not healing

Diagnosis

A doctor or paediatrician will ask about how the pain started, examine the shoulder, and check movement and strength. They will feel for swelling, warmth, and tenderness.

Tests that may be done

• X-ray to look for fractures or dislocations
• Ultrasound to see soft tissues like tendons or fluid
• MRI (magnetic resonance imaging) if the cause is not clear after other tests
• Blood tests if an infection is suspected

What to expect at your appointment

The doctor will gently move your child's arm in different directions and press on parts of the shoulder. For imaging tests, the child will need to lie still for a short time. The doctor will explain the findings and recommend treatment.

Treatment

Treatment depends on the cause. Most shoulder pain in children is treated with rest, ice, and time. If the pain is from a specific condition, the doctor will guide you on the best course, which may include physical therapy or, rarely, surgery.

Self-care at home

• Rest the shoulder for a day or two – avoid activities that cause pain
• Apply an ice pack wrapped in a cloth for 15–20 minutes several times a day
• Give over-the-counter pain relievers suitable for children (always follow the dose instructions on the pack)
• Encourage gentle movement as pain improves, like slowly raising the arm

Medical treatments

A doctor may recommend physiotherapy (exercises to strengthen and stretch the muscles around the shoulder). In some cases, they might suggest a referral to a paediatric orthopaedic specialist. If there is an infection, antibiotics will be needed. Never give a child aspirin unless prescribed by a doctor.

When is surgery considered?

Surgery is rarely needed for shoulder pain in children. It may be considered for a fracture that does not heal properly, a dislocated shoulder that keeps happening, or an infection that does not respond to antibiotics. Your doctor will discuss all options with you.

Living with this condition

Most children return to normal activities within a few days to a couple of weeks. Encourage them to rest and avoid sports or rough play until the pain is gone. Gradually increase activity as the shoulder feels better.

Lifestyle tips

• Make sure your child uses proper technique in sports – poor form can strain the shoulder
• Warm up before sports with gentle stretches and light activity
• Take breaks during repetitive activities, like throwing or swimming
• Carry school bags on both shoulders to avoid straining one side

Diet and exercise

A balanced diet with enough calcium and vitamin D helps keep bones and joints healthy. Once the pain resolves, gentle exercises such as swimming or light stretching can strengthen the shoulder without overloading it.

Mental health and emotional wellbeing

Chronic pain or being unable to play can sometimes make children feel frustrated or sad. Talk to your child about their feelings. Reassure them that they will get better. If signs of worry or low mood continue, speak to your doctor or a school counsellor.

Prevention

Many cases can be prevented or the risk lowered by teaching children safe ways to fall, using proper sports equipment, and avoiding overtraining. Encourage good posture and balanced activity.

Complications

If left untreated

• Chronic pain that lasts for months
• Stiffness in the shoulder joint (frozen shoulder)
• Delayed healing of a fracture or dislocation
• Spread of infection if not treated promptly

Long-term outlook

The outlook for children with shoulder pain is excellent. With rest and proper care, most children recover fully within a few weeks. Even more serious problems like fractures or infections usually heal well with timely medical treatment.

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