Shoulder pain

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LateralityChoose oneFirst line

Findings presentChoose any

Findings absentChoose any

Neck examChoose one

Likely causeChoose one

ImagingChoose one

PlanChoose any

ThrowingChoose any

Pitch countsChoose any

SupportChoose any

Physical therapyChoose any

ReferralChoose one

DispositionChoose one

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Counseling paragraphChoose oneParagraph

CounselingNot in the note with these choices

Discussed the need for emergency evaluation today. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Shoulder pain
• No bony tenderness, deformity, or instability
• Neck exam normal
• Exam reassuring; x-ray deferred after shared decision making
• Relative rest from overhead and throwing activities that cause pain
• Home rotator cuff and shoulder blade strengthening exercises
• Physical therapy referral
• Follow up if worsening or not improving

Most shoulder pain in active children comes from overuse and improves over a few weeks with rest from painful activities and strengthening exercises. Recommended supportive care with ice and tylenol or motrin as needed, with an emphasis on the home strengthening exercises and a gradual return to sports. Return precautions given including weakness, numbness or tingling, a shoulder that slips out of place, night pain, pain that keeps getting worse, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Bony tenderness, deformity, instability present or absent
Neck exam (referred pain)
Likely cause: rotator cuff, impingement, little league shoulder, AC sprain, instability, strain, referred from the neck
Defer x-ray; x-ray given exam; comparison views
Relative rest; rotator cuff and scapular exercises
Rest from throwing, return-to-throw; pitch counts
PT, orthopedics

Return precautions in the template

weaknessnumbness or tinglinga shoulder that slips out of placenight painpain that keeps getting worse

Sources

Sport-Related Concussion in Children and Adolescents. Clinical Report. Pediatrics 2018;142(6):e20183074. (newest AAP concussion CR found; also Early Childhood…
Overuse Injuries, Overtraining, and Burnout in Young Athletes. Clinical Report. Pediatrics 2024;153(2):e2023065129. (replaces earlier report)
Early Childhood Concussion. State-of-the-art review. Pediatrics 2024;154(5):e2023065484 (not an AAP policy)
The Cribsiders #86: , #94 Overuse Injuries

Few formal guidelines cover this topic, so the template also leans on expert opinion.