As pediatric sports participation increases, shoulder injuries in children and adolescents are becoming increasingly more common. In general, shoulder injuries fall into two categories: overuse injuries and traumatic injuries. The unique anatomy of the child and adolescent shoulder leads to a predictable pattern of injury. In addition, congenital anomalies can predispose a patient to certain injuries as well. The children’s orthopedist or sports medicine physician must understand the unique anatomy of the child’s shoulder in order to effectively treat the maladies of the immature shoulder. This chapter will review relevant development and anatomy of the immature shoulder as well as discuss several common injuries that arise in this unique population.