Shoulder

Little Leaguer's Shoulder

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Little Leaguer's Shoulder, Little League Shoulder, Proximal Humeral Epiphysitis, Proximal Humeral Epiphysiolysis

  • See Also
  1. Pediatric Sports Overuse Injury
  • Definitions
  1. Little League Shoulder
    1. Proximal Humerus physis injury with open Growth Plate
  • Epidemiology
  1. Age distribution: 9 to 16 years old (peak age 13 years old)
  2. Gender: More common in young males
  3. Most common occurence in young pitchers
    1. Especially with breaking pitches (e.g. curve balls)
  4. Aklso seen in young athletes involved with overhead activity
    1. Racquet sports (e.g. Tennis)
    2. Volleyball
    3. Baseball
    4. Swimming
    5. Gymnastics
  • Pathophysiology
  1. Stress injury to proximal humeral physis
  2. Injury secondary to throwing sports (esp. pitching)
    1. Stress occurs before Growth Plate closure
      1. Stress transmitted to proximal physis of Humerus
    2. Contrast with after Growth Plate closure (adults)
      1. Stress transmitted to rotator cuff
  • Symptoms
  1. Gradual pain onset (often over months)
  2. Diffuse proximal Shoulder Pain
    1. Pain typically localizes to lateral proximal Humerus
  3. Pain provoked by overhead activity (e.g. throwing)
    1. Associated with decreased throwing velocity and accuracy
  • Signs
  1. Tenderness over proximal lateral Humerus
  2. Pain limits Shoulder Range of Motion (esp. Shoulder flexion and rotation)
  • Imaging
  1. Bilateral three view Shoulder XRay (comparison)
    1. Proximal Humerus physis widening on affected side
  2. Other imaging (e.g. MRI) only needed in uncertain cases
  • Management
  1. See Prevention below
  2. Complete rest from throwing for 3 to 4 months (anticipate 4 to 6 months until full resolution)
  3. Strengthening Exercises via physical therapy when pain decreased
  4. Throwing Exercises in intervals once pain-free
  • Prevention
  1. Allow for adequate recovery between outings
  2. Consider throwing biomechanics evaluation
    1. Evaluate throwing technique
    2. Generate power from lower body
  3. Core Muscle Strengthening (esp. abdominal Muscles, quadriceps)
  4. Stretching Program (Shoulder, thorax)
  5. New guidelines recommend no throwing for 3-4 months (2 contiguous months) of every year
  6. Limit number of pitches per week and per outing
    1. Guidelines adjusted for age and pitch type
    2. AAP: 200 pitches/week and 90 pitches/outing
    3. USA-BMSAC: 125 pitches/week and 75 pitches/outing
  • References
  1. Carson (1998) Am J Sports Med 26:575-80 [PubMed]
  2. Cassas (2006) Am Fam Physician 73:1014-22 [PubMed]
  3. Lintner (2023) Am Fam Physician 108(6): 544-553 [PubMed]