Little Leaguer's Shoulder

Abstract

Twenty-three cases of Little Leaguer's shoulder were reviewed including the history and physical examination findings, as well as bilateral internal and external rotation anteroposterior comparison radiographs of the proximal humerus. The average follow-up was 9.6 months (range, 1.5 to 54), and all patients were observed until they had either returned to baseball or their symptoms had resolved. The average age of the patients in this series was 14 years. The chief complaint in all patients was pain localizing to the proximal humerus during the act of throwing. The average duration of symptoms was 7.7 months. Nineteen patients (83%) were pitchers. Physical examination revealed tenderness to palpation over the proximal humerus in 20 patients (87%), with 16 (70%) demonstrating specific tenderness over the lateral aspect of the proximal humerus. Swelling, weakness, atrophy, and loss of motion were uncommon findings. All 23 patients demonstrated radiographic widening of the proximal humeral physis of the throwing arm on internal and external rotation comparison anteroposterior radiographs of the shoulder. All patients were treated with rest from baseball throwing for an average of 3 months. Twenty-one of the 23 patients (91%) returned to playing baseball and were asymptomatic. The classic radiographic finding of widening of the proximal humeral physis can easily be seen on bilateral anteroposterior internal and external rotation radiographs of the proximal humerus. Rest from throwing for at least 3 months is recommended, followed by a gradual return to throwing in an asymptomatic shoulder.

Pediatric upper extremity stress injuries

“…1). Treatment involves rest from throwing activities until the pain resolves, which takes 3 months on average [6]. In addition, a throwing mechanics evaluation and a course of physical therapy to strengthen and stabilize the shoulder are useful adjuncts in treatment in an effort to avoid re-injury.…”

Reported mechanisms of shoulder injury during the baseball throw

“…31 This pathological condition has been referred to as: 'Little Leaguer's shoulder', proximal humeral epiphysis, proximal humeral epiphysiolysis, or a rotation stress fracture of the proximal humeral epiphyseal plate. 41 Proximal humeral epiphysiolysis is thought to occur when the rate or frequency of loading into shoulder external rotation (late cocking) causes growth plate damage. 32 Rotational torques measured during throwing in youth baseball players substantiate this injury mechanism.…”

Detection and Prevention of Glenohumeral Epiphysiolysis

“…Little League shoulder) is most commonly seen in adolescent throwing athletes from ages 11 to 16 years (1,4). The pathology is a widening of the physis, resulting in a Salter-Harris I fracture (see Figure) (8).…”

“…The quality, severity, and specific location of pain experienced as well as when the pain occurs during pitching motion are important information to obtain (4). Patients typically present with pain occurring in the shoulder that has progressively worsened over several months while throwing hard (1). The most consistent physical examination finding is tenderness over the proximal humeral physis (1).…”