Little Leaguer's Shoulder

Topic updated on 04/26/15 3:40pm
  • A Salter Harris Type I physeal injury to proximal humerus 
  • Epidemiology
    • seen in adolescent pitchers
    • occasionally seen in tennis players
  • Mechanism
    • arm overuse causes repetitive microtrauma at physis
      • from high loads of torque
      • breaking pitches are implicated
  • Pathophysiology
    • hypertrophic zone is affected 
      • due to being weakest portion of the growth plate
  • Symptoms
    • arm and shoulder pain with throwing
      • worse in late cocking or deceleration phases
      • pain resolves with rest
    • may be associated with decreased velocity and control
  • Physical exam
    • point tenderness over shoulder physis
    • pain reproduced with shoulder rotation
  • Radiographs
    • may be unremarkable
    • findings
      • widened proximal humerus physis
      • metaphyseal bony changes
  • MRI
    • shows edema around physis
    • may be helpful to rule out other pathology
      • labral pathology
  • Nonoperative
    • rest, ice, PT, progressive throwing program
      • indications
        • mainstay of treatment
      • technique
        • refrain from pitching for 2-3 months
          • return to play only after asymptomatic
        • PT focuses on
          • rotator cuff strengthening
          • posterior shoulder capsule stretches
          • core strengthening and stretching
        • progressive throwing program
          • starts with short tosses at low velocity
          • slowly progresses distance and velocity
  • Prevention
    • correction of pitching mechanics
      • using pitching coaches
    • discourage breaking ball pitches
      • until skeletal maturity
    • enforcement of pitch counts
Pitch Count Recommendations
Age (years of age)  Pitches per Game
Max Games per Week
8-10 yrs. 52 2
11-12 yrs. 68 2
13-14 yrs. 76
15-16 yrs. 91 2
17-18 yrs. 106 2
  • Premature growth arrest of proximal humeral epiphysis
    • can cause
      • growth arrest
      • angular deformity


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Qbank (1 Questions)

(OBQ13.64) A 12-year-old right-hand-dominant pitcher presents with progressive right shoulder pain. He is now unable to pitch. He is tender to palpation over the lateral shoulder and has pain with rotation. An AP radiograph of the affected shoulder is shown in Figures A and a contralateral radiograph is shown in Figure B. What is the most likely diagnosis?
Topic Review Topic
FIGURES: A   B        

1. Septic arthritis of the shoulder
2. SLAP tear
3. Little Leaguer’s shoulder
4. External impingement
5. Internal impingement



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