II. Definition
- Proximal Humerus physis injury with open Growth Plate
III. Epidemiology
- Age distribution: 9 to 16 years old (mean age 14)
- Seen in young athletes involved with overhead activity
- Racquet sports
- Volleyball
- Baseball
- Swimming
- Gymnastics
- Most common occurence in young pitchers
- Especially with breaking pitches (e.g. curve balls)
IV. Pathophysiology
- Stress injury to proximal humeral physis
- Injury secondary to throwing sports (esp. pitching)
- Stress occurs before Growth Plate closure
- Stress transmitted to proximal physis of Humerus
- Contrast with after Growth Plate closure (adults)
- Stress transmitted to rotator cuff
- Stress occurs before Growth Plate closure
V. Symptoms
- Gradual pain onset (often over months)
- Pain located at lateral proximal Humerus
- Pain provoked by overhead activity
VI. Signs
- Tenderness over proximal lateral Humerus
VII. Imaging
- Bilateral three view Shoulder XRay (comparison)
- Proximal Humerus physis widening
- Other imaging (e.g. MRI) only needed in uncertain cases
VIII. Management
IX. Prevention
- Allow for adequate recovery between outings
- Consider throwing mechanics evaluation
- New guidelines recommend no throwing for 3 months of every year
- Limit number of pitches per week and per outing
- Guidelines adjusted for age and pitch type
- AAP: 200 pitches/week and 90 pitches/outing
- USA-BMSAC: 125 pitches/week and 75 pitches/outing
