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Little Leaguer's Shoulder
Aka: Little Leaguer's Shoulder
- Definition
- Proximal Humerus physis injury with open Growth Plate
- 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)
- 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
- Symptoms
- Gradual pain onset (often over months)
- Pain located at lateral proximal Humerus
- Pain provoked by overhead activity
- Signs
- Tenderness over proximal lateral Humerus
- Imaging
- Bilateral three view Shoulder XRay (comparison)
- Proximal Humerus physis widening
- Other imaging (e.g. MRI) only needed in uncertain cases
- Management
- See Prevention below
- Relative rest from throwing for 3 months
- Strengthening Exercises when pain decreased
- Throwing Exercises in intervals once pain-free
- 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
- References
- Carson (1998) Am J Sports Med 26:575-80 [PubMed]
- Cassas (2006) Am Fam Physician 73:1014-22 [PubMed]