Little League Shoulder
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Michael T. Reeder
A 13-year-old male baseball player presented with severe proximal humerus pain and limited range of motion. Two months previously after pitching 2 weeks into the season, vague, lateral right shoulder pain developed. He stated that at the time he had full range of motion, with end-range pain, normal strength, and no instability. He continued playing outfield and, after 6 weeks, he felt a sudden pain and pop in his shoulder while throwing.
Radiographs revealed a Salter-Harris II fracture of the proximal humerus, with widening of the lateral physis (image A). Magnetic resonance imaging of the shoulder (image B) revealed a sub-acute Salter-Harris II fracture of the proximal humerus, with periosteal fluid and associated marrow edema. The initial treatment was rest followed by rehabilitation, including thoracic mobilization. The patient then progressed through a regimented throwing program.
“Little league shoulder” is caused by repeated overhead throwing in athletes between the ages of 11 and 14 years during peak proximal physis growth.1,2 The rotational torque during maximum external rotation when throwing overhead seems to be the primary cause of growth plate failure.1-3
References
1. Osbahr DC ,KimHJ,DugasJR. Little league shoulder [review].Curr Opin Pediatr.2010;22(1):35-40. doi:10.1097/MOP.0b013e328334584c.10.1097/MOP.0b013e328334584cSearch in Google Scholar PubMed
2. Zaremski JL ,KrabakBJ. Shoulder injuries in the skeletally immature baseball pitcher and recommendations for the prevention of injury.PM R.2012;4(7):509-516. doi:10.1016/j.pmrj.2012.04.005.10.1016/j.pmrj.2012.04.005Search in Google Scholar PubMed
3. Sabick MB ,KimYK,TorryMR,KeirnsMA,HawkinsRJ. Biomechanics of the shoulder in youth baseball pitchers: implications for the development of proximal humeral epiphysiolysis and humeral retrotorsion.Am J Sports Med.2005;33(11):1716-1722.10.1177/0363546505275347Search in Google Scholar PubMed
© 2015 American Osteopathic Association
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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Articles in the same Issue
- AOA COMMUNICATION
- 10.7556/jaoa.2015.086
- IN MY VIEW
- The State of Graduate Medical Education Funding and Meeting Our Nation’s Health Care Needs
- ORIGINAL CONTRIBUTION
- Accuracy of Anterior Superior Iliac Spine Symmetry Assessment by Routine Structural Examination
- REVIEW
- Modeled Osteopathic Manipulative Treatments: A Review of Their in Vitro Effects on Fibroblast Tissue Preparations
- MEDICAL EDUCATION
- Using Simulation-Based Medical Education to Meet the Competency Requirements for the Single Accreditation System
- Role Modeling in the First 2 Years of Medical School
- CASE REPORT
- Bilateral Shoulder Dislocation Presenting as a Unilateral Shoulder Dislocation: Case Report
- Iliac Crest Herniation Secondary to Autogenous Bone Grafting Found on Osteopathic Examination
- CLINICAL IMAGES
- Little League Shoulder
- IN YOUR WORDS
- A Physician’s Living Will—‘Till Death Do Us Part
