Little Leaguer’s Shoulder

The term Little Leaguer’s Shoulder is used to describe a growth plate injury in the proximal humerus (the upper part of the long bone of the arm) near the shoulder joint. It is an overuse injury typically seen in young pitchers but can be found in any young athlete who participates in repetitive overhead activity. Growth plates are found at the ends of long bones where new bone growth occurs. They are made of hyaline cartilage so that area has not truly ossified yet. Because it is made of cartilage and has not yet hardened, it can be very vulnerable to injury. 

A typical case of Little Leaguer’s Shoulder presents as pain in the upper arm, worse with throwing motion (usually in the late cocking or deceleration phases) but can get better with rest. Pain will return the minute the throwing motion begins again. On exam, patients will be tender to the touch over the upper arm along the growth plate and may have pain that is reproduced with passive external rotation. X-rays can help confirm the diagnosis. Growth plates look like an empty space on x-ray as it is cartilage that has not yet turned to bone. Measuring the width of the growth plate on X-ray can show widening or gapping especially compared to radiographs of the uninjured arm. MRI can also confirm diagnosis and will show swelling around the growth plate but is not often necessary to perform. 

The best treatment for Little Leaguer’s Shoulder is rest. It could take up to 3 months of no throwing depending on the severity of the injury. Rest is also accompanied by formal physical therapy to work on rotator cuff strengthening, posterior capsular stretching, posture, and throwing form. Then there is a slow gradual progression back into a throwing program to get the patient back to full function without restriction or pain. Prevention is the key when avoiding Little Leaguer’s Shoulder. Teaching proper pitching mechanics, enforcing pitch counts, and avoiding year round pitching can be very helpful in preventing this overuse injury. If your young throwing athlete has been experiencing shoulder pain, have them evaluated by an orthopedic specialist to prevent any further damage.

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Nicole D'Apice PA-C

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