What is Little Leaguer’s Shoulder?

Little leaguer’s shoulder also known as proximal humerus epiphysis is a condition that presents itself in young individuals involved in throwing sports such as baseball or javelin. It has a high occurrence rate between the age of 11 to 16 years. 

In adolescents’ proximal humeral epiphysis is responsible for 80% of the humeral growth which makes it more vulnerable to injury in the growing years. The epiphyseal plates close in adulthood, ages ranging from 20 to 22. 

The shape of the epiphyseal plates creates an interlocking of the physis and metaphysis of the plate. The thick tissues of the epiphysis secure the humeral head and the tuberosities, while simultaneously strengthening the shaft region. However, the strength is not consistent throughout the growth plate. The growth plate is weaker and thinner in the growing years making it more prone to injury. 

Little leaguer’s shoulder is similar to a stress fracture or pediatric fracture called Salter-Harris Type 1.


Causes of Little Leaguer’s Shoulder?

Little leaguer’s shoulder is typically caused by repetitive overhead motion with high velocity created in the arm during the cocking phase of throwing causes stress in the shoulder. This results in the deformation of the epiphyseal cartilage and humeral retro-torsion.

This puts pressure on the bone ultimately leading to injury. Little leaguer’s shoulder becomes more apparent during the growth spurt, where strength and flexibility become imbalanced making the growth plate weaker than the muscles and ligaments around it. 

Symptoms of Little Leaguer’s Shoulder

Little Leaguer’s symptoms will show up as:

  • Pain and swelling in the shoulder due to repeated motions of throwing/pitching 
  • Increase in joint laxity due to immature growth plates 
  • Lack of muscle strength especially in the upper back portion 
  • Decrease in throwing speed and accuracy

Diagnosis of Little leaguer’s shoulder

Initially, the doctor will look into the medical history of the patient and the sports activities performed. Then a physical examination of the shoulder will be carried out. 

This will help in not only ruling out other shoulder pain-related possibilities but also help in diagnosing little leaguer’s shoulder successfully. Taking into consideration the symptoms of the patient, the doctor will ask the patient to perform the overhead throwing motion to understand the location of the pain.  

This will be followed by an X-ray and MRI scan. An X-ray will help in showing the widening distance and irregularity in the growth plate comparing it to the unaffected arm. MRI scan will show the damage to the muscles around the structures and will also show laxity in the joints if any. 


Treatment for Little leaguer’s shoulder

Little leaguer’s shoulder can be treated with conservative non-surgical methods. These include:

  • Rest:  Ample amount of rest and any activities that may aggravate the pain especially throwing should be avoided.
  • Ice Packs: To reduce the swelling and pain in the upper back and shoulder, ice packs should be applied at least twice a day.
  • Physical Therapy: Under a trained professional, exercises focusing on strengthening and flexibility of the shoulder should be performed. The focus should also be on the core, legs, and hips to enhance overall stability and ability to throw. 
  • Video Throwing Analysis: A video analyzing the throwing motion and posture of the patient will help in breaking down the phases of throwing and also help in understanding how to perform the motion better. 

Operative treatment is rarely indicated but if the patient is still suffering from severe pain the doctor may opt for surgery.

Prevention of Little leaguer’s shoulder

While no injury can be completely prevented, steps can be taken to minimize the damage that could be caused. This includes improving the posture while throwing or pitching, enforcement of pitch or throw count per day, and a proper warm-up routine.