Little League Shoulder, also called proximal humerus epiphysitis, is a stress injury to the physis (growth plate) of the proximal humerus (upper arm bone).
The growth plate is a layer of cartilage near the end of a bone whose cells multiply and turn into bone as we grow. In growing athletes, the growth plate can be more susceptible to injury than the surrounding bone, muscle, or ligaments. Repetitive forces from throwing or other overhead activities such as swimming, volleyball, and racquet sports are the most common cause.
What Is Little League Shoulder?
Little League Shoulder is a stress injury to the growth plate of the proximal humerus while it is still developing.
The condition results from overuse and repetitive injury. Repeated stress can cause a fracture or separation of the growth plate.
Causes and Risk Factors
Little League Shoulder may result from overuse and repetitive stress to the proximal humerus growth plate.
Risk factors include:
- Repetitive overhead-motion sports such as baseball, softball, and swimming
- Prolonged sports seasons without adequate rest or downtime
- Poor throwing mechanics
- Poor physical conditioning, including strength and flexibility
- Rapid skeletal growth
- Overuse without adequate rest
Symptoms
Common signs and symptoms include:
- Gradual onset of symptoms following frequent and prolonged activity
- Pain, tenderness, bruising, and swelling
- Weakness or inability to use the injured arm during athletic activities
- Pain with throwing or inability to throw at full speed
- Pain that improves with rest but returns with repetitive throwing and activity
Treatment
Initial treatment consists of a period of rest from throwing to allow the bone time to heal and repair itself.
These injuries may require a few weeks to several months of rest, followed by a gradual return to activity and a gradual return to throwing with an interval throwing program.
Recovery is complete when the patient:
- Is no longer tender to touch
- Is completely pain free
- Has allowed sufficient time for bone healing
- Has gradually resumed activities
Surgery is rarely needed in the growing patient. However, surgery may sometimes be necessary when the stress injury is not allowed to heal within a reasonable period of time.
Nonsteroidal anti-inflammatory medications such as aspirin and ibuprofen should be avoided because they may inhibit early inflammatory events in the healing process. Other pain relievers, such as acetaminophen, may be used as directed by a physician.
Cold may be used to relieve pain and reduce inflammation. Heat may be used before stretching and strengthening exercises as directed by a physician, physical therapist, or athletic trainer.
Recovery and Outcomes
Mild cases may resolve with a slight reduction in activity, while moderate to severe cases may require significantly reduced activity for three to four months.
Returning to sports too quickly can cause the injury to recur. Adequate rest and appropriate treatment help reduce the likelihood of recurrence.
Potential complications include:
- Progression of an untreated growth plate stress injury to a complete fracture or separation of the growth plate
- Prolonged healing if the injury is not treated appropriately or given enough time to heal
- Recurrence or worsening of symptoms if sports are resumed too soon
When to See Dr. Chudik
If a growing athlete develops shoulder pain, tenderness, weakness, or pain with throwing that improves with rest but returns with activity, schedule an evaluation with Dr. Chudik.
Call 630-324-0402, request an appointment online, or email contactus@chudikmd.com.