I recently had the opportunity to give a talk on Little League Shoulder at the Valley Hospital Orthopaedic Surgery Grandrounds in Ridgewood, NJ.
League Shoulder (LLC) is a common overuse injury affecting young pitchers. With too much throwing, repeated throwing using improper mechanics, lack of muscle strength and fatigue young pitchers suffer an injury to the growth plate of the humerus at the shoulder joint. LLS is also know as proximal humeral epiphysiolysis. Youth athletes present to the doctors office with diffuse pain around the shoulder that is worse when throwing. They may be tender to palpation specifically on outside part of their shoulder. A small percentage may also complain of elbow pain. About 33% will have glenohumeral internal rotation deficit (GIRD), a condition where internal rotation and/or total arc of motion is less when compared to the oposite side.
The history, physical exam and plain radiographs are ususally diagnostic
.Radiographs show widening of the growth plate (A) when compared to normal (B)
If the diagnosis is not clear and there is concern of other pathology inside the shoulder joint it self, an MRI may be ordered.
Treatment consists of rest, ice, antiinflammatories. Physical therapy may also be helpful, especially in those patients who suffer from GIRD. A review of proper throwing mechanics and a gradual return to throwing progam are important for successful return to sport. Some studies have shown that ~25% of players return to sport at a different position. These studies also show that patients who suffer from GIRD have a 3x higher rate of recurrance at 6-12 months after returning to sport.
There are many ways to prevent overuse injuries. Recognizing and treating injuries early often decreases total amount of time away from sport. Athletes often don't speak up about pain or fatigue and therefore present later in the disease process. Teaching proper throwing mechanics can be very helpful. Little league has guide lines to limit pitches and rest days required by age group. http://www.littleleague.org/assets/forms_pubs/media/pitchingregulationchanges_bb_11-13-09.pdf. These guide lines are to prevent injury and keep our youth athletes on the field. It is also recommended that pitchers take at least 3 months away from pitching per year.
Should you have any questions please don't hesitate to contact me at Specialty Orthopaedics of New Jersey, P.A., Ridgewood, NJ 07450. Office (201) 447-1188 and visit http://www.specialtyortho.org.
