(Proximal Humeral Epiphysiolysis)
Comprehensive Study Guide & Practical Reference
Principles & Core Concepts
Definition – Little League Shoulder (LLS) is a Salter-Harris I stress injury of the proximal humeral physis caused by repetitive overhead throwing.
Pathophysiology – Repeated rotational torque during pitching > physeal cartilage micro-trauma > physeal widening ± fragmentation.
Epidemiology – ~10 % of paediatric shoulder pain; peak in 11-15 y/o male baseball pitchers (also tennis, cricket, javelin).
Clinical Presentation & Diagnosis
Component | Key Points | Pearls |
Symptoms | Gradual, throwing-related pain over anterolateral proximal humerus; ↓ velocity/control | May present acutely after velocity jump |
Exam | TTP over physis (66 %); pain/limitation on ABD/ER; possible GIRD | Compare ROM bilaterally |
Imaging | Bilateral AP & axillary X-ray – widening of dominant-arm physis (99 % cases) | Look for sclerosis, fragmentation |
MRI/CT – if atypical, to assess marrow oedema or fragmentation | MRI helpful early when X-ray normal | |
Differential | Little-League elbow, rotator-cuff tendinopathy, fracture, infection, tumour | Age & sport history guide work-up |
Management Strategy
- Immediate Phase – REST
- Stop all throwing (game & practice) immediately.
- Typical rest ≈ 3-4 months (range 1 m – 1 y).
- Continue lower-impact cross-training (cycling, running, fielding).
- Rehabilitation
Stage | Goals | Interventions |
Acute (0-6 wks) | Pain-free ADLs, scapular control | Gentle ROM, posterior-capsule stretching, ice/NSAIDs PRN |
Sub-acute (6-10 wks) | Restore full ROM & symmetric IR | Sleeper stretch, low-load rotator-cuff & scap-stabiliser reps |
Advanced (10-16 wks) | Strength, proprioception | High-rep, low-load tubing, plyometrics, core/hip program |
- Graduated Return-to-Throwing Program
- Pain-free at rest & exam (no tenderness/ROM deficit).
- Optional: radiographic physeal healing.
- Interval throwing plan (e.g., USA Baseball 7-step):
- 45 ft ×25 throws ➜ 60 ft ×25 ➜ 90 ft ×20 ➜ mound work.
- Monitor pain/fatigue; regress if symptoms recur.
Outcome: ~94 % return to sport; ~19 % report transient symptom recurrence—manage with rest/tune mechanics.
Complications & Prognosis
- Rare – premature physeal closure, humeral length discrepancy, increased humeral retroversion.
- Recurrence – 7-80 % across series; strongly related to premature RTS & pitch-count non-compliance.
- Long-term function – Excellent when protocols followed; no arthritis in short-term cohorts.
Prevention Framework
- Pitch Counts & Rest (USA Baseball / Little-League rules).
- One season off throwing each year.
- No breaking pitches before skeletal maturity.
- Mechanics coaching – trunk utilisation, balanced stride, avoid “early trunk rotation.”
- Strength & Flexibility – posterior-capsule stretch, rotator-cuff endurance, hip/core conditioning.
- Education – players, parents, coaches recognise early pain.
Psychosocial Considerations
- Injury may trigger frustration, isolation, identity loss in youth athletes.
- Parental & coach support: emphasise long-term health > short-term play, encourage alternative roles.
- Consider referral to sports psychologist if anxiety/depression signs appear.
Glossary (selected)
- Physis – growth plate cartilage enabling longitudinal bone growth.
- GIRD – Glenohumeral Internal-Rotation Deficit.
- Humeral Retroversion – posterior twist of humeral head, adaptive in pitchers.
- Pitch-Count Limit – age-based ceiling of pitches per outing/week to curb overuse.
0000Call to Action
If you have pain, book an appointment to be reviewed by Prof Imam or another member of our specialist team at The Arm Clinic. Early specialist care helps prevent long-term issues. Visit www.TheArmDoc.co.uk or book your consultation today. Phone: 020 3384 5588 | Email: Info@TheArmDoc.co.uk
Disclaimer
This information is for general educational purposes and should not be used as a substitute for professional medical advice. Consult a healthcare professional for individual guidance on your condition and treatment options.
This page was last clinically updated in May 2025
© 2025 Arm Doc Education | For educational purposes; not a substitute for professional medical advice.