Little League Should#4B41F8 - Orthopedics for Kids

1 Little League ShoulderProximal HumerusEpiphysiolysisLittle League shoulder is anoveruse injury commonly seen inpitchers, gymnasts, and tennisplayers usually from ten to fifteenyears of age with open growthplates. The condition begins as avague shoulder pain that worsenswith stressful use of the armduring or after a game or anintensive practice injury to the growth plate isthe result of the extreme rotatorytorque that occurs with therepetitive, overhead movement ofthe shoulder followed by a rapiddeceleration common to these literature suggests that forbaseball, pitching is limited to three tofour innings per game or ninety pitchesper game, and less than two hundredpitches per week.

2 However, parentsand coaches often fail to include thenumber of repetive practice movements that are typical for devotedtrainees, whether they are pitchers,gymnasts, or tennis players. training. Itis the cumulative number of overheadmaneuvers over days or weeks that can lead to injury of the proximal humeralgrowth If treatment is sought at theonset of pain, the physicalexamination will demonstratetenderness around the upper armand some loss of flexibility. Thedifferential diagnosis includestumors of the upper arm, painfulimpingement arc, and rotator cuffinjury.

3 X-rays at this stage areoften interpreted as restriction of theseactivities can prevent the patientfrom entering the next stage stress fracture of the proximalhumeral growth plate. With thisstage, the pain does not appearto resolve with rest and adecrease in the child s sports skilllevel is reported. Physicalexamination may demonstrate loss of range of motion and global muscleweakness. The tell-tale signs of the diagnosis can now be confirmed on x-raywith widening of the growth plate due to the repetive stress fractures that havenot been given a chance to heal properly.

4 In extreme cases, the growth platewill completely fracture into two pieces. The treatment of a chronic stressfracture or proximal humeral epiphysiolysis, is three to six months of rest andelimination of extreme overhead sports activity. Once the growth plate isnormal on x-ray, the pediatric orthopedic surgeon will prescribe a regimen oftruncal core muscle conditioning and isometric upper extremity muscleconditioning to decrease the likelihood of this condition recurring. Once thegrowth plates have closed with the onset of hormones and adolescent growthspurt, this condition cannot 10th Avenue South POB 1 Birmingham, AL 35205 205-933-8588 All of the content and images on this Brochure are protected by United States and International copyright lawand may not copied, scanned, reproduced, published or altered in any way without written permission.

5 John T. Killian, MD 2009 Widened humeral growthplate stress fractur