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John A. Schlechter, DO, is a Pediatric Orthopedic Surgeon, Children's Hospital of Orange County.
Disclosure: John A. Schlechter has received speaking fees from Arthrex, Inc. (an orthopedic medical device company).
As participation in organized year-round sports increases, there are a significant number of youth athletes affected by overuse injuries who present to pediatric and adult health care providers seeking treatment. Athletes who throw are especially at risk for overuse syndromes affecting the dominant arm.
Illustrative Case
A 12-year-old boy who pitches year round for his club baseball team presented with lateral shoulder pain that started about 3 weeks prior. One week before that, his pitching coach taught him how to throw a curveball. Initially, his shoulder pain only lasted about a day after the games in which he pitched, but now the pain had become almost constant. His shoulder pain led to him having trouble pitching.
Upon further questioning, the athlete admits to playing baseball year round since age 7 years. He currently participates on his local Little League team while simultaneously playing on a club travel team. He also recently finished a weekend showcase event where he threw 50 hard pitches in front of many coaches and scouts. The entire family is especially concerned because two of his teammates are currently unable to pitch due to arm pain. They want to know if this is the dreaded "Little League shoulder" and how to prevent future overthrowing injuries. Six weeks after his initial presentation, he was expected to travel to Cooperstown, NY, for a 3-day tournament, and the parents state that the team really needs him to be ready to throw.
His general physical examination was unremarkable. Musculoskeletal examination yielded postural imbalances with forward sloping shoulders, forward head lean, and scapular winging. There was mild swelling of the upper arm and shoulder with tenderness of the posterior lateral proximal humerus. He had a 20-degree internal rotation restriction with increased external rotation when comparing his dominant and nondominant shoulders. Radiographs of the involved extremity and contralateral shoulder are shown in Figure 1 .
His physical examination and imaging findings were consistent with proximal humeral physis injury, commonly referred to as proximal humeral epiphysiolysis or "Little League shoulder." Immediate cessation of throwing was recommended for at least...