Proximal humeral epiphysiolysis (PHE), or Little League shoulder, is an overuse stress injury to the epiphyseal cartilage that occurs in young athletes whose growth plate has not yet closed in the humerus.
Cause
Little League Shoulder is caused by repetitive force across the growth plate (or physis) in the upper arm causing it to become irritated and sometimes widen. This occurs when the athlete is still maturing physically and the epiphyseal plate is at an increased risk of injury due to the weakened state of the growth plate and the stress from the rotator cuff ligaments.
Who is at risk?
It most commonly affects adolescents from the age of 11-16 years old. Typically seen with baseball players but also can occur to other athletes that do repetitive overhead motion (volleyball, lacrosse, tennis, etc.).
Signs and Symptoms
- Pain in the upper arm, that worsens with throwing
- Swelling
- Longer recovery time between events
- Worsening performance on the mound/field
- Limited Shoulder movement
Diagnosis
- Will take a history or when and how long your pain has been going on.
- Look at your throwing schedule
- Physical Exam
- X-rays
Treatment
- Rest
- Physical Therapy for strengthening
- Once pain is gone and range of motion and strength are normal they can do a gradual return to throwing program.
Prevention
- Limit pitch counts
- Stretching
- Take a season off, avoid playing year round
- Ensure proper biomechanics
