Trends in the Presentation, Management and Outcomes of Little League Shoulder

OBJECTIVES: With rising participation in youth sports such as baseball, proximal humeral epiphysiolysis (“Little league Shoulder,” LLS), is being seen with increasing frequency. However, there remains a paucity of literature regarding the causes or outcomes of LLS. This study’s purpose was to analyze the demographics, symptoms, diagnosis, and treatment of LLS, with an emphasis on identifying underlying risk factors for development and recurrence of LLS. METHODS: A departmental database at a single pediatric referral center was queried to identify cases of LLS between 1999 and 2013, which were reviewed to analyze age, sex, physical examination and radiologic findings, treatment details, and rates of recurrence. RESULTS: 95 patients (93 males; mean age 13.1 years, range 8-17 years) were diagnosed with LLS, with volumes increasing over the study period (Figure 1). In addition to the primary complaint of shoulder pain with overhead athletics seen in all patients, 13% reported elbow pain, 10% reported shoulder fatigue or weakness, and 8% reported mechanical symptoms. While the vast majority of patients (97%) were baseball players (86% pitchers, 8% catchers, 7% other positions), 3% were tennis players. On physical exam, 30% were reported to have glenohumeral internal rotation deficit (GIRD). Treatment recommendations included rest in 98% of cases, physical therapy in 79% (100% of patients with GIRD), and position change upon return to play in 25%. Average time to resolution of symptoms was 2.6 months, while average time to return to competition was 4.2 months. Recurrent symptoms were reported in 7.4% in the overall population at a mean of 8 months following symptom resolution. The odds ratio of recurrence between the group with diagnosed GIRD (14.3%) and those without GIRD (4.5%) was approximately 3:1. CONCLUSION: Little league shoulder is being diagnosed with increasing frequency. While most common in male baseball pitchers, the condition can occur in females, youth catchers, other baseball positions players, and tennis players. Concomitant elbow pain may be seen in up to 13%. After rest and physical therapy, recurrent symptoms can occur, generally 6-12 months after return to sports. Almost one-third of LLS patients with had GIRD, and this group had three times higher probability of recurrence compared to those without GIRD.