SEATTLE—Proximal humeral epiphysiolysis, or little league shoulder (LLS), is being diagnosed with increasing frequency, according to data presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine. Concomitant elbow pain may also be seen in up to 13% of youth athletes diagnosed with LLS. After rest and physical therapy, recurrent symptoms can occur, generally 6 to 12 months after return to sports.
With rising participation in youth sports such as baseball and tennis, there remains a paucity of literature regarding the causes or outcomes of LLS. Benton E. Heyworth, MD, from Children’s Hospital Boston, Division of Sports Medicine in Boston, Massachusetts, and colleagues examined 95 patients with LLS. The researchers reviewed cases of LLS between 1999 and 2013 at a single pediatric referral center. The study analyzed age, sex, physical examination, radiologic findings, treatment approaches, and rates of recurrence.
Of the 95 patients (93 males; mean age 13.1 years, range 8-17 years), 13% reported elbow pain, 10% reported shoulder fatigue or weakness, 8% reported mechanical symptoms, and all patients complained of shoulder pain with overhead athletics. “These related symptoms should be recognized as possible identifiers for injured athletes in the future,” said Dr. Heyworth. On physical examination, 30% were reported to have glenohumeral internal rotation deficit (GIRD). Patients with GIRD were 3 times more likely to experience an injury recurrence 6 to 12 months after returning to play. “Not surprisingly, we found 97% of the affected athletes were baseball players, with 50% of the patients being only 12 or 13 years old—a good indicator of the stress being put on young arms,” added Dr. Heyworth.
Treatment recommendations included rest in 98% of cases, physical therapy in 79%, and position change upon return to play in 25%. Average time to resolution of symptoms was 2.6 months, with average time for 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.