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Baseball is back! You are seeing a 13 year old boy who plays year-round baseball with a tournament team as a pitcher. He has been having more and more right shoulder pain with throwing over the last few months. He, his family, and his coach are concerned because his pitch velocity and accuracy have worsened. He cannot localize the pain well, but is tender on palpation of the proximal lateral humerus. He has full range of motion and no neurovascular deficits. Radiographs of bilateral shoulders show the right proximal humeral physis widened compared to the left.
April 1, 2025 at 8:14 pm
E) Little league shoulder (epiphysiolysis)
Little league shoulder is an overuse injury seen primarily in pitchers aged 11-16 years with a peak incidence at 13 years old. The patient is tender over the proximal humerus growth plate. Radiographs may show widening of the proximal humeral physis; the best view is the AP shoulder view with the arm in external rotation. Initial management is to rest / stop throwing.