Physeal Stress Injuries of the Shoulder

Physeal stress injuries of the shoulder include proximal humeral epiphysiolysis, also known as Little League shoulder (LLS), and acromial apophysiolysis, with LLS far more common. These stress injuries of the shoulder are most common in adolescent male baseball pitchers, presenting as pain, particularly with throwing. Radiographs may show widening of the physis, and magnetic resonance imaging, if needed, will show bone marrow edema. Conservative modalities including rest, physical therapy, and cessation from throwing for a period of approximately 3–4 months are the mainstay of treatment. Risk factors include pitching mechanics and the number of pitches thrown and prevention is arguably the most important aspect of treatment for physeal stress injuries of the shoulder. Most patients are able to return to sport and throwing following a period of rest and conservative management. However, in those that do return to pitching, recurrence of little league shoulder, and the development of os acromiale have been reported.