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Your young ball player is a pitcher for the little league team when one day he (or she) comes home complaining his shoulder hurts when he throws the baseball. Questions race through your head. What is it? What caused it? What should we do? Is this going to end his season?
Young pitchers that are not fully grown can suffer from little league shoulder (also known as pitcher’s or throwing shoulder). Little league shoulder is technically osteochondrosis of the proximal humeral epiphysis and is usually due to overuse. In layman terms, this ailment is caused by the widening of the growth plate where the humerus, or upper arm bone meets the scapula to form the shoulder. This widening is caused by repetitive stress that is usually caused by throwing a ball over and over. The widening causes an inflammatory response by the body, which is what causes the shoulder pain.
If your child begins to have shoulder pain and is involved in a throwing activity, then you should see your pediatrician, a sports medicine specialist, or an orthopedic surgeon. X-rays will be taken which show widening of the growth plate (physis) and sometimes some fragmentation of the bone in this area.
Once the diagnosis is made, then resting the injured shoulder is required. Most doctors will recommend not using the shoulder for throwing until at least three months of no pain has passed before they are allowed to return to throwing. If your athlete returns to throwing and continues to experience pain, then more rest is required. Returning too early or using the shoulder before it is fully recovered will only worsen and lengthen the total recovery time. Sometimes physical therapy is used to work on and maintain range of motion and strength during the resting and recovery/return period.
With the appropriate treatment, children can return to throwing sports without lasting effects. If appropriate treatment is not completed, then there can be long term issues with shoulder pain and it can affect their ability to throw well, limiting the length of their throwing career.
Preventing little league shoulder injuries
Many specialists have conducted studies to determine the cause of little league shoulder injuries. It is thought that the number of pitches and the amount of rest between pitches are the primary things that can be adjusted to decrease the chance of having shoulder or elbow pain. The American Sports Medicine Institute and USA Baseball Medical & Safety Advisory Committee have published information on recommended pitch limits, days of rest between pitching, and also limiting curve balls or breaking pitches until the athlete is skeletally mature. Also, the number of days between pitching should be limited based on how many pitches were made. None of these factor into throwing from another position or practicing, so this is something that should also be factored in when working with your young athletes.
So, pay attention to any shoulder pain, but otherwise get out there, and let’s play ball!
Written by: Jason Rhodes, MD, Pediatric Orthopedic Surgery, Children’s Hospital Colorado. To learn more, visit our Orthopedic Institute, or schedule an appointment at 720-777-6600. We are happy to consult with parents or referring providers before a patient is seen at Children’s Colorado.