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Little leaguer's shoulder

Case contributed by Samir Benoudina
Diagnosis almost certain

Presentation

Volleyball player (spiker) with the right hand dominant, complains from progressive shoulder pain. Tenderness to palpation of the lateral proximal humerus.

Patient Data

Age: 16 years
Gender: Male
x-ray

Widened proximal humeral physis, with adjacent sclerosis.

Features are most consistent with little leaguer's shoulder.

Annotated image
  • Red arrow: widened proximal humeral physis.
  • Yellow arrows: sclerosis.

Case Discussion

Little Leaguer's shoulder was first described in 1953 by Dotter 1. It is an overuse or stress injury of the proximal humeral growth plate or the adjacent metaphysis. Most commonly seen in 12 to 16-year-old boys. The etiology is likely repetitive rotational stress 2. It is most commonly seen in baseball players, but it can also occur in tennis players, swimmers, gymnasts, volleyball players, and cricket players 3,4.

The classic radiographic signs are widening of the proximal humeral physis on an anteroposterior view of the shoulder in external rotation. Other signs of chronic changes can be seen: sclerosis, demineralization, and fragmentation 5.

Treatment consists of rest and physical therapy.

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