Little League shoulder

Anatomy

Your child’s shoulders contain structures called growth plates. They are collections of soft tissues found near the ends of bones that enable further physical growth and maturity.

About

Athletic competition can sometimes cause growth plates to expand. As this expansion progresses, shoulders can become irritated or inflamed, resulting in uncomfortable and potentially activity-limiting symptoms.

Causes

Little League shoulder has several underlying causes, including:

• Improper throwing technique
• Overuse of the shoulders
• Inadequate rest between competition
• Underdeveloped shoulder or upper back muscles

Risk factors

Little League shoulder is often seen in youths between the ages of 11 and 16. The injury is most common in sports that require repeated, forceful usage of the shoulders, such as baseball pitchers and football quarterbacks. The problem also frequently occurs in those competing in tennis and volleyball.

Symptoms

The most apparent sign of Little League shoulder is pain:

• Occurs while your child pitches, throws, or extends their shoulder
• Develops gradually
• May linger for days following the specific athletic competition
• Worsens over time
• Worsens when increasing activity such as a pitcher upping the speed at which they throw

Your child might also experience swelling in the injured shoulder, decreased pitching, or throwing speeds, and throwing inaccuracy.

Complications

Untreated cases can result in minor to serious complications.

Occasionally, the condition could eventually damage your child’s arm bone (the humerus). Moreover, unchecked incidents could weaken the shoulder and its components. It might ultimately lay the foundation for potentially serious physical injuries like SLAP (superior labral tear from anterior to posterior) tears and rotator cuff problems later in your child’s life or athletic careers.

Diagnosis

In many instances, your child’s doctor can confirm a diagnosis by taking a careful medical history and performing a thorough visual and physical examination. Sometimes, they may order internal imaging tests like X-rays and MRI (magnetic resonance imaging) to determine the condition’s severity and rule out other more serious concerns.

Treatment

Most cases respond to basic self-care methods. Most uncomplicated incidents do not need any type of surgical intervention.

Nonsurgical treatments

The most direct and effective course of treatment is rest. Once diagnosed, your child will likely be asked to stop or significantly reduce athletic participation over a period ranging from two to three months.

If your child experiences swelling, ice may bring it down and ease associated discomfort.

Your child may also need to undergo physical therapy. These are exercises specifically designed to help their shoulder maintain strength and its motion range during the healing process.

Your child’s return to competition should be slow and gradual. Upon throwing again, they are urged to use soft-tossing exercises at low speeds and progressively increase them. This takes pressure off their shoulder and limits the chances for re-injury.

Surgical treatments

Little league shoulder does not usually need surgical correction unless the affected growth plates are severely injured. Untreated cases could lead to stress fractures of surrounding bones, SLAP tears, and rotator cuff issues. Any of these concerns may eventually need surgical intervention.

Recovery

With rest and physical therapy, most incidents of Little League shoulder heal on their own, and a return to routine physical activity should occur in roughly two to three months.

Prevention

Fortunately, the condition is preventable. Effective techniques include:

• Correcting poor throwing motions – You might ask a coach or motion expert to analyze their throwing motion. If they notice poor technique, they should point them out and instruct your child on the proper technique.
• Working on pitch counts – As little league shoulder often impacts baseball pitchers, the USA Baseball organization has developed pitch count guidelines to prevent overuse. These recommendations are geared towards specific age groups, including:
  • Nine to 10 years old – They should only throw 50 pitches per game, 75 pitches a week, 1,000 a season, and 2,000 per year.
  • 11 to 12 years old – No more than 75 pitches per game, 100 a week, 1,000 a season, and 3,000 per year.
  • 13 to 14 years old – They should not exceed 75 pitches a game, 125 tosses a week, 1,000 pitches a season, and 3,000 per year.

USA Baseball has also established resting guidelines, which are as follows:

• Pitchers age seven to 16 – If your child throws up to 20 pitches per day, they should rest for one day. 21 to 40 pitches a day should be followed by two rest days. 41 to 60 tosses should have three rest days. Four days of rest following 61 or more pitches.
• Pitchers age 17 to 18 – If your child throws up to 25 pitches a game (or bullpen session), one day of rest should follow. Two days of rest when they throw anywhere from 26 to 50 tosses. 51 to 75 pitches should have three days rest. If they make 76 or more throws, take the next four days off.