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Little League Shoulder on the Rise

Little League Shoulder (LLS) was once considered relatively rare, but doctors like orthopedic surgeon Benton Heyworth, MD, are seeing more cases.

Little League shoulder (LLS) primarily affects male baseball pitchers between the ages of 8 and 16 years; 13 years is the peak age. It has also been documented in catchers, tennis players and female ball players, says Boston Children’s Hospital orthopedic surgeon Benton Heyworth, MD.

Heyworth presented a retrospective case series in July at the American Orthopaedic Society for Sports Medicine’s annual meeting. The researchers reviewed 95 cases and documented an increasing number of patients diagnosed with LLS at Boston Children’s during the period from 1999 to 2013, with one patient diagnosed in 1999 and 12 diagnosed in 2012.

Symptoms and Diagnosis

The primary symptom of LLS is diffuse shoulder pain or upper arm pain with throwing, and in severe cases, even at rest. Nearly one-third of patients presented with a glenohumeral internal rotation deficit (GIRD), or reduced range of motion. Secondary symptoms include elbow pain, shoulder weakness and mechanical symptoms.

The condition can be diagnosed by x-ray. External rotation views of the shoulder and contralateral comparison studies should be ordered.

Heyworth recommends pediatricians consider referring patients with suspected LLS or a pattern of pain with throwing to an orthopedic surgeon or sports medicine specialist. “The diagnostic workup—the physical exam and consideration of alternative entities on the differential diagnosis—can be complex.” The specialist may follow the patient for one year or longer to ensure resolution of risk factors and prevent recurrence.

How LLS is managed

The standard treatment is rest; Boston Children’s Orthopedic Center recommends three months’ rest from throwing. Physical therapy and/or programs to improve strength and throwing mechanics are also recommended to address risk factors for recurrence. To facilitate an early return to play, the treating physician may recommend a temporary position change as a short-term treatment and recurrence prevention strategy.

The recent study found that LLS symptoms returned in 7 percent of patients, typically 6 to 12 months after return to sports. Almost one-third of patients with a recurrence had been diagnosed with GIRD, which can be addressed with the proper approach to physical therapy.

Nearly all patients outgrow LLS when their growth plates close, but without the proper treatment, some may experience a pattern of persistent symptoms that can limit future participation in throwing sports.  

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