By: Dev K. Mishra, M.D., President, Sideline Sports Doc
This week I’ve already seen three young baseball players with “Little League Shoulder”, which unfortunately puts us on record pace. In years past I’ve usually seen only 3-5 of these in a quarter and definitely not in one week.
Little League Shoulder is essentially a stress injury through the upper growth plate in the arm bone (called the “humerus”). It happens through overthrowing. In a growing child the growth plate is made of cartilage. Lengthening of the bone happens through this area. As the child reaches maturity the cartilage area turns into bone.
Throwing a baseball can put tremendous amounts of stress upon the throwing arm of both adults and younger baseball players. In adults the ligaments and tendons absorb the stress, and as a result they tend to get ligament injuries from overthrowing. However, in growing children the stress is absorbed by the weakest part of the bone, which is the growth plate. Damage to a growth plate can lead to long-term problems such as shortening of the bone or abnormal angulation of the bone.
The earliest sign of possible Little League Shoulder is pain with throwing, and as the damage progresses the pain can continue after throwing. If the damage becomes worse there may be weakness, limited motion, and a complete inability to play any sports involving the arm.
If you’re consistently feeling shoulder pain with pitching or throwing get rest early and get some help
This is a classic example of an injury that needs rest early, and that rest can save a huge amount of downtime later. As a player, a parent, or coach beware of persistent pain. Rest the player from throwing for several days. Often that will let the shoulder return to normal with a minimum amount of time off. For any pain that lasts more than a few days, or keeps coming back with each throwing session it’s very important to see a physician skilled in diagnosing and treating shoulder injuries.
The physician will listen to the description of the problem, do an exam, and probably get X-rays. On the X-ray the growth plate damage may show up as widening of the growth plate. If the X-rays are normal then it may be necessary to do other studies, such as a bone-scan or an MRI (Magnetic Resonance Imaging). These tests may show subtle damage not visible on regular X-rays.
A confirmed Little League Shoulder can take many months to return to throwing
The initial treatment for a confirmed growth plate injury is complete rest from sports. If the shoulder is very painful an arm sling might be needed. Here’s a typical progression that I see from the young athletes in my office:
- First 3 weeks: complete rest
- Weeks 4-6: partial activity possible, such as running, bike
- Weeks 7-10: usually physical therapy to get strength and motion back
- Weeks 11-14: sport specific training, such as interval throwing program
Every one responds a bit differently but the timelines are usually pretty close to the one above. Wouldn’t you rather take a few days or a week off early rather than lose 4 months? Pay attention to total innings, pitch counts, and absolutely pay attention to early arm pain.