Little League Shoulder (Proximal Humeral Epiphysiolysis): Symptoms, Diagnosis, and Treatment
Little League Shoulder is a stress injury that affects the upper arm growth plate in growing athletes. If your child complains of shoulder pain while pitching or throwing, it’s important to understand the early warning signs and how to manage it properly.
Little League Shoulder, officially known as proximal humeral epiphysiolysis, occurs when the growth plate at the top of the humerus becomes irritated due to repetitive overhead activity. This growth plate is still open in young athletes making it more vulnerable to stress. This is a very common youth baseball or softball injury and can occur in gymnasts as well.
The most common signs of Little League Shoulder include:
Gradual onset of shoulder pain, especially during or after throwing
Decreased throwing speed or accuracy
Swelling or tenderness in the upper arm near the shoulder
Reduced range of motion or stiffness in the shoulder
Pain that improves with rest but returns with activity
It's crucial not to ignore these signs—continuing to throw through the pain can lead to more serious injuries or long-term damage, such as a fracture of the growth plate.
Diagnosis will start with a detailed history and physical examination focusing on the shoulder. Diagnostic steps may also include x-rays to assess the growth plate for widening with a comparative x-ray of the other side.
Early detection is key to effective recovery and safe return to play.
The primary treatment for Little League Shoulder is rest and activity modification. Most cases resolve with conservative care:
Rest from throwing
Physical therapy with a therapist who frequently works with throwing athletes to restore flexibility, shoulder strength, and proper throwing mechanics
Gradual return-to-throwing programs under supervision
Ice and anti-inflammatory medications
Preventive strategies are also important—these include pitch count limits, proper warm-ups, rest periods from throwing sports, and educating coaches and parents about injury signs. Dr. Casadei’s background playing and coaching baseball can help to set a more structured return to play protocol, return to throw protocol, and preventive strategy for the future.