For a throwing sport such as baseball, and overhead sports like swimming and tennis, shoulder pain can be a common complaint among the young athletes who compete. More kids are playing sports than ever, and more and more children are playing a single sport year round at a very early age. It might be little surprise that more orthopedic surgeons and sports medicine physicians are seeing young athletes in their offices for shoulder pain, especially from Little Leaguer’s shoulder.
Little Leaguer’s Shoulder (LLS) is an overuse injury to the proximal humerus (upper arm) originally described in young baseball players. In a study presented recently at the American Orthopaedic Society for Sports Medicine’s Annual Meeting in Seattle, Washington, researchers from Children’s Hospital Boston shared data on this common problem in youth sports.
The researchers presented the findings from cases of Little League Shoulder seen at their program between 1999 and 2013. They analyzed patients from that 15-year period to better understand the demographics, symptoms, risk factors and treatment outcomes of LLS.
Who develops Little Leaguer’s shoulder?
97% of the LLS patients seen at that sports medicine center in those 15 years were baseball players. 86% of those patients were pitchers. 3% of the LLS patients were tennis players.
Of the 95 cases of Little League Shoulder, 93 of the patients (98%) were male, with an average age of 13.1 years. The ages of the patients ranged from 8 to 16 years old.
What were the symptoms of the young throwers?
Shoulder pain was the main complain in the children seen for LLS. As one might expect, the pain affected the throwing arm or the arm holding the tennis racquet. Many athletes complained of shoulder weakness or fatigue, mechanical symptoms, such as ‘clicking’ in the shoulder, and instability.
Symptoms other than simply pain in the shoulder were not uncommon for the diagnosis of Little League Shoulder. One of the authors, Benton E. Heyworth, MD, emphasized, “The data showed 13% of patients treated also reported elbow pain, 10% reported shoulder pain or weakness, and 8% reported other mechanical symptoms. These related symptoms should be recognized as possible identifiers for injured athletes in the future.”
Also of note, 30% of the affected young athletes were diagnosed with glenohumeral internal rotation deficit (GIRD), a loss of total range of motion in the shoulder, in association with their diagnosis of LLS.
How were the athletes treated?
Fortunately Little Leaguer’s Shoulder does not require surgery. It does often involve a fairly long period of rest from throwing and overhead sports. In this study, the period of rest averaged 4.2 months. In addition to rest, almost 4 in 5 patients underwent physical therapy as well.
Tips for parents whose children who play throwing and overhead sports
• Remember that young athletes who play all overhead sports can develop Little League Shoulder. While this is frequently an overuse injury among baseball pitchers, players at other positions, such as catchers, can develop it as well. Likewise, parents of young tennis players, football quarterback and swimmers should watch for shoulder pain in their kids.
• Young baseball pitchers should not pitch through shoulder pain. LLS involves widening of the growth plate caused by repetitive stress over time. If a young overhead athlete has shoulder pain, he should rest from throwing or participating in the sport for a few days rather than push through pain and risk a serious injury that keeps him out for months.
• If there is any question at all whether shoulder pain in a young athlete represents a serious injury, take the child to the doctor for examination. If the shoulder pain not improving, it can be a good idea to see a doctor or sports medicine orthopaedic surgeon. The physician can perform a physical exam, order x-rays or other studies, and prescribe treatments that could resolve the injury and prevent further damage.
Also listen to these discussions from The Dr. David Geier Show:
Episode 85: How can we prevent youth pitching injuries? (starts at 3:47)
Episode 36: How can parents and coaches prevent youth pitching injuries? (starts at 2:59)
Note: The following post appears in a modified form as an article I wrote for the Be Active Your Way blog of the United States Department of Health and Human Services.
Reference: Heyworth BE, Kramer D, Martin DJ, Kocher MS, Micheli LJ, Bae DS. Trends in the Presentation, Management, and Outcomes of Little League Shoulder. Presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine.