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The pediatric population is prone to unique upper extremity injuries that are not typically seen in adults. The normal dynamic maturation pattern of ossification centers and open physis can potentially confuse radiologists who are not familiar with the pediatric patients. In this review article, we discuss the normal anatomy and commonly encountered acute and chronic upper extremity injuries such as supracondylar distal humeral fracture and osteochondritis dissecans, in pediatric patients. Diagnosing the correct type of fracture (e.g., buckle vs Salter-Harris) is important for proper management of the injury. With an increasing number of adolescents participating in competitive sports, specific sports related injuries such as little league shoulder, gymnast wrist, and medial epicondyle apophysitis, are also discussed in this review. We examine late complications of injuries, such as physeal bar formation and fishtail deformity of the distal humerus. • Radial neck and olecranon fractures are more common than previously reported and frequently missed. • It is important to differentiate buckle fractures from Salter-Harris fractures which lead to different management and orthopedic referral. • Ultrasound is an important imaging modality to accurately diagnose trans-physeal distal humeral fractures. • Repetitive stress injuries such as gymnast wrist, little league shoulder, and medial epicondyle apophysitis may be normal on radiograph that MRI may serve as an adjunct or problem-solving modality. [ABSTRACT FROM AUTHOR]

The young, overhead throwing athlete is prone to overuse injuries because of their variable skeletal maturity and often improper technique. An overuse injury to the digit(s) in the overhead throwing athlete, Little Leaguer's Finger, has never been discussed in the literature to our knowledge. We present a case of a 14-year-old man with atraumatic pain, swelling, and edema to his dominant pitching index finger after throwing greater than 90 pitches in one setting. Initial workup of the patient, including an MRI, ruled out an infectious process, and it was determined that there was a stress epiphysitis within the proximal phalanx of the digit. Symptoms within the digit resolved given time, rest, and cessation of throwing activities. The purpose of this report was to stress the importance of establishing the etiology of finger pain in the throwing athlete and to describe a previously unreported overuse injury, Little Leaguer's Finger. [ABSTRACT FROM AUTHOR]

Background: With rising participation in youth sports such as baseball, proximal humeral epiphysiolysis, or Little League shoulder (LLS), is being seen with increasing frequency. However, there remains a paucity of literature regarding the causes, natural history, or treatment outcomes of LLS. Purpose: To analyze the demographic, clinical, and diagnostic features of a population of LLS patients, with an emphasis on identifying underlying risk factors for the development and recurrence of LLS after nonoperative treatment. Study Design: Case series; Level of evidence, 4. Methods: A departmental database at a high-volume regional children’s hospital was queried to identify cases of LLS between 1999 and 2013. Medical records were reviewed to allow for analysis of age, sex, athletic information, physical examination and radiologic findings, treatment details, clinical course, and rates of recurrence. Results: Ninety-five patients (93 males, 2 females; mean age, 13.1 years; range, 8-16 years) were diagnosed with LLS. The number of diagnosed cases increased annually over the study period. All patients had shoulder pain with overhead athletics; secondary symptoms included elbow pain in 13%, shoulder fatigue or weakness in 10%, and mechanical symptoms in 8%. While the majority of patients (97%) were baseball players (86% pitchers, 8% catchers, 7% other positions), a small subset (3%) were tennis players. On physical examination, 30% were reported to have glenohumeral internal rotation deficit (GIRD), defined as a decreased arc of rotational range of motion of the shoulder. Treatment recommendations included rest in 99% of cases, physical therapy in 79% (including 100% of patients with GIRD), and position change upon return to play in 26%. Average time to full resolution of symptoms was 2.6 months, while average time to return to competition was 4.2 months. Recurrent symptoms were reported in 7% of the overall cohort at a mean of 7.6 months after initial diagnosis. The odds of recurrence in the group with diagnosed GIRD (14%) were 3.6 times greater than those without GIRD (5%; 95% CI: 0.7-17.1), but this difference was not statistically significant (P = .11). Conclusion: Little League shoulder is being diagnosed with increasing frequency. While most common in male baseball pitchers, the condition can occur in females, youth catchers, other baseball positions players, and tennis players. Concomitant elbow pain may be seen in up to 13%. After rest and physical therapy, recurrent symptoms may occur in a small subset of patients (7%), generally 3 to 6 months after return to sports. Almost one-third of LLS patients had GIRD, and this group had approximately three times higher probability of recurrence compared with those without GIRD. [ABSTRACT FROM AUTHOR]

With increasing levels of competition at earlier ages, young athletes are becoming more susceptible to shoulder injuries. Overuse injuries in throwers are common conditions seen in pediatric and adolescent athletes. Little League shoulder and superior labial injuries are common due to the repetitive and high rotational forces placed on the shoulder during the throwing motion. Shoulder instability as a result of traumatic events occurring in collision sports is another frequent reason for young athletes to present to a sports medicine clinic. Although no operative treatment is often the first-line treatment for most of these injuries, shoulder surgery is becoming increasingly warranted in these young patients. Advanced cross-sectional imaging is important in guiding treatment for many of these injuries. [ABSTRACT FROM AUTHOR]

The use of the ultrasound examination became a routine procedure in managing shoulder pathologies and in clinical diagnosis. Depending on the economic system of reimbursement and on the formation of the orthopaedic surgeons, ultrasound for shoulder conditions may be performed by the radiologist or by the orthopaedic specialist. The accuracy of the diagnosis is excellent in the recent studies since the introduction and use of high resolution transducers and equipment. The current paper describes the routine ultrasound examination of the shoulder performed by a qualified orthopaedic consultant. Emphasis is given to the diagnosis of “subtle” lesions that can be visualized within the “dynamic” exploration with the high density transducer in full motion of the shoulder. Knowledge of the shoulder anatomy and fine details are compulsory for practicing ultrasound examination on a regular basis. Technical details and fine schemes of work are demonstrated. [ABSTRACT FROM AUTHOR]