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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: Little League shoulder (LLS) is an overuse injury characterized by throwing-related pain that commonly presents in adolescent male athletes. Investigations into the optimal duration of rest from throwing and protocols for graduated return to sports (RTS) are lacking. Purpose: To summarize the current literature with respect to the diagnosis, management, RTS, and return to throwing for LLS. Design: Systematic review; Level of evidence, 4. Methods: The databases EMBASE, MEDLINE, and PubMed were searched between inception and April 22, 2020. References of retrieved records were reviewed for potentially eligible studies. English-language studies that reported the diagnosis and/or management of LLS in children or adolescents were included. Studies of animals or cadavers, review articles, and non—peer reviewed records were excluded. Data were summarized narratively using descriptive statistics. Results: Overall, 23 studies (21 level 4 studies, 2 level 3 studies) met the criteria for a total of 266 participants with a weighted mean age of 12.8 years (range, 7.4-17 years). Treatment recommendations evolved from prolonged rest and complete cessation of throwing to shorter periods of rest and graduated RTS. Less than half (11/23) of studies reported specific criteria to RTS; 1 case report discussed a coaching strategy to resume throwing, and 1 case report discussed a regimented throwing program. The proportion of participants returning to any sport participation was 94.0% (n = 157/167). The proportion returning to their preinjury level of sport was 92.5% (n = 123/133). Upon RTS, 18.7% (n = 35/187) of participants experienced a recurrence of symptoms. Premature closure of the epiphysis was reported in 1 participant. Conclusion: Young athletes with LLS may return to play after a period of rest, and a high proportion return to their preinjury level of sport. Further prospective studies are warranted to develop evidence-based, graduated RTS protocols and to better capture any long-term sequelae of the condition. [ABSTRACT FROM AUTHOR]

Baseball athletes across all levels of play are at an increased risk for upper extremity injury due to the supraphysiologic demands on the shoulder and elbow during overhead throwing. Little league baseball players present with a unique subset of injuries that can affect the growth plate, commonly at the shoulder or the elbow. Ascertaining a diagnosis and plan of care for little league shoulder (LLS) historically focuses on the proximal humeral physis in skeletally immature throwing athletes presenting with shoulder pain. However, while not a current standard of care, posterior glenoid dysplasia is often present in youth baseball athletes presenting with LLS, warranting a shift in the way clinicians evaluate for and treat the youth baseball athlete's pathologic shoulder. Therefore, purpose of this narrative review is 2-fold: first, to describe the current standard of care as it relates to a diagnosis of LLS, and second, to critically describe a comprehensive evaluation process for youth throwing athletes with shoulder pain that includes screening for evidence of posterior glenoid dysplasia. This paper summarizes the current state of the available evidence for anatomic considerations of LLS in the baseball athletes throwing shoulder. Additionally, we provide a framework for clinical evaluation using a multidisciplinary approach to evaluate the entire kinetic chain of the youth baseball athlete presenting with LLS and posterior glenoid dysplasia. A case study is presented to describe common presentations, clinical and objective examinations, and a plan of care from time of evaluation to return to throwing., (© 2024 The Author(s).)

Abstract Objective To present the case of a 15 year-old baseball player with Little League Shoulder (LLS) and describe how developmental changes in the angle of humeral retrotorsion (HRT) may contribute to the underlying pathology of this condition. Design Case report. Setting Two years earlier, the patient had participated in a healthy player screening program at which time measurements of height, weight, shoulder motion, and HRT were obtained. These same measures were obtained during the initial evaluation after injury. Between measurements, the patient grew more than 12 cm in height and demonstrated a large shift in proximal humeral torsional alignment with a change of 13° and 19° of HRT in the dominant and non-dominant sides respectively. Participant 15 year-old male (1.88 m, 79.8 kg), right hand dominant baseball pitcher and 3rd baseman diagnosed with right LLS. Conclusion The pathoanatomical factors contributing to LLS are not well understood. The degree of HRT is a developmental characteristic that changes over the course of physiological maturation. The large changes in HRT seen in this case, may implicate rapid changes in HRT angle create a window of increased susceptibility to physeal damage, and contribute to the development of LLS. [ABSTRACT FROM AUTHOR]

Background The purpose of this study was to investigate the factors associated with poor results and pain recurrence in young baseball players with Little League shoulder (LLS). Methods Eighty-seven young baseball players with LLS (mean age, 12.1 years) underwent conservative treatment. Of the players, 68 (78%) underwent conservative treatment involving the prohibition of throwing for an average of 1.2 months whereas the remaining 19 (22%) continued throwing with limitations. We analyzed the factors associated with poor results at 2 months and pain recurrence. Results At 2 months, 18% of participants reported the presence of pain, and the results regarding the return to baseball were as follows: complete return in 43%, incomplete return in 33%, and no return in 24%. A total of 83 subjects (95%) had completely returned at an average of 2.8 months. Pain recurrence was present in 20 subjects (25%) at an average of 6.2 months. Statistical analysis showed that the following factors were significantly associated with poor results at 2 months: longer period from initial presentation to throwing prohibition and worse shoulder flexibility ( P  = .04 and P  = .01, respectively). It also revealed that the following factors were significantly associated with pain recurrence: higher frequency of pain at 2 months and longer duration until complete return ( P  = .0003 and P  = .04, respectively). Conclusions It is important for subjects with LLS to be prohibited from throwing immediately after initial presentation. Good shoulder flexibility was associated with a return to baseball without pain. A complete return in subjects who had pain at 2 months was significantly delayed, and these subjects exhibited more rapidly recurring pain after their return. [ABSTRACT FROM AUTHOR]

Background The relationship between the disabled throwing shoulder and humeral retroversion has recently attracted a great deal of attention. However, none of the previous studies clarified when the side-to-side difference of humeral retroversion in young baseball players would start. This study aimed to clarify when the difference of humeral retroversion in the dominant and nondominant sides appeared in baseball players. Methods The bicipital-forearm angle in bilateral shoulders of 172 elementary school baseball players was measured by ultrasound. The bicipital-forearm angle was defined as an angle between the perpendicular line to the bicipital groove and the ulnar long axis with the elbow flexed at 90°. The correlation between the bicipital-forearm angle and the grade and the difference of the bicipital-forearm angle between the dominant and nondominant sides were analyzed. Results In the nondominant shoulders, the bicipital-forearm angle increased with the grade in school ( r  = 0.32, P  < .0001), but this was not observed in the dominant shoulders. In the fourth to sixth graders, the bicipital-forearm angles were significantly smaller in the dominant shoulders than in the nondominant shoulders. Conclusion Our findings indicated that humeral retroversion decreased with age in the nonthrowing side but not in the throwing side and that the side-to-side difference of humeral retroversion in the baseball players became obvious from the fourth grade. We assume that the repetitive throwing motion restricts the physiologic humeral derotation process and the difference became apparent from the fourth grade when the growth spurt begins in boys. [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]

Adolescent baseball players, especially pitchers, are at increased risk for shoulder and elbow injuries as their level of competition increases. The intersection of the adolescent growth spurt with the high levels of elbow valgus and shoulder rotational torques placed upon the arm during overhand pitching predisposes the shoulder and elbow to physeal injuries.Little League shoulderandLittle League elbowsyndromes most commonly represent pathology at the physeal regions of the proximal and distal humerus and proximal ulna sustained from repetitive loads caused by overhead throwing. There is a growing understanding that these injuries occur on a wide spectrum from delayed physeal closure and physeal widening to acute transphyseal fracture. Although operative intervention is infrequently required, patient and parent counseling can be complex. Health care professionals who care for adolescent baseball players also can play an important role in prevention. Appropriate counseling requires a comprehensive understanding of the clinical, radiographic, and biomechanical aspects of these injuries. This review summarizes these major concepts, focusing on the best available evidence from recent biomechanical and clinical studies on shoulder and elbow injuries in adolescent baseball pitchers. [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]

CONTEXTO: Existem diversas causas de dor no ombro do atleta. Estruturas como tendões e ligamentos são freqüentemente acometidas por lesões. No atleta jovem com esqueleto imaturo, as afecções ósseas devem ser lembradas como possíveis causas de dor. RELATO DE CASO: Os autores relatam a ocorrência da epifisiólise proximal do úmero em um atleta de ginástica olímpica e discutem a literatura a respeito do assunto. CONCLUSÃO: A lesão da placa fisária proximal do úmero em atletas é pouco freqüente. O diagnóstico precoce e correto tratamento evitam que ocorra deformidades severas e déficits funcionais.CONTEXT: There are different causes for shoulder pain in athletes. Structures such as tendons and ligaments are frequently affected by injuries. In young athletes with immature skull, bone injuries must be ruled as a cause of pain. CASE REPORT: The authors present a case of proximal humeral epiphysiolysis in a gymnast and review literature addressing this topic. CONCLUSION: Injuries on proximal humeral physeal plates of athletes are uncommon. The early diagnosis and correct treatment can avoid deformity and functional deficits.