Stress fracture of the proximal humeral physis, also referred to as "Little League shoulder", can occur in baseball pitchers prior to fusion of the proximal humeral physis.


Synonyms: proximal humeral epiphyseolysis, osteochondrosis of the proximal humeral epiphysis


Mechanism: torsional overload


Athletes at risk: before fusion of the proximal humeral epiphysis (according to Ogden this is 12-14 years in girls and 15-17 years in boys. Fusion may be delayed until the early 20's if there is an endocrine disorder.)


Risk factors:

(1) overuse

(2) playing year round in warm weather climates


Clinical findings:

(1) pain in the proximal humerus when throwing

(2) painful arc of motion

(3) tenderness over the lateral proximal humerus

(4) swelling and weakness are rarely seen


The key radiographic feature is widening of the proximal humeral physis. Other findings may include:

(1) sclerosis of the proximal humeral metaphysis

(2) slipped humeral capital epiphysis

(3) lateral metaphyseal fragmentation

(4) demineralization


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