Little League Shoulder (Proximal Humeral Epiphysiolysis)

Little League shoulder is an overuse injury in skeletally immature throwers caused by repetitive rotational stress at the proximal humeral physis (growth plate). It presents as lateral shoulder pain in young pitchers and overhead athletes and is the throwing equivalent of Little League elbow. Early recognition and rest are critical to prevent growth disturbance.

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Typical Recovery Time

3–6 months of complete throwing rest required

Symptoms

•Lateral shoulder pain in a young overhead athlete
•Pain that worsens during or after pitching or throwing
•Decreased throwing velocity
•Tenderness directly over the proximal humerus growth plate
•No pain at rest initially

Common Causes

•Repetitive rotational stress at the open growth plate in throwers under 16
•Excessive pitch counts or year-round throwing without adequate rest
•Poor throwing mechanics
•Early sports specialization
•Inadequate strength and conditioning

Treatment Options

1Complete rest from throwing (typically 3 months)

2Physical therapy addressing mechanics, strength, and flexibility

3Pitch count and workload guidelines upon return

4Throwing mechanics evaluation with a pitching coach

5Return to throwing program (interval throwing program)

When to See a Doctor

Any young pitcher with lateral shoulder pain should stop throwing immediately and see a sports medicine provider — X-ray with comparison views confirms physeal widening.

Frequently Asked Questions

What is Little League shoulder?

Little League shoulder is an overuse injury to the growth plate of the upper arm bone in young athletes. It occurs near the shoulder and is most common in throwing sports. The condition causes pain and limits performance.

What causes Little League shoulder?

It is caused by repetitive throwing, especially without proper rest or pitch limits. Overuse places stress on the growth plate, leading to irritation. Poor mechanics can also increase the risk.

What are the symptoms?

Symptoms include shoulder pain during throwing, decreased velocity, and soreness after activity. Some athletes may feel weakness or fatigue. Pain often improves with rest.

How is it treated?

Treatment involves rest from throwing, followed by a structured rehabilitation program. Physical therapy focuses on strength, flexibility, and mechanics. Return to throwing is gradual and carefully monitored.

When can I return to throwing?

Return to throwing usually takes several weeks to months depending on healing. Athletes must be pain-free with full strength before starting a throwing program. Following pitch count guidelines helps prevent recurrence.

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