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Published in: Pediatric Radiology 9/2007

01-09-2007 | Original Article

Little Leaguer’s shoulder (proximal humeral epiphysiolysis): MRI findings in four boys

Authors: Olufolajimi O. Obembe, Cree M. Gaskin, Matthew J. Taffoni, Mark W. Anderson

Published in: Pediatric Radiology | Issue 9/2007

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Abstract

Background

Shoulder pain is a common problem among adolescent athletes. A possible cause of such pain that can be diagnosed on MRI is a stress injury to the proximal humerus known as Little Leaguer’s shoulder (proximal humeral epiphysiolysis).

Objective

Our objective was to describe the MRI appearance of Little Leaguer’s shoulder.

Materials and methods

Four patients (all boys; age range 11–15 years; median 13 years) with clinical, plain radiographic, and MR imaging findings of Little Leaguer’s shoulder were studied retrospectively.

Results

MRI demonstrated focal physeal widening in all four boys with extension of physeal signal intensity into the metaphysis on T1-weighted and gradient echo coronal and sagittal sequences. T2-weighted sequences were of limited use in demonstrating the physeal widening, which is critical to the diagnosis. Abnormal high T2-signal intensity was seen in the metaphysis adjacent to the focal physeal widening in all the boys.

Conclusion

Focal extension of normal physeal T1-weighted and gradient echo signal intensity into the adjacent metaphysis is a sign of stress injury in the proximal humeral physis (Little Leaguer’s shoulder). Children should suspend the offending sport to allow healing.
Literature
1.
go back to reference Dotter WE (1953) Little Leaguer’s shoulder. Guthrie Clin Bull 23:68PubMed Dotter WE (1953) Little Leaguer’s shoulder. Guthrie Clin Bull 23:68PubMed
2.
go back to reference Adams JE (1966) Little league shoulder: osteochondrosis of the proximal humeral epiphysis in boy baseball pitchers. Calif Med 105:22–25PubMed Adams JE (1966) Little league shoulder: osteochondrosis of the proximal humeral epiphysis in boy baseball pitchers. Calif Med 105:22–25PubMed
3.
go back to reference Ireland ML, Andrews JR (1988) Shoulder and elbow injuries in the young athlete. Clin Sports Med 7:473–494PubMed Ireland ML, Andrews JR (1988) Shoulder and elbow injuries in the young athlete. Clin Sports Med 7:473–494PubMed
4.
go back to reference Tullos HS, Fain RH (1974) Little League shoulder: rotational stress fracture of the proximal epiphysis. J Sports Med 2:152–153PubMed Tullos HS, Fain RH (1974) Little League shoulder: rotational stress fracture of the proximal epiphysis. J Sports Med 2:152–153PubMed
5.
go back to reference Carson WG Jr, Gasser SI (1998) Little League shoulder: a report of 23 cases. Am J Sports Med 26:575–580PubMed Carson WG Jr, Gasser SI (1998) Little League shoulder: a report of 23 cases. Am J Sports Med 26:575–580PubMed
6.
go back to reference Lyman S, Fleisig GS, Waterbor JW et al (2001) Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exerc 33:1803–1810PubMedCrossRef Lyman S, Fleisig GS, Waterbor JW et al (2001) Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exerc 33:1803–1810PubMedCrossRef
7.
go back to reference Sabick MB, Torry MR, Kim YK et al (2005) Biomechanics of the shoulder in youth baseball pitchers. Am J Sports Med 33:1716–1722PubMedCrossRef Sabick MB, Torry MR, Kim YK et al (2005) Biomechanics of the shoulder in youth baseball pitchers. Am J Sports Med 33:1716–1722PubMedCrossRef
8.
go back to reference Fleming JI, Hollingsworth CL, Squire DL et al (2004) Little Leaguer’s shoulder. Skeletal Radiol 33:353–354CrossRef Fleming JI, Hollingsworth CL, Squire DL et al (2004) Little Leaguer’s shoulder. Skeletal Radiol 33:353–354CrossRef
10.
go back to reference Barnett LS (1985) Little League shoulder syndrome: proximal humeral epiphysiolysis in adolescent baseball pitchers – a case report. J Bone Joint Surg Am 67:495–496PubMed Barnett LS (1985) Little League shoulder syndrome: proximal humeral epiphysiolysis in adolescent baseball pitchers – a case report. J Bone Joint Surg Am 67:495–496PubMed
11.
go back to reference Hatem SF, Recht MP, Profitt B (2006) MRI of Little Leaguer’s shoulder. Skeletal Radiol 35:103–106PubMedCrossRef Hatem SF, Recht MP, Profitt B (2006) MRI of Little Leaguer’s shoulder. Skeletal Radiol 35:103–106PubMedCrossRef
12.
go back to reference Song JC, Lazarus ML, Song AP (2006) MRI findings in Little Leaguer’s shoulder. Skeletal Radiol 35:107–109PubMedCrossRef Song JC, Lazarus ML, Song AP (2006) MRI findings in Little Leaguer’s shoulder. Skeletal Radiol 35:107–109PubMedCrossRef
13.
go back to reference Shih C, Chang CY, Penn IW et al (1995) Chronically stressed wrists in adolescent gymnasts: MR imaging appearance. Radiology 195:855–859PubMed Shih C, Chang CY, Penn IW et al (1995) Chronically stressed wrists in adolescent gymnasts: MR imaging appearance. Radiology 195:855–859PubMed
14.
go back to reference Laor T, Wall EJ, Vu LP (2006) Physeal widening in the knee due to stress injury in child athletes. AJR 186:1260–1264PubMedCrossRef Laor T, Wall EJ, Vu LP (2006) Physeal widening in the knee due to stress injury in child athletes. AJR 186:1260–1264PubMedCrossRef
15.
go back to reference Trueta J, Amato VP (1960) The vascular contribution to osteogenesis III. Changes in the growth cartilage caused by experimentally induced ischemia. J Bone Joint Surg Br 42:571–587PubMed Trueta J, Amato VP (1960) The vascular contribution to osteogenesis III. Changes in the growth cartilage caused by experimentally induced ischemia. J Bone Joint Surg Br 42:571–587PubMed
16.
go back to reference Kleinman PK, Marks SC Jr, Spevak MR et al (1991) Extension of growth-plate cartilage into the metaphysis: a sign of healing fracture in abused infants. AJR 156:775–779PubMed Kleinman PK, Marks SC Jr, Spevak MR et al (1991) Extension of growth-plate cartilage into the metaphysis: a sign of healing fracture in abused infants. AJR 156:775–779PubMed
17.
go back to reference Jaramillo D, Laor T, Zaleske DJ (1993) Indirect trauma to the growth plate: results of MR imaging after epiphyseal and metaphyseal injury in rabbits. Radiology 187:171–178PubMed Jaramillo D, Laor T, Zaleske DJ (1993) Indirect trauma to the growth plate: results of MR imaging after epiphyseal and metaphyseal injury in rabbits. Radiology 187:171–178PubMed
18.
go back to reference Osier LK, Marks SC Jr, Kleinman PK (1993) Metaphyseal extensions of hypertrophied chondrocytes in abused infants indicate healing fractures. J Pediatr Orthop 13:249–254PubMed Osier LK, Marks SC Jr, Kleinman PK (1993) Metaphyseal extensions of hypertrophied chondrocytes in abused infants indicate healing fractures. J Pediatr Orthop 13:249–254PubMed
19.
go back to reference Jaramillo D, Bamidele KF, Shapiro F (2000) Cartilaginous path of physeal fracture-separations: evaluation with MR imaging – an experimental study with histologic correlation in rabbits. Radiology 215:504–511PubMed Jaramillo D, Bamidele KF, Shapiro F (2000) Cartilaginous path of physeal fracture-separations: evaluation with MR imaging – an experimental study with histologic correlation in rabbits. Radiology 215:504–511PubMed
20.
go back to reference Cassas KJ, Cassettari-Wahys A (2006) Childhood and adolescent sports-related overuse injuries. Am Fam Physician 73:1014–1022PubMed Cassas KJ, Cassettari-Wahys A (2006) Childhood and adolescent sports-related overuse injuries. Am Fam Physician 73:1014–1022PubMed
Metadata
Title
Little Leaguer’s shoulder (proximal humeral epiphysiolysis): MRI findings in four boys
Authors
Olufolajimi O. Obembe
Cree M. Gaskin
Matthew J. Taffoni
Mark W. Anderson
Publication date
01-09-2007
Publisher
Springer-Verlag
Published in
Pediatric Radiology / Issue 9/2007
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-007-0539-5

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