History Age: 12 years History: Male baseball pitcher with 2-3 month history of gradually increasing right shoulder pain while pitching. Pain is anterior.

History

• Age: 12 years

• History: Male baseball pitcher with 2-3 month history of gradually increasing right shoulder pain while pitching. Pain is anterior shoulder. No numbness or tingling. Pain relieved with heating pad and ibuprofen.

Radiographic Images

Axillary View External Rotation View

Radiographic Images

Axillary View External Rotation View

Course

• Patient told to rest his shoulder from throwing or other sporting activities to prevent further physeal injury

• Return in three weeks for repeat x-ray and reassess whether he can return to practice

• Diagnosis: Little Leaguer’s shoulder of the right shoulder• Radiographic Features

– Little Leaguer’s Shoulder = Widening of the proximal humeral physis in adolescent athletes between the ages of 13 and 16

– Focal physeal widening of the anterior and lateral aspect of the right humeral proximal physis

Differential Diagnosis

• Posterosuperior glenoid impingement (PSGI)– occurs during the hyperextension phase of

throwing– causing the posterosuperior edge of the

glenoid labrum to catch between the humeral head and the rotator cuff

• Salter-Harris type I

References

• Fleming JL, et al. Little leaguer’s shoulder. Skeletal Radiol (2004) 33:352-354.

• Song JC, et al. MRI findings in little leaguer’s shoulder. Skeletal Radiol (2006) 35: 107-109.

Randal Aschenbeck