Age / Sex : 12 / M

Chief complaint: right shoulder pain for  7 month

What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(답안은 한 개만 보내주시기 바랍니다)

Courtesy: 이승훈 (Seunghun Lee) 한양대학교병원 (Hanyang University Hospital)

Little leaguer’s shoulder

Discussion

Findings: plain radiography - Widening of the right proximal humeral epiphyseal plate compared to the left.

MR; Asymmetric physeal widening with adjacent periosteal edema

Differential Diagnosis:

Diagnosis: Little leaguer’s shoulder

Discussion:

•        Overuse injury of the proximal humeral epiphyseal plate, most commonly occurring in youth and adolescent baseball pitchers = proximal humeral epiphyseolysis, osteochondrosis of the proximal humeral epiphysis, stress fracture of the proximal humeral epiphyseal plate, and rotational stress fracture of the proximal humeral epiphyseal plate

•       m/c accepted theory

–      Repetitive rotational stress on the proximal humerus causes a growth-plate injury with resultant stress fracture or inflammation

•       Typical age of patients is 14 years

•       Should be considered in the differential diagnosis of shoulder pain in these throwing adolescents

•       Plain radiography

-       May be subtle, especially soon after onset of pain

-       Widening of the epiphyseal plate (m/c)

-       Chronic nature of the injury (less frequently)

-       Demineralization, sclerosis, fragmentation of the physis or metaphyseal involvement, and cystic change

-       In subtle cases, radiographs of the contralateral shoulder recommended

•       MRI

-       Asymmetric physeal widening with adjacent periosteal edema (diagnostic!)

•       Treatment

–      Conservative Restriction of throwing until painfree, to restriction of throwing until physeal closure

References:

 Resnick D.: Bone and joint imaging, 3^rd. Philadelphia: Elsevier-Saunders