Little Leaguer's Shoulder (Proximal Humeral Epiphysiolysis)

Who: Skeletally immature overhead athletes. Baseball pitchers and catchers above all; the same logic applies to cricket bowlers, javelin and swimmers.
What: Stress failure at the proximal humeral physis.
How it behaves: Gradual lateral shoulder or proximal arm ache. Worse with throwing volume, worst through cocking and acceleration. No single trauma.

The one thing to take from this page:

The open growth plate is the diagnosis. Same sport, same position, same load — in the growing shoulder the physis is the weak link, and that changes the management before you have touched them.

The safety split

⚠️ No Australian guideline exists, and the pitch-count numbers you'll hear are American governing-body rules, not clinical thresholds. The principle transfers: count the load, mandate rest days, don't throw year-round. The number comes from the local competition, not from a page.

Five stages, in your course's order. The workload history is the diagnosis and the treatment. You are taking it from a child, a parent, and indirectly a coach — and the three of them will give you three different stories about how much throwing has happened.

MAIN PROBLEM

"My shoulder aches when I throw."
"He's lost velocity."
"He can't get it in from the outfield anymore."

Velocity loss and loss of control are the presenting symptom as often as pain is. They frequently arrive first.

BODY CHART

• Mark the lateral shoulder and proximal arm — that is the pattern.
• Not the neck, not the AC joint, not the bicipital groove, not a diffuse scapular ache. Each of those points elsewhere.
• Mark any numbness, tingling or weakness — that is a different conversation.

BEHAVIOUR

HISTORY — the workload audit

Ask all of it. This is the assessment.

• Pitch counts, innings, rest days.
• Multiple teams, overlapping seasons, showcases, year-round throwing.
• Position — pitcher and catcher carry the load.
• Velocity change, control change, fatigue during outings.
• Was he throwing through pain? Ask the child on their own if you can.
• Recent spike — a carnival, a representative squad, a new coach.

SPECIAL / SCREENING QUESTIONS

• Night pain, rest pain, fever, weight loss, feeling unwell? This is an adolescent with bone pain. Ask it.
• Any single traumatic event?
• Numbness, tingling, weakness, wasting?
• Growth spurt? Physeal injury tracks growth and load together [1].

The two that outrank the table

Proximal humeral fracture or a bone lesion. Adolescent, proximal humerus, and it is the classic site. Trauma, night pain, rest pain, systemic symptoms or a non-mechanical story means you image before you rehabilitate.

Little leaguer's elbow, sitting alongside it. The same workload produces both. Screen the medial elbow in every young thrower's shoulder — you will find it more often than you expect.

And the one that changes what a normal picture means

Physeal widening may be only part of the story. A narrative review argues that posterior glenoid dysplasia and shoulder adaptation also belong in the picture [2]. So a physis that looks normal does not close the question — the workload pattern still does the reasoning.