Study finds increased incidence of little league shoulder diagnosis

Investigators of this study found an increased frequency in the diagnosis of little league shoulder and that a third of patients showed evidence of glenohumeral internal rotation deficit.

“With the rise of intensity and participation in pediatric sports activities, which includes baseball and pitching, we are seeing more sports injuries. This condition [little league shoulder], is being seen with increasing frequency,” Benton E. Heyworth, MD, from the Department of Orthopaedic Surgery at Boston Children’s Hospital, told Healio.com/Orthopedics. “While it is most common in male baseball pitchers, we have also seen it in other position players — in females and even in tennis players.” In an interview, Heyworth credited his team of collaborators.

Benton E. Heyworth

Using a departmental database from a high-volume, regional children’s hospital, Heyworth and his colleagues retrospectively identified 95 patients with a mean age of 13.1 years diagnosed with little league shoulder. Investigators obtained medical records and analyzed the data for patient demographics, athletic information, physical examinations, radiologic findings, treatment detail, clinical course and recurrence rates.

Results showed the number of patients diagnosed with little league shoulder increased each year. Researchers found all patients reported shoulder pain with overhead athletics. In addition, investigators found 13% of patients had elbow pain, 10% had shoulder fatigue or weakness, and 8% had mechanical weakness. Results from the physical examination showed 30% had glenohumeral internal rotation deficit (GIRD).

“We found that a third of the patients had some underlying biomechanical problems in their shoulders in the form of posterior tightness, and this may be a risk factor for developing the condition,” Heyworth said.

Symptoms were recurrent in 7% of the overall study population at a mean of 7.6 months after diagnosis. Although not statically significant, patients diagnosed with GIRD had a 3.6-times higher odds for recurrence than patients without GIRD.

“I think caregivers who diagnose this condition need to have an awareness of these underlying factors and direct physical therapy towards resolving them or improving them, not simply resting the patients,” Heyworth said. “The standard of care is traditionally 3 months of rest, but if you do not address some of the underlying biomechanical risk factors, there may be a higher chance of recurrence.” ‒ by Monica Jaramillo

Reference:

Heyworth BE, et al. Am J Sports Med. 2016;doi:10.1177/0363546516632744.

Disclosure: Heyworth reports no relevant financial disclosures.