Little League shoulder: growth plate pain in young throwers

Whittington Health, an NHS trust, describes Little League shoulder as common in young athletes who participate in throwing sports such as baseball or volleyball. It involves inflammation and stress injury to the growth plate in the shoulder, at the top of the upper arm bone (the proximal humerus).

KidsHealth, a US children's health site, explains that growth plates are the areas of new bone growth in children and teens, made of cartilage, usually near the ends of long bones. As children grow the growth plates harden into solid bone, and a growth plate that has completely hardened is called a closed growth plate, after which the bone is no longer growing. Growth plates usually close near the end of puberty, which it says is usually when girls are 13 to 15 and boys 15 to 17.

Because the growth plate is weaker than solid bone, it is more likely to be injured. KidsHealth lists Little League shoulder, along with Little League elbow, Osgood-Schlatter disease and Sever disease, among the overuse or repetitive stress injuries that can affect the growth plate in kids and teens. Overuse injuries happen from repeating the same movement over and over and usually affect people who play sports.

The main symptom is shoulder pain related to throwing. Whittington Health says the pain is sometimes felt during activity but more often is felt after finishing the activity. A child may notice it after a match or training session, and it may settle with rest and return when the sport resumes.

The same page describes the closely related Little League elbow, with pain felt on the inner side of the elbow due to repetitive throwing motions, which follows the same pattern. Because both come from repeated throwing, young players can have problems in more than one place.

Whittington Health says to speak to your GP about a referral to paediatric physiotherapy if your child experiences persistent upper limb pain, difficulty participating in activities or pain that affects daily life, or if there is any swelling.

If there is a new onset of upper limb pain following an injury, and the child is unable to weight-bear through the arm, or there is swelling, bruising and loss of range of motion, the same page advises attending A&E for assessment for a fracture. A sudden painful shoulder after a fall is a different problem from gradual overuse pain, and should be examined promptly.

Whittington Health sets out management strategies. These are rest from sports participation involving throwing, icing the shoulder daily by wrapping an ice pack in a towel for 15 minutes 2 to 3 times a day, and stretching the muscles around the shoulder. Once the pain has reduced, gradual strengthening of the muscles around the shoulder helps to support proper function, followed by a graded return to sport once pain has settled.

The page notes that most musculoskeletal conditions see improvement within 8 to 12 weeks with exercises, and that its exercises assist with managing symptoms at home, including shoulder movement exercises and band strengthening. The exact exercises should be chosen with a physiotherapist who has seen the child.

The sources used for this page describe the treatment steps but do not give a fixed recovery time for Little League shoulder specifically; the general statement is that most musculoskeletal conditions improve within 8 to 12 weeks with exercise. Individual children vary, and a physiotherapist or doctor can advise on timing.

Because the injury comes from repetitive throwing, the practical aim is a gradual return that does not restart the cycle of overuse. That usually means building up the amount of throwing in stages and watching for pain afterwards, which Whittington Health identifies as the typical time when symptoms appear. Parents and coaches can help by encouraging children to report pain rather than play through it.

On the NHS, the route is through a GP referral to paediatric physiotherapy, as Whittington Health describes, or an A&E visit if there has been an injury with swelling or inability to use the arm. Many trusts publish home exercise advice for children.

Private paediatric physiotherapists and sports medicine clinics also see young athletes, often with quicker appointments. The advice is similar in either setting: relative rest, a structured exercise plan and a graded return to sport.