| Introduction |
 A Salter Harris Type I physeal injury to proximal humerus- Epidemiology
- seen in adolescent pitchers
- occasionally seen in tennis players
- Mechanism
- arm overuse causes repetitive microtrauma at physis
- from high loads of torque
- breaking pitches are implicated
- Pathophysiology
- hypertrophic zone is affected
- due to being weakest portion of the growth plate
|
| Presentation |
- Symptoms
- arm and shoulder pain with throwing
- worse in late cocking or deceleration phases
- pain resolves with rest
- may be associated with decreased velocity and control
- Physical exam
- point tenderness over shoulder physis
- pain reproduced with shoulder rotation
|
| Imaging |
- Radiographs
- may be unremarkable
- findings
- widened proximal humerus physis
- metaphyseal bony changes
- MRI
- shows edema around physis
- may be helpful to rule out other pathology
|
| Treatment |
- Nonoperative
- rest, ice, PT, progressive throwing program
- indications
- technique
- refrain from pitching for 2-3 months
- return to play only after asymptomatic
- PT focuses on
- rotator cuff strengthening
- posterior shoulder capsule stretches
- core strenghtening and stretching
- progressive throwing program
- starts with short tosses at low velocity
- slowly progresses distance and velocity
- Prevention
- correction of pitching mechanics
- discourage breaking ball pitches
- enforcement of pitch counts
|
| Pitch Count Recommendations |
| Age (years of age) |
Pitches per Game
|
Max Games per Week |
| 8-10 yrs. |
52 |
2 |
| 11-12 yrs. |
68 |
2 |
| 13-14 yrs. |
76
|
2 |
| 15-16 yrs. |
91 |
2 |
| 17-18 yrs. |
106 |
2 |
|
| |
| Complications |
- Premature growth arrest of proximal humeral epiphysis
- can cause
- growth arrest
- angular deformity
|