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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
      • labral pathology
Treatment
  • Nonoperative
    • rest, ice, PT, progressive throwing program
      • indications
        • mainstay of treatment
      • 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 strengthening and stretching
        • progressive throwing program
          • starts with short tosses at low velocity
          • slowly progresses distance and velocity
  • Prevention
    • correction of pitching mechanics
      • using pitching coaches
    • discourage breaking ball pitches
      • until skeletal maturity
    • 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
 

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