4.2 of 37 Ratings
A 12-year-old male pitcher has been complaining of shoulder pain in his dominant arm for 3 weeks. He describes that the pain occurs while throwing. On physical examination, he has tenderness to palpation over the proximal humerus and pain with external rotation of the shoulder with limited internal rotation compared to the contralateral side. Imaging is shown in Figure A. What is the next best step in treatment?
Cessation of throwing activities until completely asymptomatic and initiate physical therapy
Continue activity as tolerated and initiate physical therapy
Closed reduction and percutaneous pinning of the proximal humerus
Obtain magnetic resonance imaging (MRI) of the shoulder
Answers 2 and 4
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A 12-year-old right-hand-dominant pitcher presents with progressive right shoulder pain. He is now unable to pitch. He is tender to palpation over the lateral shoulder and has pain with rotation. An AP radiograph of the affected shoulder is shown in Figures A and a contralateral radiograph is shown in Figure B. What is the most likely diagnosis?
Septic arthritis of the shoulder
Little Leaguer’s shoulder
A 12-year-old boy who pitches on two “select” baseball teams has had pain in his dominant right shoulder for the past 6 weeks. The pain is present only with throwing and is associated with decreased throwing velocity and control. He has no radiation of pain or paraesthesias of the upper extremity. An AP radiograph and MRI scan are shown in Figures 19a and 19b, respectively. Management should consist of
rest from throwing activities.
a subacromial corticosteroid injection.
open reduction and internal fixation.
arthroscopic labral repair.
biopsy of the proximal humerus.