Review Question - QID 219487

A 12-year-old right-hand-dominant male presents to the clinic for evaluation of right shoulder pain. He reports extensive training to make his local Little League team, participating in competitive play year-round. Over the past month, he has noticed decreased pitch velocity and accuracy. On examination, there is tenderness over the proximal humerus. Imaging is obtained and demonstrated in Figure A. He subsequently refrains from pitching for one month and is cleared for gradual return to play, where he has been participating under the following requirements: utilization of a pitching coach, limiting pitch counts to 68 pitches per game, one game limit per week, and avoidance of breaking balls. Which of the following is considered a risk factor for recurrence in this patient?