This review covers acute and overuse shoulder and elbow injuries in the skeletally immature athlete. It frames how developmental anatomy and throwing biomechanics create injury patterns distinct from adults. The focus is recognition, nonsurgical management, and prevention of overuse injury.
The central mental model: in the skeletally immature thrower, the open physis is the weak link, so the same overhead forces that tear ligaments in adults instead injure the growth plate. Apply this when a young pitcher presents with shoulder pain and physeal widening on external-rotation AP views, think Little League shoulder, not rotator cuff tear.
Most of these conditions respond to rest, activity modification, and a graduated throwing program, so early nonsurgical management is the default. The key exceptions requiring surgery: traumatic instability with a labral detachment (given recurrence up to 100% with open physes) and a medial epicondyle fracture displaced beyond 5 mm with valgus instability.
Prevention is treatment here, honor AAOS pitch-count limits, emphasize control over velocity, and discourage sidearm mechanics, which triple injury risk.
This review covers acute and overuse shoulder and elbow injuries in the skeletally immature athlete. It frames how developmental anatomy and throwing biomechanics create injury patterns distinct from adults. The focus is recognition, nonsurgical management, and prevention of overuse injury.
The central mental model: in the skeletally immature thrower, the open physis is the weak link, so the same overhead forces that tear ligaments in adults instead injure the growth plate. Apply this when a young pitcher presents with shoulder pain and physeal widening on external-rotation AP views, think Little League shoulder, not rotator cuff tear.
Most of these conditions respond to rest, activity modification, and a graduated throwing program, so early nonsurgical management is the default. The key exceptions requiring surgery: traumatic instability with a labral detachment (given recurrence up to 100% with open physes) and a medial epicondyle fracture displaced beyond 5 mm with valgus instability.
Prevention is treatment here, honor AAOS pitch-count limits, emphasize control over velocity, and discourage sidearm mechanics, which triple injury risk.