Year: 2026
Type: review
Study design: Systematic Review
Abstract: BACKGROUND: Physeal stress injuries involving the shoulder epiphyseal growth plate complex, known as Little League Shoulder (LLS), occur primarily in skeletally immature overhead athletes. SOURCES OF DATA: This systematic review included research on LLS published within the last 10 years, from 1 January 2015 through 23 September 2025, from four electronic databases (Embase, PubMed, SPORTDiscus, Cochrane Library) focusing on diagnosis, management, imaging, and criteria for return-to-sport. AREAS OF AGREEMENT: LLS is mainly described in male, skeletally immature overhead athletes aged 11-15. Early specialization, multi-team participation, and inadequate rest are reported risk factors. LLS commonly presents with throwing-related shoulder pain, proximal humeral physis tenderness, posterior capsule tightness, and scapular dyskinesia. X-rays remain first-line imaging, demonstrating lateral physeal widening and irregularity. Throwing cessation for 2-4 months, followed by rehabilitation and gradual return-to-throwing yields excellent short-term outcomes, with low rates of growth disturbance. Prevention strategies include pitch-counts, rest, proper throwing mechanics, and delayed specialization. AREAS OF CONTROVERSY: The prevalence of LLS remains unknown due to variable diagnostic criteria, imaging use, and underreporting. Recurrence and long-term sequelae are inconsistent across studies, and the reasons athletes discontinue baseball remain uncertain. Evidence is conflicting regarding the benefits of formal rehabilitation compared with rest alone. GROWING POINTS: Advanced imaging demonstrates structural remodeling of the shoulder, suggesting that repetitive loading during skeletal immaturity impacts long-term morphology and mechanics. AREAS TIMELY FOR DEVELOPING RESEARCH: Prospective studies using clinical and imaging criteria may help define the incidence, severity, risk factors, sport-specific patterns, and to clarify symptom resolution, humeral remodeling, and factors influencing attrition. Longitudinal studies should compare rest versus structured rehabilitation and varying return-to-throwing protocols.
Source: British Medical Bulletin
DOI: 10.1093/bmb/ldag044
Institution: University of Utah
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,362
OpenAlex ID: W7225094858