Proximal Humeral Epiphysiolysis

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 3 min read
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Proximal humeral epiphysiolysis (Little League shoulder) is a shear or stress injury of the epiphyseal cartilage of the proximal humerus. Little League shoulder has also been referred to as osteochondrosis of the proximal humeral epiphysis and rotation stress fracture of the proximal humeral epiphyseal plate. Little...

For severe symptoms, danger signs, pregnancy, child illness, or sudden worsening, seek urgent medical care.

বাংলা রোগী নোট এখনো যোগ করা হয়নি। পোস্ট এডিটরে “RX Bangla Patient Mode” বক্স থেকে সহজ বাংলা সারাংশ যোগ করুন।

এই তথ্য শিক্ষা ও সচেতনতার জন্য। এটি ডাক্তারি পরীক্ষা, রোগ নির্ণয় বা প্রেসক্রিপশনের বিকল্প নয়।

Article Summary

Proximal humeral epiphysiolysis (Little League shoulder) is a shear or stress injury of the epiphyseal cartilage of the proximal humerus. Little League shoulder has also been referred to as osteochondrosis of the proximal humeral epiphysis and rotation stress fracture of the proximal humeral epiphyseal plate. Little League shoulder is usually caused by overuse or poor throwing technique, and most often occurs in pitchers, catchers, and other athletes...

Key Takeaways

  • This article explains Pathophysiology in simple medical language.
  • This article explains Causes in simple medical language.
  • This article explains Risk Factors in simple medical language.
  • This article explains Differential Diagnosis in simple medical language.
Educational health guideWritten for patient understanding and clinical awareness.
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Emergency safety firstUrgent warning signs are highlighted below.

Seek urgent medical care if you notice

These warning signs are general safety guidance. Local emergency numbers and clinical judgment should always come first.

  • Severe symptoms, breathing difficulty, fainting, confusion, or rapidly worsening illness.
  • New weakness, severe pain, high fever, or symptoms after a serious injury.
  • Any symptom that feels urgent, unusual, or unsafe for the patient.
1

Emergency now

Use emergency care for severe, sudden, rapidly worsening, or life-threatening symptoms.

2

See a doctor

Book a professional medical evaluation if symptoms persist, worsen, recur often, affect daily activities, or occur in a high-risk patient.

3

Learn safely

Use this article to understand possible causes, tests, treatment options, prevention, and questions to ask your clinician.

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Definition

Proximal humeral epiphysiolysis (Little League shoulder) is a shear or stress injury of the epiphyseal cartilage of the proximal humerus. Little League shoulder has also been referred to as osteochondrosis of the proximal humeral epiphysis and rotation stress fracture of the proximal humeral epiphyseal plate. Little League shoulder is usually caused by overuse or poor throwing technique, and most often occurs in pitchers, catchers, and other athletes who do overhand activities, including volleyball and tennis players. There are three bones that make up a shoulder — the collar bone, the upper arm bone, and the shoulder blade.

Other Names

  • Little League Shoulder
  • Little Leaguer’s Shoulder
  • Proximal Humeral Epiphysiolysis
  • Osteochondrosis of proximal humeral epiphysis
  • Stress fracture of the proximal humeral epiphyseal plate
  • Rotation stress fracture

Pathophysiology

  • General
    • Defined as a shearing or stress injury of the epiphyseal cartilage of the proximal humerus
    • Represents a Salter-Harris 1 Fracture

Causes

  • Occurs as a result of excessive rotational, distraction forces that occur with repetitive overhead throwing
  • Repetitive microtrauma leads to cartilage damage of the proximal humeral epiphysis
  • Epiphyseal plate injury is the weakest point in the kinetic chain
  • Believed to occur during the late cocking phase of throwing
    • At this point, there is significant rotational torque immediately prior to acceleration

Osteology

  • Proximal Humeral Epiphysis
    • Four growth centers: head, shaft, greater tubercle, lesser tubercle
    • Typically fuses between ages 14-20
    • Contributes about 80% of longitudinal growth of humeral shaft

Risk Factors

  • Male > Female
  • Age (11-16, average 14)
  • Overhead/ Throwing Sports
    • Baseball, especially pitching
    • Tennis
    • Volleyball
    • Swimming
  • Pitching specific
    • Poor throwing mechanics
    • High pitch count
    • “Breaking” pitch
  • Playing year-round sports
  • Glenohumeral Internal Rotation Deficit (GIRD)

diagnosis: Differential diagnosis is a list of possible conditions that may explain symptoms. সহজ বাংলা: একই লক্ষণের সম্ভাব্য রোগের তালিকা।" data-rx-term="differential diagnosis" data-rx-definition="Differential diagnosis is a list of possible conditions that may explain symptoms. সহজ বাংলা: একই লক্ষণের সম্ভাব্য রোগের তালিকা।">Differential Diagnosis

  • Fractures
    • Proximal Humerus Fracture
    • Humeral Shaft Fracture
    • Clavicle Fracture
    • Scapula Fracture
    • First Rib Fracture (traumatic or atraumatic)
  • Dislocations & Separations
    • Acromioclavicular Joint Separation
    • Glenohumeral Dislocation (Acute)
    • Sternoclavicular Joint Dislocation
    • Glenohumeral Instability (Chronic)
  • Arthropathies
    • Glenohumeral pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।" data-rx-term="arthritis" data-rx-definition="Arthritis means joint inflammation causing pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।">Arthritis
    • Acromioclavicular Joint pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।" data-rx-term="arthritis" data-rx-definition="Arthritis means joint inflammation causing pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।">Arthritis
  • Muscle & Tendon Injuries
    • Pectoralis Major Injuries
    • Pectoralis Minor Injuries
    • Proximal Biceps Tendon Injuries
    • Scapular Dyskinesis
  • Rotator Cuff
    • Rotator Cuff Tear
    • Rotator Cuff Tendonitis
    • Calcific Tendinitis of the Rotator Cuff
    • Subcoracoid Impingement Syndrome
  • Bursopathies
    • Subacromial Bursitis
    • Scapulothoracic Bursitis
  • Ligament Injuries
    • Glenoid Labral Tears
  • Neuropathies
    • Suprascapular Nerve Injury
    • Parsonage-Turner Syndrome
    • Quadrilateral Space Syndrome
    • Winged Scapula
  • Other
    • Adhesive Capsulitis
    • Paget-Schroetter Syndrome
  • Pediatrics
    • Coracoid Avulsion Fracture
    • Humeral Head Epiphysiolysis (Little League Shoulder)

Diagnosis

  • History
    • Typical age 10 to 16
    • Onset is by definition insidious although an acute trauma or event could occur
    • Pain initially only with significant exertion (i.e. hard-throwing)
    • Eventually progresses to pain at rest or with light exertion (i.e. soft, short throws)
    • May endorse decreased throwing accuracy, velocity
  • Physical: Physical Exam Shoulder
    • The patient will be tender along the humeral epiphysis, especially laterally
    • Can have pain, weakness in external rotation
    • May have Glenohumeral Internal Rotation Deficit
    • Painful range of motion

Radiographs

  • Standard Radiographs Shoulder initially
  • Findings
    • May be normal
    • May show widened physis
    • Less commonly: demineralization, sclerosis, cystic changes, and lateral fragmentation of the prox humeral metaphysis
  • Compare to unaffected shoulder if needed

MRI

  • Rarely required
  • If highly suspicious with uncertain radiographs or clinical exam, can clarify the diagnosis
  • Findings: physical edema

Ultrasound

  • Can be used to help confirm the diagnosis
  • Findings
    • Increased hypoechoic swelling not seen on the contralateral side

Classification

Neer and Horwitz’s classification

  • Displacement[7]
    • Grade I: Less than 5 mm
    • Grade II: Less than one-third of shaft width
    • Grade III: Two-thirds of shaft width
    • Grade IV: More than two-thirds of shaft width

Treatment

Nonoperative

  • Remove from play/ activity modification
    • No throwing or overhead activities for at least 6 weeks, often 8-12 weeks
    • Ok to do general conditioning, lower extremity training
  • Ice
  • Analgesia including NSAIDs, Acetaminophen
  • Consider a Shoulder Sling for comfort
  • Prevention
    • Proper pitching mechanics
    • Educate athletes, parents, coaches
    • Avoid single sport, year-round activity
    • Rigidly follow pitch count guidelines
    • Avoid “breaking” pitch
    • Improve core strength, cardiovascular fitness
Doctor visit helper

Prepare before seeing a doctor

A simple rural-patient checklist to help you explain symptoms clearly, ask better questions, and avoid unsafe self-treatment.

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

  • Write when the problem started and how it changed.
  • Bring old prescriptions, investigation reports, and current medicines.
  • Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
  • Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

  • What is the most likely cause of my symptoms?
  • Which danger signs mean I should go to hospital quickly?
  • Which tests are necessary now, and which can wait?
  • How should I take medicines safely and what side effects should I watch for?
  • When should I come for follow-up?

Tests to discuss

  • Vital signs: temperature, pulse, blood pressure, oxygen saturation
  • Basic physical examination by a clinician
  • CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

  • Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
  • Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
  • Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Rest, drink safe water, and observe symptoms carefully.
  • Keep a written note of symptoms, duration, temperature, medicines already taken, and allergy history.
  • Seek medical care quickly if symptoms are severe, worsening, or unusual for the patient.

OTC medicine safety

  • For mild pain or fever, ask a registered pharmacist or doctor before using common over-the-counter pain/fever medicines.
  • Do not combine multiple pain medicines without advice, especially if you have kidney disease, liver disease, stomach ulcer, asthma, pregnancy, or take blood thinners.
  • Do not give adult medicines to children unless a qualified clinician advises it.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Severe symptoms, confusion, fainting, breathing difficulty, chest pain, severe dehydration, or sudden weakness need urgent medical care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Doctor / qualified healthcare provider
Tests to discuss with doctor
  • Basic vital signs: temperature, pulse, blood pressure, oxygen level if needed
  • Relevant blood, urine, imaging, or specialist tests only after clinical assessment
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Proximal Humeral Epiphysiolysis

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

RX Patient Help

Ask a health question safely

Write your symptom story. A health professional or site editor can review it before any answer is prepared. This box is not for emergency care.

Emergency first: Severe chest pain, breathing trouble, unconsciousness, stroke signs, severe injury, heavy bleeding, or rapidly worsening symptoms need urgent local medical care now.

Frequently Asked Questions

Is this article a replacement for a doctor?

No. It is educational content only. Patients should consult a qualified clinician for diagnosis and treatment.

When should I seek urgent care?

Seek urgent care for severe symptoms, rapidly worsening condition, breathing difficulty, severe pain, neurological changes, or any emergency warning sign.

References

Add references, clinical guidelines, textbooks, journal articles, or trusted medical sources here. You can edit this area from the RX Article Professional Blocks panel.

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