Proximal Humeral Epiphysiolysis

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 3 min read
Patient Tools

Read, save, and share this guide

Use these quick tools to make this medical article easier to read, print, save, or share with a family member.

On this page13 sections

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.
Before reading

RX Patient Tools

Use these quick guides before reading the article, or return to them when you need help preparing questions for a doctor.

Start here Choose the right pathway for symptoms, reports, medicines, or urgent warning signs. Disease article roadmap Read this topic step by step: meaning, symptoms, warning signs, diagnosis, treatment, prevention, and follow-up. Treatment planner Prepare questions about treatment choices, benefits, risks, side effects, and follow-up. Family & caregiver guide Organize symptoms, reports, medicines, questions, and follow-up safely. Nutrition & diet guide Prepare food, hydration, supplement, and medicine-timing questions safely. Prevention guide Organize risk factors, protective habits, screening, and warning signs. Recovery guide Prepare a safe plan for activity, rehabilitation, warning signs, and follow-up.
Educational health guideWritten for patient understanding and clinical awareness.
Reviewed content workflowUse writer and reviewer profiles for stronger trust.
Emergency safety firstUrgent warning signs are highlighted below.
Definition

Proximal humeral epiphysiolysis (Little League shoulder) is a shear or stress injury of the epiphyseal of the proximal . Little League shoulder has also been referred to as osteochondrosis of the proximal humeral epiphysis and rotation stress 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 .

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)

  • Fractures
    • Proximal Humerus Fracture
    • Humeral Shaft Fracture
    • Fracture
    • Fracture
    • First Rib Fracture (traumatic or atraumatic)
  • Dislocations & Separations
    • Acromioclavicular Joint Separation
    • Glenohumeral  ()
    • Sternoclavicular
    • Glenohumeral Instability ()
  • Arthropathies
    • Glenohumeral
    • Acromioclavicular Joint Arthritis
  • Muscle & Injuries
    • Pectoralis Major Injuries
    • Pectoralis Minor Injuries
    • Proximal Biceps Tendon Injuries
    • Scapular Dyskinesis
  • Rotator Cuff
    • Rotator Cuff
    • Calcific of the Rotator Cuff
    • Subcoracoid Impingement
  • Bursopathies
    • Subacromial
    • Scapulothoracic Bursitis
  • Injuries
    • Glenoid Labral Tears
  • Neuropathies
    • Suprascapular Nerve Injury
    • Parsonage-Turner Syndrome
    • Quadrilateral Space Syndrome
    • Winged Scapula
  • Other
    • Paget-Schroetter Syndrome
  • Pediatrics
    • Coracoid Avulsion Fracture
    • Humeral Head Epiphysiolysis (Little League Shoulder)

  • History
    • Typical age 10 to 16
    • is by definition insidious although an acute or event could occur
    • 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, 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, , cystic changes, and lateral fragmentation of the prox humeral metaphysis
  • Compare to unaffected shoulder if needed

  • Rarely required
  • If highly suspicious with uncertain radiographs or 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
More from this topic
  1. Isolated Congenital Elbow Dislocation

    DefinitionIsolated congenital? elbow dislocation? is a very rare condition present from birth. In most medical papers, the more exact name is congenital radial head dislocation, because...

    April 2, 2026 • Gastrointestinal, Pelvic & Liver Disease, (A - Z)
  2. Congenital Radial Head Dislocation

    DefinitionCongenital? radial head dislocation? means the top part of the radius? bone, called the radial head, is out of its normal place at the elbow from...

    April 2, 2026 • Degenerative Bones, Joints, and Spine Care (A - Z)
  3. Congenital Elbow Dislocation

    DefinitionCongenital? elbow dislocation? usually means a baby is born with abnormal alignment around the elbow joint, most often a congenital radial head dislocation. It is rare,...

    April 2, 2026 • Degenerative Bones, Joints, and Spine Care (A - Z)
  4. Carbohydrate Deficiency Glycoprotein Syndrome

    DefinitionCarbohydrate deficiency glycoprotein syndrome? is the older name for part of a larger group now called congenital? disorders of glycosylation, or CDG. In simple words, the...

    April 1, 2026 • Rx Blood, Metabolism, and Infectious Diseases (A - Z)
  5. Hypothalamic-Pituitary Hypothyroidism

    DefinitionHypothalamic-pituitary hypothyroidism? is usually called central hypothyroidism. It happens when the hypothalamus or the pituitary gland? does not send the right hormone signals to the thyroid?...

    March 30, 2026 • Rx Endocrinology, Enzymes and Hormonal Diseases (A - Z)
  6. Myopathy, Mitochondrial Progressive, with Congenital Cataract and Developmental Delay

    DefinitionMyopathy?, mitochondrial progressive, with congenital? cataract and developmental delay is a very rare inherited? mitochondrial disease. It is now often grouped under GFER-related primary mitochondrial disease....

    March 29, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)
  7. Congenital Atresia of Colon

    DefinitionCongenital? atresia of colon? means a baby is born with a part of the large intestine, also called the colon, closed, blocked, missing inside, or not...

    March 9, 2026 • Gastrointestinal, Pelvic & Liver Disease, (A - Z)
  8. Congenital Aortopulmonary Septal Defect

    DefinitionCongenital? aortopulmonary septal defect is a very rare birth defect? of the heart. It is also called an aortopulmonary window. In this condition, there is an...

    March 9, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)
  9. Congenital Aortopulmonary Artery Fistula

    DefinitionCongenital? aortopulmonary artery? fistula is a very rare heart blood vessel defect present from birth. In very simple words, it means there is an abnormal passage...

    March 9, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)
  10. Congenital Aortopulmonary Window

    DefinitionCongenital? aortopulmonary window is a rare heart defect present at birth. In this condition, there is an abnormal opening between the ascending aorta? and the main...

    March 9, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)
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.