Treatment for Little League Shoulder in an 11-Year-Old
The treatment for an 11-year-old with Little League shoulder requires complete cessation of throwing for a minimum of 3 months, followed by a structured rehabilitation program emphasizing rotator cuff and scapular strengthening before initiating a gradual return-to-throwing protocol. 1
Immediate Management: Complete Rest from Throwing
- Eliminate all throwing activities for at least 6 weeks after diagnosis 1
- The evidence consistently supports a 3-month total rest period from throwing, with the most successful outcomes reported when patients rested for an average of 3 months 2
- Earlier cessation of throwing after symptom onset correlates with better outcomes—delays in implementing throwing prohibition are significantly associated with poor results at 2 months 3
- During this rest phase, the patient should avoid all overhead activities that reproduce symptoms 1
Critical Pitfall to Avoid
- Do not allow the patient to continue throwing with limitations—only 22% of patients who continued throwing with restrictions had optimal outcomes compared to 78% who completely stopped 3
- Premature return to throwing before radiographic healing significantly increases recurrence risk 3, 4
Rehabilitation Phase: Weeks 6-12
After the initial 6-week rest period, begin a structured strengthening program while continuing to prohibit throwing for an additional 6 weeks 1
Specific Strengthening Targets
- Rotator cuff muscles: Focus on external rotators and supraspinatus to address the eccentric stress that caused the injury 1
- Periscapular muscles: Strengthen to prevent scapular dyskinesia and secondary impingement 1
- Core musculature: Address the kinetic chain to reduce compensatory stress on the shoulder 1
Flexibility Component
- Restore capsular flexibility, particularly focusing on posterior shoulder tightness that commonly develops in young throwers 1
- Good shoulder flexibility at 2 months is significantly associated with successful return to baseball without pain 3
Return-to-Throwing Protocol: After 3 Months
Initiate a gradual throwing program only after the patient is completely asymptomatic and has completed the strengthening phase 1
Prerequisites for Starting Throwing
- Pain-free range of motion achieved 1
- Normal strength restored 1
- Radiographic healing confirmed (though healing may take 4-5 months on average) 4
Structured Progression
- Implement a progressive throwing program over 1-3 months depending on response 1
- For an 11-year-old, adhere to pitch count limits of 75 pitches per game and 100 pitches per week 1
- Require 3 days of rest after throwing 51-65 pitches 1
Biomechanical Correction
Address improper pitching mechanics during the rehabilitation phase before return to throwing 1
- Coordinate with a pitching coach to identify abnormal motions, particularly during the maximum external rotation phase where torsional overload occurs 1
- The maximum external rotation phase generates the highest rotational torque contributing to Little League shoulder 5
Monitoring for Recurrence
Recurrence occurs in approximately 19-25% of cases, with specific risk factors identifiable 6, 3
High-Risk Indicators for Recurrence
- Presence of pain at 2 months post-diagnosis significantly predicts recurrence (P = 0.0003) 3
- Longer duration until complete return correlates with higher recurrence rates (P = 0.04) 3
- If pain persists at 2 months, expect delayed complete return (average 2.8 months vs. shorter for asymptomatic patients) 3
Prevention Strategies Post-Recovery
- Mandate at least 3 months off from throwing each year to prevent re-injury 1
- Avoid pitching on consecutive days 1
- Do not allow the patient to play catcher after being removed from pitching in the same game 1
- Prohibit throwing sliders and curveballs, which increase loads on open growth plates 1
- Monitor for arm fatigue—pitching with a fatigued arm increases surgical injury risk 36-fold 1