Little league shoulder revisited: a systematic review of the last decade.
- 1Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, United States.
- 2Department of Physical Medicine and Rehabilitation, University of Utah, 85 N. Medical Drive, Salt Lake City, UT 84132, United States.
- 3Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, United States.
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.
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BibTeX
@article{lenz2026little,
title = {{Little league shoulder revisited: a systematic review of the last decade.}},
author = {Annika Lenz and Luke Johnson and Mark Riederer and Aaron Provance},
journal = {British medical bulletin},
year = {2026},
month = oct,
doi = {10.1093/bmb/ldag044},
url = {https://europepmc.org/article/MED/42969580},
note = {CC BY},
}
RIS
TY - JOUR
TI - Little league shoulder revisited: a systematic review of the last decade.
AU - Annika Lenz
AU - Luke Johnson
AU - Mark Riederer
AU - Aaron Provance
PY - 2026
DA - 2026/10/01
JO - British medical bulletin
DO - 10.1093/bmb/ldag044
UR - https://europepmc.org/article/MED/42969580
AB - 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.
SN - 0007-1420
SN - 1471-8391
ER -