Little Leaguer’s shoulder (proximal humeral epiphysiolysis): MRI findings in four boys

Abstract

Shoulder pain is a common problem among adolescent athletes. A possible cause of such pain that can be diagnosed on MRI is a stress injury to the proximal humerus known as Little Leaguer's shoulder (proximal humeral epiphysiolysis). Our objective was to describe the MRI appearance of Little Leaguer's shoulder. Four patients (all boys; age range 11-15 years; median 13 years) with clinical, plain radiographic, and MR imaging findings of Little Leaguer's shoulder were studied retrospectively. MRI demonstrated focal physeal widening in all four boys with extension of physeal signal intensity into the metaphysis on T1-weighted and gradient echo coronal and sagittal sequences. T2-weighted sequences were of limited use in demonstrating the physeal widening, which is critical to the diagnosis. Abnormal high T2-signal intensity was seen in the metaphysis adjacent to the focal physeal widening in all the boys. Focal extension of normal physeal T1-weighted and gradient echo signal intensity into the adjacent metaphysis is a sign of stress injury in the proximal humeral physis (Little Leaguer's shoulder). Children should suspend the offending sport to allow healing.