Arm Rest Research Articles

A musculoskeletal modelling approach to explain sit-to-stand difficulties in older people due to changes in muscle recruitment and movement strategies

By 2050 the proportion of over 65s is predicted to be 20% of the population. The consequences of an age-related reduction in muscle mass have not been fully investigated and, therefore, the aim of the present study was to quantify the muscle and joint contact forces using musculoskeletal modelling, during a sit-to-stand activity, to better explain difficulties in performing everyday activities for older people. A sit-to-stand activity with and without the use of arm rests was observed in ninety-five male participants, placed into groups of young (aged 18–35 years), middle-aged (aged 40–60 years) or older adults (aged 65 years and over). Older participants demonstrated significantly lower knee extensor and joint forces than the young when not using arm rests, compensating through elevated hip extensor and ankle plantarflexor muscle activity. The older group were also found to have higher shoulder joint contact forces whilst using arm rests. This tendency to reorganise muscle recruitment to include neighbouring groups or other parts of the body could make everyday activities more susceptible to age-related functional decline. Reductions in leg strength, via age- or atrophy- related means, creates increased reliance on the upper body and may result in further lower limb atrophy through disuse. The eventual decline of upper body function reduces strength reserves, leading to increased vulnerability, dependence on others and risk of institutionalisation.

Serratus anterior weakness is a key determinant of arm-assisted standing difficulties

The ageing population has led to recent increases in musculoskeletal conditions, with muscle weakness a major contributor to functional decline. Understanding the early phases of muscle weakness will help devise treatments to extend musculoskeletal health. Little is understood of the effects of muscle weakness on everyday activities such as sit-to-stand, a determinant of mobility that, in the early stages of weakness, requires upper limb compensation. This experimental and computational modelling study investigated the effects of muscle weakness on upper-extremity muscle forces of 27 healthy adults when using arm rests. Weakness of 29 upper limb muscles was simulated by individually removing each from a musculoskeletal model. Serratus anterior weakness was highlighted as detrimental, with the model unable to fully solve the loadsharing redundancy in its absence, and forces at the elbow and glenohumeral joint and in other muscles were found to be profoundly increased. Its large number of fast-twitch muscle fibres, predisposed to atrophy with age, highlight the centrality of the serratus anterior as a key determinant of mobility in this critical task and a potential source of early immobility through its preferential loss of strength and thus point to the requirement for early clinical interventions to mitigate loss.

Managing an Agent's Self-Presentational Strategies During an Interaction.

In this paper we present a computational model for managing the impressions of warmth and competence (the two fundamental dimensions of social cognition) of an Embodied Conversational Agent (ECA) while interacting with a human. The ECA can choose among four different self-presentational strategies eliciting different impressions of warmth and/or competence in the user, through its verbal and non-verbal behavior. The choice of the non-verbal behaviors displayed by the ECA relies on our previous studies. In our first study, we annotated videos of human-human natural interactions of an expert on a given topic talking to a novice, in order to find associations between the warmth and competence elicited by the expert's non-verbal behaviors (such as type of gestures, arms rest poses, smiling). In a second study, we investigated whether the most relevant non-verbal cues found in the previous study were perceived in the same way when displayed by an ECA. The computational learning model presented in this paper aims to learn in real-time the best strategy (i.e., the degree of warmth and/or competence to display) for the ECA, that is, the one which maximizes user's engagement during the interaction. We also present an evaluation study, aiming to investigate our model in a real context. In the experimental scenario, the ECA plays the role of a museum guide introducing an exposition about video games. We collected data from 75 visitors of a science museum. The ECA was displayed in human dimension on a big screen in front of the participant, with a Kinect on the top. During the interaction, the ECA could adopt one of 4 self-presentational strategies during the whole interaction, or it could select one strategy randomly for each speaking turn, or it could use a reinforcement learning algorithm to choose the strategy having the highest reward (i.e., user's engagement) after each speaking turn.

Leap Motion- and Mouse-Based Target Selection: Productivity, Perceived Comfort and Fatigue, User Preference, and Perceived Usability

ABSTRACTRemote pointing is an input method that involves in-air gesticulation. Target selection via Leap Motion-based remote pointing and mouse-based pointing were compared while addressing methodological limitations that were present in previous studies. Participants completed the ISO 9241-9 multidirectional tapping test for pointing device evaluation with a wide range of target size-distance combinations and a standardized arm posture. Dependent variables included movement time, errors, throughput, perceived comfort, perceived fatigue, user preference, and perceived usability. Leap Motion-based input led to (a) worse user productivity, (b) more finger, wrist, shoulder, and neck fatigue, (c) lower preference ratings, and (d) lower usability ratings than mouse-based input. The experiment (i) confirmed findings about remote pointing-related productivity and fatigue, and did so while controlling methodological limitations present in prior studies, (ii) revealed significant discomfort and fatigue despite the presence of an arm rest, and (iii) revealed new findings about preference and usability.

Smartwatch for the analysis of rest tremor in patients with Parkinson's disease

Wearable technology used in Parkinson's disease (PD) research has become an increasing focus of interest in this field. Our group assessed the feasibility, clinical correlation, reliability, and acceptance of smartwatches in order to quantify arm resting tremors in PD patients. An Android application on a smartwatch was used to obtain raw data from the smartwatch's gyroscopes. Twenty-two PD patients were consecutively recruited and followed for 1 year. Arm rest tremors were video filmed and scored by two independent raters using the motor subscale of the Unified Parkinson's Disease Rating Scale (UPDRS-III). The tremor intensity parameter was defined by the root mean square of the angular speed measured by the smartwatch at the wrist. Sixty-four smartwatch evaluations were completed. The Spearman coefficient among the mean of the resting tremor (UPDRS-III) scores and smartwatch measurements for tremor intensity was 0.81 (p < .001); smartwatch reliability to quantify tremors was checked by intraclass reliability coefficient with a resting tremor = 0.89, minimum detectable change = 59.03%. Good acceptance of the system was shown. Smartwatch use for PD tremor analysis is possible, reliable, well-correlated with clinical scores, and well-accepted by patients for clinical follow-up. The results from these experiments suggest that this commodity hardware has the potential to quantify PD patients' tremors objectively in a consulting-room.

To Check 10% Rule of Dominance in Hand Grip Strength of Physiotherapy Students

The objective of this study was to check whether the dominant hand has 10% more grip strength than the non-dominant hand and provide normative data of hand grip strength in physiotherapy students. 100 students between 18-25 years participated in this survey. After obtaining written consent from the students they were asked to sit on the chair with straight back, with armrest with the feet flat on the floor, shoulder adducted and neutrally rotated, elbow flexed at 90°, forearm resting on the arm rest in mid prone position and wrist without support between 0o – 10o of ulnar deviation. Then the handle of dynamometer was set at setting of 3.8 cm apart and kept constant for all. Subjects were asked to hold the dynamometer first in the dominant hand in above said position and were instructed to squeeze for 3 seconds or less to initiate the optimal handgrip strength. Three attempts for each subject were conducted, alternating right and left hands with 30 seconds rest between two attempts to overcome the fatigue.100 students (72 females & 28 males) were provided with their normative data of hand grip strength. We concluded after obtaining results that there is an overall 9.10% difference between the dominant and the non-dominant hand which is approximately 10%. Thus our study supports the 10% rule of hand dominance of physiotherapy students.

Example of Using Lean Manufacturing Tools in Assessing and Improving the Process of Car Arm Rest Production

Abstract The paper deals with the use of Lean Manufacturing tools in improving the production process of car arm rests in a car manufacturing company in Poland. The article describes the original condition of a single production process of assembling ready pieces to produce car arm rests. The original condition was assessed and described with the use of some basic Lean indicators and value stream mapping. The aforementioned tools allowed to assess the process condition and to identify the organizational issues and their sources. It also enabled to reorganize the process and increase its efficiency. The further part of the article describes the results of improvement actions. The process assessment was held and improvements introduced in the first quarter of 2018.

Surface contamination with ten antineoplastic drugs in 83 Canadian centers.

The aim of this study was to monitor environmental contamination by 10 antineoplastic drugs in Canadian oncology pharmacy and patient care areas. The secondary objective was to explore the impact of factors that may explain contamination. Twelve standardized sites were sampled in each center (six in the pharmacy and six in patient care areas). Each sample was prepared to allow quantification of seven antineoplastic drugs (cyclophosphamide, ifosfamide, methotrexate, cytarabine, gemcitabine, 5-fluorouracil, irinotecan) by UPLC-MS-MS. Docetaxel, paclitaxel and vinorelbine were also detected, but not quantified due to sensibility limitations. The impact of some factors was evaluated compared with a Kolmogorov-Smirnov test for independent samples. Eighty-three Canadian centers were recruited in 2017. A total of 953 surfaces were sampled, 495 in pharmacy and 458 in patient care areas. Cyclophosphamide was most often found on surfaces (36% of samples positive, 75th percentile 0.0040 ng/cm2). The arm rest (81.7% of samples positive for at least one antineoplastic drug), the front grille inside the hood (78.3%) and the floor in front of the hood (61.4%) were more frequently contaminated. Centers who prepared more antineoplastic drugs per year had higher concentration on different surfaces ( p < 0.0001). Despite growing awareness and implementation of new safe handling guidelines, healthcare centers' surfaces remain contaminated with traces of many antineoplastic drugs. The use of personal protective equipment remains indisputable. Performing an annual monitoring remains a good indicator to monitor trends over time and to compare with similar centers.

Total hip arthroplasty following arthrodesis: a single-center experience of 17 patients.

PurposeWe aimed to present our experience with total hip arthroplasty in patients with previous hip arthrodesis.Patients and methodsThis was a retrospective study, in which clinical and radiological outcomes of total hip arthroplasty performed in 17 patients (mean age 54.2±8.5 years; age range 33–68 years; female to male ratio 10/7) with previous arthrodesis in our clinic between 2001 and 2014 were reviewed. Patients were followed up for 6.7±2.8 years (range 3–12 years) after the operation and evaluated for ipsilateral knee pain, range of motion, walking capacity, and leg-length discrepancy. The clinical outcome was assessed by the Harris Hip Score.ResultsThe outcome of arthroplasty was good or excellent in 14 of 17 patients (82.3%), fair in two patients (11.8%), and failure in one patient (5.9%). The Harris Hip Score increased to 79.8±9.8 postoperatively from a preoperative score of 40.9±10.1 (p<0.01). Pain-free hip was obtained in 15 patients (88.2%), and range of motion was 88°. Fourteen patients (82.4%) reported a significant decrease in back pain, and 11 patients (64.7%) in ipsilateral knee pain. Ten patients (58.8%) were able to walk normally, five patients (29.4%) walked with slight Trendelenburg gait without support, and two patients (11.8%) with severe Trendelenburg gait using arm rests. The mean leg-length discrepancy was 1.1 cm (range 0–3 cm). The complications were peroneal nerve palsy (n=3), superficial wound infection (n=3), hip dislocation (n=2), and heterotopic ossification (n=3).ConclusionIf it is well planned, conversion of hip arthrodesis to total hip arthroplasty is a successful and safe procedure, which increases patients’ functionality.

Methicillin-resistant Staphylococcus aureus (MRSA) screening of hospital dental clinic surfaces.

We assessed the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) strains on surfaces of hospital dental clinics. Specimens were obtained from 5 clinically symptoms-free patients of five different specialties clinics (Implantology, Pediatric Dentistry, Prosthetics, Restorative Dentistry, and Oral Medicine) of the Dental Clinic Hospital of King Saud University before and after each patient. A Q-tip swabs were used from 10 surfaces in each clinic (Arm rest of dental chair, floor beneath dental chair, sink/faucet, towel dispenser, instrument table handle, light handle, X-ray viewer, paper dental records, head rest, and bench). Specimens were cultured in CHROMagar MRSA medium. Prevalence of MRSA colonization was compared between periods before and after patients visited each clinic for treatment. The results showed that the prevalence of MRSA was remarkably increased after patients visited the area. The results indicate that dental clinics should be considered as possible reservoirs of MRSA in the hospital setting.

Electroacupuncture for the Treatment of Calcific Tendonitis. A Pilot Study

Current treatment for calcific tendonitis consists of arm rest, antiinflammatory medications, and corticosteroid injections. If unsuccessful, a lot of clinicians suggest several physiotherapy modalities, such as shockwave therapy and electrotherapy. The purpose of our study was to assess the efficacy of electroacupuncture, as a substitute for failed medical treatment in calcific tendonitis.In a pilot study, we prospectively followed 10 patients treated with electroacupuncture for calcific tendonitis who failed to respond to medical treatment. Its efficacy was assessed by evaluating the level of pain, the Beck Depression Inventory, the range of active elbow mobility, and by repeated radiological evaluation of the course of calcific deposits. All clinical and radiological observations were recorded before and within 6 months after the onset of treatment.After electroacupuncture treatment (2 Hz, 180 mA for 30–60 seconds at GB21, GB34, LI4, LI 14, LI15, TW5, TW14, Chien Chien SI9, SI12, S37, S38), the visual analog score decreased notably, and the range of motion returned to normal. Radiological evaluation demonstrated almost complete absorption of calcific deposits within 6 months, after treatment.We conclude that electroacupuncture relieved skeletal pain, improved the quality of patient's life, and contributed to total regression of the calcific depositions in followed patients. So, electroacupuncture may be a valuable treatment option for calcific tendonitis, when medical treatment fails to relieve symptoms.

Islam dan Pemberontakan terhadap Status Quo: Telaah atas Pemikiran teologi Sosial Ali Syariati

Ali Syariati, a Syiah moslem intellectual and a doctor in sociology of Islam, has written books and articles that are inspired by his Islamic internalization as a Syiah moslem. This article, through social theological perpective, is aimed at grasping sociological ideas of Syariati’s by tracing its theological and philosophical basis and his world view. It is found that his ideas are more an expression of islamic thought which are articulated in sociological terms. His ideas aimed to break the opressor-oppressed relation of Iran people at his time. The spirit of his ideas is to vanish the first and, then, awaken the second so that they are able to quit of the shackle of oppression. Those are responsible to do such a hard duty are rûshanfekr, enlightened intellectual. Qs. 28:5 and Qs. 30:1-4 and 30 are among al-Qur’an verses that inspired him and became theological arm rest of his ideas.

Differences in ergonomic and workstation factors between computer office workers with and without reported musculoskeletal pain.

Some studies have suggested a causal relationship between computer work and the development of musculoskeletal disorders. However, studies considering the use of specific tools to assess workplace ergonomics and psychosocial factors in computer office workers with and without reported musculoskeletal pain are scarce. The aim of this study was to compare the ergonomic, physical, and psychosocial factors in computer office workers with and without reported musculoskeletal pain (MSP). Thirty-five computer office workers (aged 18-55 years) participated in the study. The following evaluations were completed: Rapid Upper Limb Assessment (RULA), Rapid Office Strain Assessment (ROSA), and Maastricht Upper Extremity Questionnaire revised Brazilian Portuguese version (MUEQ-Br revised). Student t-tests were used to make comparisons between groups. The computer office workers were divided into two groups: workers with reported MSP (WMSP, n = 17) and workers without positive report (WOMSP, n = 18). Those in the WMSP group showed significantly greater mean values in the total ROSA score (WMSP: 6.71 [CI95% :6.20-7.21] and WOMSP: 5.88 [CI95% :5.37-6.39], p = 0.01). The WMSP group also showed higher scores in the chair section of the ROSA, workstation of MUEQ-Br revised, and in the upper limb RULA score. The chair height and armrest sections from ROSA showed the higher mean values in workers WMSP compared to workers WOMSP. A positive moderate correlation was observed between ROSA and RULA total scores (R = 0.63, p < 0.001). Our results demonstrated that computer office workers who reported MSP had worse ergonomics indexes for chair workstation and worse physical risk related to upper limb (RULA upper limb section) than workers without pain. However, there were no observed differences in workers with and without MSP regarding work-related psychosocial factors. The results suggest that inadequate workstation conditions, specifically the chair height, arm and back rest, are linked to improper upper limb postures and that these factors are contributing to MSP in computer office workers.

Combined Intra-articular K-wire and Coracoclavicular Screw Fixation for Type III Acromioclavicular Joint Dislocations- A Randomized Controlled Study with Minimum of 3 Years Follow-up

BACKGROUND: Treatment of Rockwood type III acromioclavicular dislocations is still controversial with evidence present in favour of both operative and non-operative interventions. MATERIAL AND METHODS: A prospective randomized controlled clinical trial was conducted at the Department of Orthopaedics of a Level I trauma centre including 54 (male = 34, female = 20) cases of type III acromioclavicular dislocations, randomized into two groups A (operative) and B (non-operative). Group A cases underwent surgery using combined intra-articular K-wire and coracoclavicular screw fixation. Group B cases were treated non-operatively using arm sling and rest. RESULTS: Mean follow-up period was 40.8 months (range = 36-49). Mean Constant Shoulder scores for group A and B were 93 and 83.5 after 12 months (p value ≤ 0.0001); 93.3 and 86.5 after 36 months (p value ≤ 0.0001), respectively. Complications reported from group A were hardware failure, heterotopic ossification, distal clavicle osteolysis and superficial stich infection and from group B were cosmetic deformity and intermittent pain around shoulder. CONCLUSIONS: In this study, operatively managed cases did significantly better than the non-operatively treated ones with faster and improved functional outcomes.

Reconstruction of human swing leg motion with passive biarticular muscle models

Template models, which are utilized to demonstrate general aspects in human locomotion, mostly investigate stance leg operation. The goal of this paper is presenting a new conceptual walking model benefiting from swing leg dynamics. Considering a double pendulum equipped with combinations of biarticular springs for the swing leg beside spring-mass (SLIP) model for the stance leg, a novel SLIP-based model, is proposed to explain human-like leg behavior in walking. The action of biarticular muscles in swing leg motion helps represent human walking features, like leg retraction, ground reaction force and generating symmetric walking patterns, in simulations. In order to stabilize the motion by the proposed passive structure, swing leg biarticular muscle parameters such as lever arm ratios, stiffnesses and rest lengths need to be properly adjusted. Comparison of simulation results with human experiments shows the ability of the proposed model in replicating kinematic and kinetic behavior of both stance and swing legs as well as biarticular thigh muscle force of the swing leg. This substantiates the important functional role of biarticular muscles in leg swing.

Perancangan Door trim Mobil Sesuai Keinginan Pengguna City Car

Nowadays, product design and development has been driven by market opportunity or known as market pull platform. Aimed to satisfy customer needs, this platform engaged customer at the first stage of the product design and development methods to be represented on the designing stage. The aim of this research is evolve driver door trim design of SmarT EV 2 with customer and ergonomic consideration. The proposed methods, based on combination solution of customers need, has arised four alternative design concepts to be assessed and selected. The choosen design as result is alternative design number four consist of power window and locks feature to enhace safety driving, retractable and electric mirror using knob, side pocket indue cup holder inside, gives dynamical sense by streamline-spherical countour design,and warped arm rest design with its panels layout that used and reached easily.

Gating of tactile information through gamma band during passive arm movement in awake primates.

To make precise and prompt action in a dynamic environment, the sensorimotor system needs to integrate all related information. The inflow of somatosensory information to the cerebral cortex is regulated and mostly suppressed by movement, which is commonly referred to as sensory gating or gating. Sensory gating plays an important role in preventing redundant information from reaching the cortex, which should be considered when designing somatosensory neuroprosthetics. Gating can occur at several levels within the sensorimotor pathway, while the underlying mechanism is not yet fully understood. The average sensory evoked potential is commonly used to assess sensory information processing, however the assumption of a stereotyped response to each stimulus is still an open question. Event related spectral perturbation (ERSP), which is the power spectrum after time-frequency decomposition on single trial evoked potentials (total power), could overcome this limitation of averaging and provide additional information for understanding the underlying mechanism. To this aim, neural activities in primary somatosensory cortex (S1), primary motor cortex (M1), and ventral posterolateral (VPL) nucleus of thalamus were recorded simultaneously in two areas (S1 and M1 or S1 and VPL) during passive arm movement and rest in awake monkeys. Our results showed that neural activity at different recording areas demonstrated specific and unique response frequency characteristics. Tactile input induced early high frequency responses followed by low frequency oscillations within sensorimotor circuits, and passive movement suppressed these oscillations either in a phase-locked or non-phase-locked manner. Sensory gating by movement was non-phase-locked in M1, and complex in sensory areas. VPL showed gating of non-phase-locked at gamma band and mix of phase-locked and non-phase-locked at low frequency, while S1 showed gating of phase-locked and non-phase-locked at gamma band and an early phase-locked elevation followed by non-phase-locked gating at low frequency. Granger causality (GC) analysis showed bidirectional coupling between VPL and S1, while GC between M1 and S1 was not responsive to tactile input. Thus, these results suggest that tactile input is dominantly transmitted along the ascending direction from VPL to S1, and the sensory input is suppressed during movement through a bottom-up strategy within the gamma-band during passive movement.

Pre- and Postseason Dynamic Ultrasound Evaluation of the Pitching Elbow

To use ultrasound imaging to document changes over time (i.e., preseason v postseason) in the pitching elbow of high school baseball pitchers. Twenty-two high school pitchers were prospectively followed. Pitchers were evaluated after a 2-month period of relative arm rest via preseason physical exams, dynamic ultrasound imaging of their throwing elbow, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) assessment. Players were reevaluated within 1 week of their last game. Dynamic ultrasound images were then randomized, blinded to testing time point, and evaluated by 2 fellowship-trained musculoskeletal radiologists. Average pitcher age was 16.9 years. Average pitches thrown was 456.5, maximum velocity 77.7 mph, games pitched 7.3, and days off between starts 6.6. From preseason to postseason, there were significant increases in ulnar collateral ligament (UCL) thickness (P = .02), ulnar nerve cross-sectional area (P = .001), UCL substance heterogeneity (P = .001), and QuickDASH scores (P = .03). In addition, there was a nonsignificant increase in loaded ulnohumeral joint space (P = .10). No pitchers had loose bodies on preseason exam, while 3 demonstrated loose bodies postseason. The increase in UCL thickness was significantly associated with the number of bullpen sessions per week (P = .01). The increase in ulnar nerve cross-sectional area was significantly associated with the number of pitches (P = .04), innings pitched (P = .01), and games pitched (P = .04). The stresses placed on the elbow during only one season of pitching create adaptive changes to multiple structures about the elbow including UCL heterogeneity and thickening, increased ulnohumeral joint space laxity, and enlarged ulnar nerve cross-sectional area. Level II prospective observational study.

A Study on the VDT Workstations Usage for Office Workers

Objective and Background: Due to increase in Musculoskeletal Disorders (MSDs) relating to computer use, a number of ergonomics recommendations have been proposed in order to tackle this problem. However, some of these recommendations have been conflicting. Method: This study was to survey the VDT (Visual Display Terminal) use of office workers. The subjects were 452 workers at 13 places of business and the data were collected by self-administered questionnaire. Results: As a result, prevalence of self-reported MSDs of all VDT workers was 90.2% and shoulder took up 57.0% and neck 38.3% by symptom part of body. The population of computer use of more than 6h/day was 84.5%, and 33.8% also reported using the VDT 2~3h/day without the rest time. Desktop computer users were 95.6%, and a 17-inch monitor accounted for 42.0% among the desktop users. As a result of satisfaction survey on overall computer work, 21.1% of the total respondents said satisfied, desk complaint was about 24.6%, and chair complaint was 33.4%. Despite the importance of computer environment, satisfaction was from fair to uncomfortable. Conclusion and Application: In conclusion, office workers are prone to the MSDs due to their work environment. Additionally, this study found that task was a significant effect for the majority of dependent variables, and therefore, the improvement of computer workstations work environment is urgent, and the improvement of desk height adjustment, chair seat size (length, width), backrest condition, location of keyboard (mouse) and arm rest is required.

Detection and prevention of glenohumeral epiphysiolysis.

Proximal humeral epiphysiolysis (a.k.a. Little League shoulder) is most commonly seen in adolescent throwing athletes from ages 11 to 16 years (1,4). The pathology is a widening of the physis, resulting in a Salter-Harris I fracture (see Figure) (8). Biomechanically, due to weaker developing epiphyseal plates, torque during maximum external shoulder rotation and excessive laxity may predispose the young thrower to this type of injury (9,10).Figure: Notice the widening of the right proximal humeral physis (on the left) compared with that in the left in this 13-year-old pitcher.Important information to elicit includes whether the athlete is a pitcher or catcher, the number and type of pitches thrown per game and season, the frequency of pitching, and the number of leagues in which the athlete competes. The quality, severity, and specific location of pain experienced as well as when the pain occurs during pitching motion are important information to obtain (4). Patients typically present with pain occurring in the shoulder that has progressively worsened over several months while throwing hard (1). The most consistent physical examination finding is tenderness over the proximal humeral physis (1). While anterior-posterior radiographs in internal and external rotation with widening of the proximal humeral physis is the hallmark of Little League shoulder, there also may be fragmentation of the lateral metaphysis, sclerosis, cystic changes, and demineralization of the proximal humeral metaphysis (2). Additionally, widening of the physis does not necessarily correlate to symptoms. An important pearl is to always obtain comparison radiographs of the nonthrowing shoulder. Magnetic resonance imaging (MRI) studies also have been used for further imaging detail with success (2). However, MRI is typically not indicated unless there is suspicion of additional injury and/or no improvement with rest for at least 3 wk (3). Nonoperative treatment typically begins with 6 wk of complete rest. If the patient is asymptomatic at rest, nonthrowing physical therapy may begin at week 7. At 3 months, if asymptomatic, a progressive throwing program with subsequent return to play is standard. Overuse throwing injury can be minimized by following national recommendation guidelines, which major league baseball has now endorsed, on pitch counts, rest days, pitch type based on age, use of radar guns, and yearly arm rest recommendations (4–7,11).