ABSTRACT
This is a six year follow-up on lesions of the proximal humeral epiphyseal plate in little league pitchers. Epiphyseal injuries are well known in the little league elbow. Dr. Adams first described this proximal humeral epi-physeal lesion and calls it an epiphysitis (I). No followup was given and no pathological interpretation was given to the lesion. The author submits that this lesion heals with rest alone and is a traumatic epiphyseal plate fatigue fracture. This is a rare lesion in little league pitchers but, if recognized, heals without event.
MATERIALS AND METHODS
Five cases have been collected by the author since 1966. The age of presentation was between I I and 12 years and the presenting symptoms were pain and inability to per-form associated with a long history of little league pitching. Signs have been limitation of motion, diffuse anterior tenderness over the glenohumeral joint and a slight fullness of this area. Followup on this series is six years with one year minimum on the most recent case.
ROENTGENOGRAPHIC EXAMINATION
X-ray films of all involved patients showed a widening of the epiphyseal line with metaphyseal bone separation representing a Thurston Hollindor type lesion which is a sign of epiphyseal separation and on which I base my pathophysiologic diagnosis that this is an epiphyseal separation. There also was a typical metaphyseal and diaphyseal new hone formation secondary to periosteal stripping.
DISCUSSION
With rest, that is no immobilization or splinting, all patients completely recovered within six weeks. The all had a full range of motion and x-ray films were normal: two of the earlier patients had played high school and major college baseball as pitchers and x-ray films of their glenohumeral joints at this date show normal findings. It is well recognized by Adams'• 2 and Tullos et al' that traction and chronic strain on the epiphysis can cause displacement and/or frank rupture to the epiphyseal plates resulting in epiphyseal fracture. It is, therefore, not unlikely that the proximal humeral epiphyseal line can undergo similar type changes from rotatory torque during the cocking and acceleration phases or the decelerating distraction forces during the follow-through of the pitching mechanism.