Growth plate injuries in youth athletes are commonly reported across all sports and in multiple regions of the body. In youth, overhead athletes we commonly see these injuries occur in bones that make up the shoulder and elbow joints. These injuries are so commonly reported in youth baseball players that the injuries themselves are nicknamed accordingly…
Little League Shoulder and Little League Elbow
As with any injury, severity of these injuries ranges widely due to a multitude of factors. However, what I have noticed is when the player informs the parents or coaching staff at the first onset of pain or fatigue, these injuries are MUCH easier to deal with and time missed from practices and games is significantly reduced. Therefore, being able to recognize risk factors and early signs and symptoms of growth plate injuries, helps us to reduce the negative impact this has on the athlete’s health, well-being and playing career.
Epiphyseal Plate
The epiphyseal plate, also known as the growth plate, is an area of cartilage toward the end of a bone where new bone forms during childhood and adolescence. Hence, the term growth plate. When we reach adulthood, these areas close and the bone stops growing. During childhood, while these areas remain open, they essentially are the weak point of the humerus (upper arm bone). Weaker even than the attaching ligaments and muscles, including the UCL (Ulnar Collateral Ligament/Tommy John Ligament).
As we’ve discussed in previous blog articles, throwing puts a tremendous amount of force through various parts of the shoulder and elbow joints. And since the growth plate is the weak link in the chain, it is more susceptible to damage from microtrauma with each throw. Over time, this repetitive trauma leads to inflammation and pain as well as changes within the bony structure around the injury such as widening of the growth plate and in more extreme cases, bony fractures.
Growth Plate Injury: Sign & Symptoms
Early detection of symptoms can help reduce the risk of a mild injury becoming more severe which could drastically decrease the number of practices and games the athlete misses due to rehab and healing time. Elbow or shoulder pain is the most obvious indicator that something may be happening at the level of an athlete’s growth plate. But decreased velocity and accuracy, even without pain, can be a sign of a growth plate related issue as well.
In the shoulder, pain is commonly reported in the front and lateral portion. There may be swelling, tenderness to touch, loss of range of motion, feeling weakness or pain with active movements especially into what we call external rotation of the shoulder.
In the elbow, pain will most likely be present around the medial epicondyle which is the bony prominence of the inner aspect elbow. Again, there may be swelling, tenderness to touch, pain with bending or straightening the elbow, and decreased grip strength.
Diagnosing a growth-plate injury can only be done by a medical professional. To fully understand the severity of an injury, imaging may be needed if there isn’t a positive response to rest and rehabilitation under the guidance of a physical therapist.
Even if there is no fracture or widening present upon taking a radiograph (X-ray), rest for 4-6 weeks may still be recommended to allow the inflammation to subside and allow the cartilage to heal. During this time, the athlete should work with a rehab professional to improve the strength and mobility in the area of the injury. Not only will the right rehab professional facilitate proper healing, but they will also be able to identify and address additional mechanic faults that may have accelerated this injury in addition to repetitive stress generally placed with throwing.
If the injury does progress to a fracture or widening of the growth plate, patients are typically splinted for a few weeks and need closer to 4-6 months of rehab which includes a gradual, return-to-throwing program. In some instances, surgery is even required to help the bony structures heal.
Can we prevent these injuries?
Injuries to the growth plate are not completely preventable. However, the likelihood of an injury happening can certainly be reduced. The most effective thing is to follow pitch count guidelines and rest from throwing 2-3 months per year. These guidelines have been designed after a thorough review of the research and when followed, are extremely useful in helping to reduce injuries to the upper extremities in baseball players.
It is recommended athletes work with a rehab or strength & conditioning professional to address any weaknesses or mobility restrictions that may be present, which could lead to increased stresses on the elbow or shoulder during the throwing motion. Proper warm-up
techniques, routine performance of resistance band rotator cuff and scapular strengthening, proper shoulder and spinal mobility, hip mobility, lower extremity strength, and balance all need to be addressed to reduce these injuries.
As we’ve discussed growth plate injuries are relatively common and the task of helping to reduce these injuries ultimately is our responsibility, the coaches and parents. Following the appropriate recommendations can help keep your young athlete on the field throughout the course of a long and tough season while also boosting the athlete’s performance.
Here's a bonus tip! Check out my favorite Pre-throw resistance band warm-up!