Proximal Humeral Apophysitis Flashcards
What is another name for a proximal humeral apophysitis?
Little league shoulder
What is the prevalence of proximal humeral apophysitis?
Rare but increasing
What population do you see proximal humeral apophysitis in?
- Adolescents
- Biological males > females
- Mostly overhead throwers but also racquet sports
What is the cause of proximal humeral apophysitis?
Growth with high activity
What are the pathomechanics of proximal humeral apophysitis?
- Bone growth exceeds rotator cuff lengthening
- Increased tendon tension
- Growth plate is the weak spot as opposed to tendon in the adult
- Most often inflammation
- Complication: avulsion and or premature closure
What are symptoms of a proximal humeral apophysitis?
- Gradual onset of shoulder pain with overuse
- a “pop” may indicate trauma and an avulsion
- Above etiology with possible loss of velocity
Proximal humeral apophysitis signs are like what other condition?
Impingements
What is a GIRD ratio in proximal humeral apophysitis?
- Resisted and MMT
- ER:IR strength ratio in adolescent athletes
- GIRD > 1
What special tests should you do with people with proximal humeral apophysitis?
- Impingement tests (+)
- Up to 30% with GIRD > 1
What will you find when you palpate in a proximal humeral apophysitis?
- TTP over the antero- and posterolateral aspect of the proximal humerus
- This is the most common sign
What patient education should be done with a proximal humeral apophysitis?
- Soreness rule
- Load management (I.I pitch count, active rest with alternate defensive positions, rest days)
- Movement cues (I.e. throwing mechanics)
- POLICED
What is your PT Rx with proximal humeral apophysitis?
- Normalize motion: often improving GIRD ratio
- Careful with prolonged stretching due to vulnerability of growth plate
- Return to play (RTP): throwing progression program
What MET should be your focus be for proximal humeral apophysitis?
- Cuff but also trunk, scapular and LE impairments
- Caution with muscle and tendons attached to growth plate
Most proximal humeral apophysitis injuries return to pre-injury levels as early as …
2 months but possibly up to 2 - 8 months
When can proximal humeral apophysitis injuries return to competition?
About 4.5 months to return to competition with an avulsion
At what age does the growth plate of the proximal humerus typically close?
Between the age of 16 and 20
T/F: Proximal humeral apophysitis can become a recurrent or persistent problem.
True
