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
