Non-Operative — Proximal Humeral Apophysitis (Little League Shoulder) — Pediatric

Massachusetts General Hospital · MGH Brigham Pediatric Sports Medicine

Weight-Bearing

N/A

Key Restrictions

Rest from overhead activities up to 3 months (or per orthopedic specialist); no throwing until Phase IV; athlete may run and field (no throwing) as symptoms allow; abide by pitch count and rest days on return; no UE functional testing normative data in pediatric population (individualize RTS criteria)

Timeline & Phases

Phase I (0-2 wks): protect/pain management, GH ROM (table slides, pendulums, cane ER), periscapular strengthening; Phase II (3-6 wks): progressive RC strengthening (side-lying ER, scaption), scapular motor control, core/LE (single leg squats, RDL, Copenhagen); Phase III (7-12 wks): dynamic stability, plyometric shoulder exercises, shadow throwing drills (towel/tube, figure-8s); Phase IV (12+ wks): MGB Youth Throwing Progression, biomechanical assessment, return to play

Notes

4-phase protocol; rest from overhead activities >=3 months; discharge criteria: QuickDASH <10, PASS >90%, ER/IR strength >=85% uninvolved, ER/IR ratio >64%, joint position sense <5-degree error, scapular dyskinesis symmetric; MGB Youth Overhead Strengthening Program included. [Archived copy — original Massachusetts General Hospital URL retired in the Mass General Brigham site migration; Wayback snapshot 2025-02-10.]

Surgeon / Author

MGH Brigham Pediatric Sports Medicine