Proximal Humeral Epiphysitis
How Is It Diagnosed?
A sports medicine or orthopedic physician makes a proper diagnosis of PHE by conducting a complete physical exam of the entire shoulder complex. X-rays of the athlete’s shoulder will show the widening of the growth plate. If conventional x-rays are negative, a physician might elect to order additional imaging studies, including an MRI.
If a child sees a physical therapist first, the physical therapist will ask:
How are you feeling (signs and symptoms)?
How long have you been experiencing your current symptoms? When do your symptoms typically occur?
What sport and position do you play, and how often do you play (practice and games) in a typical week/month/year?
If you are a pitcher, when is the last time you threw a ball? What types of pitches do you typically throw? How much rest do you get between throwing events?
A physical therapist takes this information and conducts a thorough physical exam to determine the root cause of the problem. The physical therapist examines the athlete’s shoulder and elbow range of motion, and tests the strength of the muscles around the shoulder blade, trunk, pelvis, and hip.
How Can a Physical Therapist Help?
The conditions caused by PHE, such as muscle weakness or lack of endurance, lack of range of motion, or poor throwing mechanics can all be addressed in physical therapy. The physical therapist will work with the young athlete to:
Improve muscle strength and endurance at the shoulder.
Normalize the shoulder’s range of motion.
Increase the athlete’s trunk, pelvis, and hip muscle strength and stability to provide a firm foundation from which to throw.
Observe and correct pitching mechanics to reduce stress through the shoulder.
Establish a schedule for the year with a proper amount of participation and rest.
Establish a plan for a controlled progressive return to throwing, often called an interval throwing program, for a safe return to play.
The physical therapist will work with the athlete to develop an individualized treatment plan based on the initial evaluation and goals.
Can this Injury or Condition be Prevented?
No injury is ever completely preventable. However, there are some tangible steps that players, their parents, and coaches can take to reduce the risk of shoulder injury, including:
Pitch Count and Rest. Rest is the body’s way of healing itself. Taking days off from playing or practicing gives the body a chance to repair and remain healthy. Your physical therapist will provide a guide for the amount of pitching and rest periods required to maintain a pitcher’s shoulder strength and health, based on age.
Body Mechanics. Young athletes should be supervised and monitored while participating in sports with repetitive overhead motions, like baseball and softball. Sports medicine professionals or coaches who are skilled in analyzing body mechanics should be consulted as soon as the athlete complains of any of the signs or symptoms mentioned above.
Movement Variety. It’s important as kids mature and develop that they are exposed to multiple sports and play multiple positions. Variety helps reduce the amount of repetitive stress placed on any 1 body region. Parents and coaches need to encourage this type of multisport participation. Although not fully substantiated, some research studies have suggested there might be a correlation between multisport participation and decreased injury risk.
Prescribed Rest. If an athlete develops PHE, the athlete will need to rest from the overhead activity for 4 to 6 weeks to ensure that the bone heals properly. A physical therapist can work with the athlete to provide alternative ways to remain active during the rehab process. Afterwards, the athlete will be able to work with a physical therapist to complete a gradual return to a throwing program. Rest periods will vary from injury to injury and patient to patient; your physical therapist will prescribe rest periods to address the young athlete’s individual condition and goals.
Real Life Experiences
Cade is a 12-year-old pitcher who just completed a successful season with his school’s baseball team. While pitching a win during the third game of the season, Cade started to feel pain in his right shoulder that increased near the end of the game. His pain got worse with each game. Cade’s father noticed his son’s pitching velocity slowed as each game progressed. He iced Cade’s shoulder after each game, but as soon as the season ended, he decided Cade needed to see a physical therapist.
Cade’s physical therapist asked about his medical history and his current symptoms. He found that the muscles that control the position of Cade’s shoulder blade were much weaker on his right side than on his left side. He also recorded less shoulder range of motion on Cade’s right side compared to his left side. An x-ray confirmed a diagnosis of proximal humeral epiphysitis.
Cade’s physical therapist educated Cade and his family about the importance of taking adequate rest periods between sport activities. And due to Cade’s current condition, he said Cade needed to take the entire summer off to rest and recover, and not play baseball while he was being treated.
Cade reluctantly agreed, and worked with his physical therapist to strengthen the muscles around his shoulder blade, trunk, pelvis, and hips, and regain his range of motion at his right shoulder. Cade was also given specific exercises to perform at home to supplement his physical therapy sessions. Although he missed playing baseball, Cade found he enjoyed all the new exercises he was learning.
After several weeks of physical therapy, Cade did not have any pain in his right shoulder. He reported that his muscles were feeling stronger throughout his whole body.
Once Cade was cleared by his physician, Cade’s physical therapist guided him through a gradual return to a throwing program. He worked with the pitching coach to ensure Cade was using proper mechanics as he began throwing again.
When the new school year began, Cade decided to sign up for the track team to continue to build his lower body strength and endurance. His physical therapist approved the fact that he was adding another sport to his training routine.
When baseball season came around, Cade was able to return to pitching (and catching)—pain free. His dad was amazed at how fast he rounded the bases when he got a hit!