Novel Stress Tests for Diagnosing Little League Shoulder and Determining the Timing of Return to Sports.

BACKGROUND

The primary etiology of Little League shoulder (LLS) is rotational torque caused by repetitive throwing motion. However, there are few reports on the assessment of rotational torque during physical examination.

PURPOSE: To investigate the usefulness of the resisted external rotation test (RERT) and the resisted internal rotation test (RIRT) in diagnosing LLS and determining the time to return to sports (RTS).

STUDY

DESIGN

Case series (diagnosis); Level of evidence, 4.

METHODS

In total, 101 patients were diagnosed with LLS by proximal humeral physeal widening on radiography and tenderness on palpation over the lateral aspect of the proximal humerus, and the RERT and the RIRT were performed. During the 2 tests, the examiner lifted the patient's elbow joint with one hand toward the humeral shaft and held the patient's wrist joint with the other hand. In the RERT/RIRT, the patient was instructed to apply a maximal force of external/internal rotation from neutral alignment. The examiner resisted the force of external/internal rotation and maintained the setting position while holding the wrist joint. These test results were positive if either or both tests elicited shoulder pain. Positive test results and their association with radiographic findings were examined. In case of positive test results, the time to achieve negative test results and the time to RTS were investigated.

RESULTS

The RERT and RIRT were correlated with severity of LLS. The sensitivity of RERT/RIRT for LLS was 94.1%/36.6%, respectively. In RIRT, patients with advanced-stage LLS were more likely to have positive results than those with early-stage LLS (67.4% vs 10.9%; P < .001). The mean time to achieve negative RERT and RIRT results was 6.7 and 4.7 weeks, respectively (P = .01). Patients with advanced-stage LLS had a longer mean time to achieve negative RERT results than those with early-stage LLS (6.7 vs 4.7; P < .001). The time to RTS was 8.8 weeks in the group that resumed throwing after achieving negative RERT, while the group that resumed throwing before RERT became negative took 12.7 weeks (P < .001).

CONCLUSION

The RERT may be useful in determining the presence of LLS and when RTS can be allowed.