| Shoulder injuries: |
| Transient shoulder subluxation ("dead arm") |
- Sudden onset of pain accompanied by loss of throwing velocity during arm acceleration or late cocking
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- Positive apprehension test
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| Rotator cuff injuries |
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- Pain with overhead motions during activities of daily living
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- Pain in the posterior-superior shoulder, especially at terminal cocking, suggests internal impingement with undersurface rotator cuff tear
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- Painful arc of shoulder abduction for 70 to 120 degrees
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- Positive impingement tests (Jobe, Hawkins, Neer)
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- Ultrasound or MRI often diagnostic
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| Labral tears |
- Deep shoulder pain with throwing motions, but not with general activities of daily living
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- Mechanical sensations (eg, catching, popping, clicking) within shoulder may occur, especially with overhead motions
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- Pain reproduced by provocative maneuvers (O'Brien's, O'Driscoll's, Jobe relocation, anterior slide, crank)
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- Can be difficult to diagnose; may need MRI-arthrography IF indicated
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| Glenohumeral internal rotation deficiency (GIRD) |
- Pain deep in posterior shoulder
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- Loss of internal rotation compared with the non-throwing shoulder of at least 20 degrees, and less than 180 degrees total arc of motion with shoulder abducted 90 degrees
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| Proximal humeral epiphysiolysis (Little League shoulder) |
- Pitchers between 11 and 16 years old with open growth plates
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- Progressively worsening pain in the shoulder with throwing
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- Pain over the lateral proximal humerus
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- Plain radiographs are useful for confirming presence of open growth plates at the location of pain
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| SICK (Scapular malposition, Inferior medial border prominence, Coracoid pain and malposition, and dysKinesis) scapula syndrome and scapular dyskinesis |
- Insidious anterior shoulder pain in the coracoid region
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- Lower scapula with a prominent inferior medial border on affected side
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- Abnormal and asymmetric scapular motion with shoulder abduction
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- Loss of terminal shoulder flexion and coracoid region pain that worsens with passive shoulder flexion
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| Elbow injuries: |
| Ulnar collateral ligament (UCL) sprain or tear |
- Acute onset of medial elbow pain during acceleration with a single pitch
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- Pain and laxity with UCL testing (valgus stress, moving stress, milking maneuver)
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- Ultrasound often useful for identifying injury
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| Common wrist (forearm) flexor strain |
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- Pain anterior and lateral to the medial epicondyle; not over UCL
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- Pain with resisted wrist flexion and pronation
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- UCL stress testing does not cause pain
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| Valgus extension overload (VEO) syndrome |
- Pain in the posterior elbow at ball release
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- Pain when a valgus stress is placed continuously on the elbow while extending the joint from 30 degrees of flexion into terminal extension
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- Plain radiographs useful for identifying bone spurs and other changes that may occur with VEO
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| Olecranon stress fracture |
- Focal pain to palpation over the posterior or posteromedial olecranon
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- Triceps non-tender on palpation
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- Plain radiographs should be obtained; MRI may be needed if no fracture visible on plain films
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| Triceps tendinopathy |
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- Progressively worsening pain with increased number of pitches thrown
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- Tenderness at or just proximal to insertion on the olecranon
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- Pain with resisted elbow extension
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| Ulnar neuropathy |
- Electric sensation radiating down the forearm with throwing
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- Positive ulnar Tinel sign
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| Osteochondrosis of elbow |
- Child (between 7 and 12 years; with open growth plate)
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- Plain radiographs show fragmentation of capitellar ossification center
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| Osteochondral defect (OCD) of the elbow |
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- Lateral elbow pain with throwing
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- Plain radiographs usually reveal OCD
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| Little League elbow |
- Pitchers between 9 and 12 years old with open growth plates
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- Medial elbow tenderness and pain with valgus stress
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- Plain radiographs useful to confirm presence of open growth plates
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| Vascular injury: |
| Effort thrombosis (Paget-Schroetter syndrome) |
- Discomfort and swelling of dominant arm
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- Dilated, visible veins across shoulder and upper arm (Urschel's sign)
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- Doppler ultrasound critical to rule out this emergent condition
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