Hi, this is Sagar Wagle, one of the musculoskeletal radiology fellows at Stanford University. We have a case of a 13-year-old male baseball pitcher with insidious onset right shoulder pain. The radiograph shows that there's subtle widening of the physis laterally when compared to medially in the proximal humerus. This is consistent with little Liger's shoulder, also called epiphyseolysis of the proximal humerus. The patient also has irregularity of the inferior glenoid, and on the axial MRI image, we can see that the glenoid is angled more posteriorly. Normally, the glenoid should be angled something like this. So this is a case of a dysplastic glenoid as well. The growth plate is the weakest point in a pediatric skeleton, and the fracture through the growth plate, also called a physis, is classified according to Salter-Harris classification. In type 1 fracture, the fracture goes through the physis, or the growth plate. In type 2 fracture, the fracture goes through the physis and out through the metaphysis. In type 3, the fracture goes through the physis and out from the epiphysis. And in type 4, the fracture goes through both metaphysis and epiphysis. The mnemonic to remember this physiol classification is type 1 S for same, type 2 A for above, through the metaphysis, type 3 L, low through the epiphysis, and type 4, deeper through. So our little digger shoulder is a type of type 1 Salter-Harris fracture. We have another case of a 14-year-old baseball player with chronic shoulder pain. On the radiograph, we can see that there is subtle widening of the growth plate laterally. If we are unsure if the growth plate is actually widened or not, we can get radiograph of the contralateral shoulder for comparison. In this case, we obtained a CT and we can see the widening of the growth plate. We also have a non-contrast MRI and we can see the increased signal of the growth plate laterally while the medial growth plate is normal. So this is an example of little digger shoulder. MRI with contrast is not helpful in diagnosis of little digger shoulder. Thank you for watching the video.

3rd Edition, CASE 44

3rd Edition

Pediatric Issues

Little League shoulder

glenoid dysplasia

Salter-Harris fracture

growth plate

MRI diagnosis