{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T14:27:08Z","timestamp":1787149628103,"version":"build-2736575974"},"reference-count":37,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["HSS Journal\u00ae: The Musculoskeletal Journal of Hospital for Special Surgery"],"abstract":"<jats:p>Pediatric overhead athlete injuries are increasing in frequency, many of them unique to the youth musculoskeletal system. Conditions relate not only to growth centers but also to subchondral bone and joint instability linked to immature connective tissue. Diagnosis depends on a thorough patient history, correct examination techniques, and use of imaging. Management of these patients requires a greater focus on neuromuscular rehabilitation principles than is needed for adults. There is a lack of consensus on the role of functional testing in rehabilitation decisions, and further investigation is necessary. In addition, practitioners need to be mindful of the psychosocial dynamics among players, parents, and coaches, who may not understand appropriate workloads for young athletes and feel pressured to accelerate the pace of recovery. This narrative review covers the most current principles of diagnosis, treatment, and return-to-play strategies for pediatric overhead athlete injuries including preventing of recurrent injuries and avoiding long-term sequelae.<\/jats:p>","DOI":"10.1177\/15563316261474789","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T08:13:28Z","timestamp":1786954408000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Trending Pediatric Injuries in the Overhead Athlete: A Narrative Review"],"prefix":"10.1177","author":[{"given":"Joseph","family":"Molony","sequence":"first","affiliation":[{"name":"Pediatric Rehabilitation and Young Athlete Center, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna","family":"Merkel","sequence":"additional","affiliation":[{"name":"Cogent Steps, LLC, Alexandria, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"McElheny","sequence":"additional","affiliation":[{"name":"Vermont Orthopaedic Clinic, Rutland, VT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9774-0496","authenticated-orcid":false,"given":"Yukiko","family":"Matsuzaki","sequence":"additional","affiliation":[{"name":"Pediatric Rehabilitation and Young Athlete Center, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Hospital for Special Surgery, Paramus, NJ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","unstructured":"Heyworth BE Kramer DE Martin DJ Micheli LJ Kocher MS Bae DS. Trends in the presentation management and outcomes of Little League shoulder. Am J Sports Med. 2016;44(6):1431-1438. https:\/\/doi.org\/10.1177\/0363546516632744","DOI":"10.1177\/0363546516632744"},{"key":"e_1_3_2_3_2","unstructured":"Hodge C Schroeder JD. Medial epicondyle apophysitis (Little League elbow). StatPearls; 2023. Accessed June 30 2026. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK570592\/"},{"key":"e_1_3_2_4_2","doi-asserted-by":"crossref","unstructured":"Braithwaite KA Marshall KW. The skeletally immature and newly mature throwing athlete. Radiol Clin North Am. 2016;54(5):841-855. https:\/\/doi.org\/10.1016\/j.rcl.2016.04.006","DOI":"10.1016\/j.rcl.2016.04.006"},{"key":"e_1_3_2_5_2","doi-asserted-by":"crossref","unstructured":"Lin KM James EW Spitzer E Fabricant PD. Pediatric and adolescent anterior shoulder instability: clinical management of first-time dislocators. Curr Opin Pediatr. 2018;30(1):49-56. https:\/\/doi.org\/10.1097\/MOP.0000000000000566","DOI":"10.1097\/MOP.0000000000000566"},{"key":"e_1_3_2_6_2","doi-asserted-by":"crossref","unstructured":"Patel DR Breisach S. Evaluation and management of shoulder pain in skeletally immature athletes. Transl Pediatr. 2017;6(3):181. https:\/\/doi.org\/10.21037\/TP.2017.04.06","DOI":"10.21037\/tp.2017.04.06"},{"key":"e_1_3_2_7_2","doi-asserted-by":"crossref","unstructured":"Rawal A Eckers F Lee OSH Hochreiter B Wang KK Ek ET. Current evidence regarding shoulder instability in the paediatric and adolescent population. J Clin Med. 2024;13(3):724. https:\/\/doi.org\/10.3390\/JCM13030724","DOI":"10.3390\/jcm13030724"},{"key":"e_1_3_2_8_2","doi-asserted-by":"crossref","unstructured":"van Bergen CJA van den Ende KIM ten Brinke B Eygendaal D. Osteochondritis dissecans of the capitellum in adolescents. World J Orthop. 2016;7(2):102. https:\/\/doi.org\/10.5312\/wjo.v7.i2.102","DOI":"10.5312\/wjo.v7.i2.102"},{"key":"e_1_3_2_9_2","doi-asserted-by":"crossref","unstructured":"Bednar ED Kay J Memon M Simunovic N Purcell L Ayeni OR. Diagnosis and management of Little League shoulder: a systematic review. Orthop J Sports Med. 2021;9(7):23259671211017564. https:\/\/doi.org\/10.1177\/23259671211017563","DOI":"10.1177\/23259671211017563"},{"key":"e_1_3_2_10_2","doi-asserted-by":"crossref","unstructured":"Williams CM Welch JJ Scheper M Tofts L Pacey V. Variability of joint hypermobility in children: a meta-analytic approach to set cut-off scores. Eur J Pediatr. 2024;183(8):3517-3529. https:\/\/doi.org\/10.1007\/S00431-024-05621-4","DOI":"10.1007\/s00431-024-05621-4"},{"key":"e_1_3_2_11_2","doi-asserted-by":"crossref","unstructured":"Jones SD Safran MR. Current concepts: the hip core and kinetic chain in the overhead athlete. J Shoulder Elbow Surg. 2024;33(2):450-456. https:\/\/doi.org\/10.1016\/j.jse.2023.10.009","DOI":"10.1016\/j.jse.2023.10.009"},{"key":"e_1_3_2_12_2","doi-asserted-by":"crossref","unstructured":"Zheng ET Bae DS Yen YM Vuillermin CB Miller PE Heyworth BE. Medial epicondylar apophyseal avulsion fractures in youth throwers: a severe variant of Little League elbow. Orthop J Sports Med. 2025;13(9):23259671251365974. https:\/\/doi.org\/10.1177\/23259671251365974","DOI":"10.1177\/23259671251365974"},{"key":"e_1_3_2_13_2","doi-asserted-by":"crossref","unstructured":"Herring SA Ben Kibler W Putukian M et al. Initial assessment and management of select musculoskeletal injuries: a team physician consensus statement. Curr Sports Med Rep. 2024;23(3):86-104. https:\/\/doi.org\/10.1249\/JSR.0000000000001151","DOI":"10.1249\/JSR.0000000000001151"},{"issue":"6","key":"e_1_3_2_14_2","first-page":"544","article-title":"Childhood and adolescent sports-related overuse injuries","volume":"108","author":"Lintner LJ","year":"2023","unstructured":"Lintner LJ, Swisher J, Sitton ZE. Childhood and adolescent sports-related overuse injuries. Am Fam Physician. 2023;108(6):544-553.","journal-title":"Am Fam Physician"},{"key":"e_1_3_2_15_2","doi-asserted-by":"crossref","unstructured":"Cao J Smetana BS Carry P Peck KM Merrell GA. A pediatric medial epicondyle fracture cadaveric study comparing standard AP radiographic view with the distal humerus axial view. J Pediatr Orthop. 2019;39(3):E205-E209. https:\/\/doi.org\/10.1097\/BPO.0000000000001274","DOI":"10.1097\/BPO.0000000000001274"},{"key":"e_1_3_2_16_2","doi-asserted-by":"crossref","unstructured":"Edmonds EW. How displaced are \u201cnondisplaced\u201d fractures of the medial humeral epicondyle in children? Results of a three-dimensional computed tomography analysis. J Bone Joint Surg Am. 2010;92(17):2785-2791. https:\/\/doi.org\/10.2106\/JBJS.I.01637","DOI":"10.2106\/JBJS.I.01637"},{"key":"e_1_3_2_17_2","doi-asserted-by":"crossref","unstructured":"Saper MG Bompadre V Schmale GA et al. Association between 45\u00b0 flexion anteroposterior elbow radiographs and diagnostic accuracy of capitellum osteochondritis dissecans. Am J Sports Med. 2021;49(10):2778-2782. https:\/\/doi.org\/10.1177\/03635465211027178","DOI":"10.1177\/03635465211027178"},{"key":"e_1_3_2_18_2","doi-asserted-by":"crossref","unstructured":"Nguyen JC Degnan AJ Barrera CA Hee TP Ganley TJ Kijowski R. Osteochondritis dissecans of the elbow in children: MRI findings of instability. AJR Am J Roentgenol. 2019;213(5):1145-1151. https:\/\/doi.org\/10.2214\/AJR.19.21855","DOI":"10.2214\/AJR.19.21855"},{"key":"e_1_3_2_19_2","doi-asserted-by":"crossref","unstructured":"M\u00fcller SA M\u00fcller-Lebschi JA Shotts EE et al. Advantages of CT versus MRI for preoperative assessment of osteochondritis dissecans of the capitellum. Am J Sports Med. 2022;50(14):3941-3947. https:\/\/doi.org\/10.1177\/03635465221129598","DOI":"10.1177\/03635465221129598"},{"key":"e_1_3_2_20_2","doi-asserted-by":"crossref","unstructured":"Thomas JM Chang EY Ha AS et al. ACR Appropriateness Criteria\u00ae chronic elbow pain. J Am Coll Radiol. 2022;19(11):S256-S265. https:\/\/doi.org\/10.1016\/j.jacr.2022.09.022","DOI":"10.1016\/j.jacr.2022.09.022"},{"key":"e_1_3_2_21_2","doi-asserted-by":"crossref","unstructured":"Lund P Waslewski GL Crenshaw K et al. FEVER: the flexed elbow valgus external rotation view for MRI evaluation of the ulnar collateral ligament in throwing athletes \u2013 a pilot study in Major League Baseball pitchers. AJR Am J Roentgenol. 2021;217(5):1176-1183. https:\/\/doi.org\/10.2214\/AJR.21.25608","DOI":"10.2214\/AJR.21.25608"},{"key":"e_1_3_2_22_2","doi-asserted-by":"crossref","unstructured":"Roedl JB Gonzalez FM Zoga AC et al. Potential utility of a combined approach with US and MR arthrography to image medial elbow pain in baseball players. Radiology. 2016;279(3):827-837. https:\/\/doi.org\/10.1148\/RADIOL.2015151256","DOI":"10.1148\/radiol.2015151256"},{"key":"e_1_3_2_23_2","doi-asserted-by":"crossref","unstructured":"Yang TH Lee YY Huang CC et al. Effectiveness of ultrasonography screening and risk factor analysis of capitellar osteochondritis dissecans in adolescent baseball players. J Shoulder Elbow Surg. 2018;27(11):2038-2044. https:\/\/doi.org\/10.1016\/j.jse.2018.07.018","DOI":"10.1016\/j.jse.2018.07.018"},{"key":"e_1_3_2_24_2","doi-asserted-by":"crossref","unstructured":"Perry DC Achten J Zimmermann A et al. Surgical fixation versus non-surgical care for children with a displaced medial epicondyle fracture of the elbow (the SCIENCE study): a multicentre randomised controlled superiority trial and economic evaluation. Lancet. 2026;407(10528):577-586. https:\/\/doi.org\/10.1016\/S0140-6736(25)02098-7","DOI":"10.1016\/S0140-6736(25)02098-7"},{"key":"e_1_3_2_25_2","doi-asserted-by":"crossref","unstructured":"Smith MV Bedi A Chen NC. Surgical treatment for osteochondritis dissecans of the capitellum. Sports Health. 2012;4(5):425-432. https:\/\/doi.org\/10.1177\/1941738112444707","DOI":"10.1177\/1941738112444707"},{"key":"e_1_3_2_26_2","doi-asserted-by":"crossref","unstructured":"Chau MM Klimstra MA Wise KL et al. Osteochondritis dissecans: current understanding of epidemiology etiology management and outcomes. J Bone Joint Surg Am. 2021;103(12):1132-1151. https:\/\/doi.org\/10.2106\/JBJS.20.01399","DOI":"10.2106\/JBJS.20.01399"},{"key":"e_1_3_2_27_2","doi-asserted-by":"crossref","unstructured":"Wilk KE Lupowitz LG Arrigo CA. The Youth Throwers Ten Exercise Program: a variation of an exercise series for enhanced dynamic shoulder control in the youth overhead throwing athlete. Int J Sports Phys Ther. 2021;16(6):1387-1395. https:\/\/doi.org\/10.26603\/001C.29923","DOI":"10.26603\/001c.29923"},{"key":"e_1_3_2_28_2","doi-asserted-by":"crossref","unstructured":"Tooth C Schwartz C Ann C et al. Upper limb functional testing in athletes: a Delphi study. Shoulder Elbow. 2024;16(1 suppl):89-99. https:\/\/doi.org\/10.1177\/17585732221101880","DOI":"10.1177\/17585732221101880"},{"key":"e_1_3_2_29_2","doi-asserted-by":"crossref","unstructured":"Wilk KE Bagwell MS Davies GJ Arrigo CA. Return to sport participation criteria following shoulder injury: a clinical commentary. Int J Sports Phys Ther. 2020;15(4):624. https:\/\/doi.org\/10.26603\/ijspt20200624","DOI":"10.26603\/ijspt20200624"},{"key":"e_1_3_2_30_2","doi-asserted-by":"crossref","unstructured":"Brenner JS LaBella CR Brooks MA et al. Sports specialization and intensive training in young athletes. Pediatrics. 2016;138(3):e20162148. https:\/\/doi.org\/10.1542\/PEDS.2016-2148","DOI":"10.1542\/peds.2016-2148"},{"key":"e_1_3_2_31_2","doi-asserted-by":"crossref","unstructured":"Putukian M Leclere LE Herring SA et al. The adolescent athlete and the team physician: a consensus statement. 2025 Update. Med Sci Sports Exerc. 2026;58(2):371-402. https:\/\/doi.org\/10.1249\/MSS.0000000000003863","DOI":"10.1249\/MSS.0000000000003863"},{"key":"e_1_3_2_32_2","doi-asserted-by":"crossref","unstructured":"Harada M Takahara M Maruyama M et al. Outcome of conservative treatment for Little League shoulder in young baseball players: factors related to incomplete return to baseball and recurrence of pain. J Shoulder Elbow Surg. 2018;27(1):1-9. https:\/\/doi.org\/10.1016\/j.jse.2017.08.018","DOI":"10.1016\/j.jse.2017.08.018"},{"key":"e_1_3_2_33_2","doi-asserted-by":"crossref","unstructured":"Jensen EJ Pennock AT Hulbert MA Tadlock JC Paranjape CS Bryan TP. What happens to youth baseball players diagnosed with Little League shoulder and Little League elbow syndrome?. J Pediatr Orthop. 2024;44(8):e722-e726. https:\/\/doi.org\/10.1097\/BPO.0000000000002731","DOI":"10.1097\/BPO.0000000000002731"},{"key":"e_1_3_2_34_2","doi-asserted-by":"crossref","unstructured":"Lane G Smith MV Goldfarb CA Coronado RA Bowman EN. Outcomes and return to sport after osteochondral autograft transplantation for osteochondritis dissecans of the capitellum: a systematic review. JSES Rev Rep Tech. 2024;4(3):563-570. https:\/\/doi.org\/10.1016\/j.xrrt.2024.02.011","DOI":"10.1016\/j.xrrt.2024.02.011"},{"key":"e_1_3_2_35_2","doi-asserted-by":"crossref","unstructured":"Wilk KE Thomas ZM Mangine RE Fuller P Davies GJ. Neurocognitive and reactive return to play testing protocol in overhead athletes following upper extremity injury. Int J Sports Phys Ther. 2023;18(6):1364-1375. https:\/\/doi.org\/10.26603\/001C.89926","DOI":"10.26603\/001c.89926"},{"key":"e_1_3_2_36_2","doi-asserted-by":"crossref","unstructured":"Pontillo M Bellm E Barber P Gauthier M Unverzagt C Davies G. Upper extremity return to sport functional testing: a systematic review. Sports Med Open. 2026;12(1):13. https:\/\/doi.org\/10.1186\/S40798-026-00984-4","DOI":"10.1186\/s40798-026-00984-4"},{"key":"e_1_3_2_37_2","doi-asserted-by":"crossref","unstructured":"Riemann BL Wilk KE Davies GJ. Reliability of upper extremity functional performance tests for overhead sports activities. Int J Sports Phys Ther. 2023;V18(3):687-697. https:\/\/doi.org\/10.26603\/001C.74368","DOI":"10.26603\/001c.74368"},{"key":"e_1_3_2_38_2","doi-asserted-by":"crossref","unstructured":"Patel P Vaishnav J. Rehabilitative and preventive effects of the Thrower\u2019s Ten Program in overhead athletes: a systematic review. Cureus. 2025;17(10):e95081. https:\/\/doi.org\/10.7759\/CUREUS.95081","DOI":"10.7759\/cureus.95081"}],"container-title":["HSS Journal\u00ae: The Musculoskeletal Journal of Hospital for Special Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15563316261474789","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15563316261474789","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15563316261474789","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T13:48:48Z","timestamp":1787147328000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15563316261474789"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,17]]},"references-count":37,"alternative-id":["10.1177\/15563316261474789"],"URL":"https:\/\/doi.org\/10.1177\/15563316261474789","relation":{},"ISSN":["1556-3316","1556-3324"],"issn-type":[{"value":"1556-3316","type":"print"},{"value":"1556-3324","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,17]]},"article-number":"15563316261474789"}}