0:01

So this is a picture, it's a 16-year-old picture

0:06

who had little leaguer shoulder at age 12

0:10

or 13, I can't remember,

0:12

but he was certainly several years younger than this.

0:15

Let's go three up.

0:17

We've got a, a couple of coronal images,

0:20

a T one spin echo in the center, a proton density,

0:24

fat suppression on the right,

0:27

and an axial, uh, fat suppression image on the left.

0:32

Now, if you look on the right, um, we, we heard earlier

0:36

that he had little leaguer shoulder and you saw at least two

0:39

or three excellent examples of that, uh, with feal widening

0:43

and, and Don's talk.

0:46

Um, so if we look carefully here, he's now 16 years of age

0:50

and the growth plate is still open, uh,

0:54

but starting to, starting to close

0:57

and look at this funny pattern

0:59

of edema along the medial aspect of the growth plate.

1:02

Now, in my experience, little leaguer shoulder,

1:06

60 40, 70 30 more often conspicuous in the lateral aspect,

1:11

uh, of, of the humerus.

1:13

But the reason I'm showing this case is

1:14

for the uniqueness of this finding.

1:17

Um, I don't know if we have another Nora lesion cooking

1:20

in the shoulder or not.

1:21

We have a very weird looking piece of bone.

1:24

There's a little cleft between it

1:26

and the underlying humerus,

1:27

and it's sitting right in front of this area

1:30

where we see some edema

1:32

or about the FSIS in this child, who, by the way,

1:36

was left unchecked.

1:37

The parents persisted.

1:39

He continued to pitch from age 13 to 16,

1:43

and now he's having difficulty throwing

1:45

and internally rotating the shoulder.

1:47

So Don, what do you think of this? What?

1:49

Can you go baby canter on this? Yes.

1:52

One the see as you go into, so, yeah.

1:56

So at this age, you know, the, the FSIS of the, uh,

2:00

lesser tuberosity is gonna be continuous with the FSIS

2:04

of the proximal humerus.

2:05

And I just wonder, uh, you know,

2:07

we had touched upon this whether this was a, originally

2:12

a apophyseal injury, uh, of the lesser tuberosity,

2:17

and that we now have some edema

2:21

and bone formation related to displacement of that, uh, ssis

2:26

that's extending into the, uh, uh, deis

2:31

of the proximal humerus.

2:33

And, and you don't know when his symptoms began?

2:36

I do not. Um, I had a few, what I call quirky ideas,

2:40

none of which I liked.

2:42

I like your idea a lot.

2:43

I, I really, it would be interesting, you know, to, to see

2:45

what conventional radiographs and CT might, might look like.

2:49

But I think that's the most likely thing

2:51

that's occurred here.

2:53

And it's interesting, I have seen about four

2:55

or five of those cases where

2:57

that particular fais is involved and younger people,

3:00

but I just wonder if this is the residual of something

3:04

that occurred when he was like five

3:06

or seven years old or something of that.

3:08

Well, I, I appreciate your perspective on this one.

3:10

Do we have time for one more or are we Yeah, we do. We do.