KidsMD Health Topics

Little League Shoulder

  • Overview

    Little League shoulder happens when an athlete throws too often or repeatedly throws the wrong way and hurts his shoulder. In younger athletes, growth plates—soft places toward the end of the bone that cause it to grow—are prone to injury, and can get irritated with too much use. Usually, the arm may be tender and sore, and it will hurt to throw. 

    Most athletes with Little League shoulder need to stop throwing for a minimum of three months, and go through several months of physical therapy before fully returning to sports. 

    Little League shoulder can be prevented by making sure your child throws in a way that won’t hurt his arm, and by making sure he doesn’t throw more than is healthy for his age and physical development.

    How Boston Children’s Hospital approaches Little League shoulder

    At Boston Children’s Hospital, our doctors specialize not only in orthopedic care, but in pediatric orthopedic care.  Our clinical experts lead the country in research and care, and have the pediatric orthopedic expertise to treat the unique needs of children and young adults' musculoskeletal systems.

    Each year, our orthopedic team attends to more than 92,000 patient visits and performs over 6,000 surgeries. While assessing Little League shoulder, our doctors search for signs that change with age and maturity level and deliver the most precise diagnosis possible so children can get back to their lives.

    Little League shoulder: Reviewed by Benton Heyworth, MD

    Boston Children's Hospital  
    319 Longwood Avenue
    Boston MA 02115


    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 2
    Boston MA 02115

    Boston Children's Hospital at Lexington
    482 Bedford Street
    Lexington MA 02420

    Boston Children's Hospital at Waltham
    9 Hope Avenue
    Waltham MA 02453

    Boston Children's North

    10 Centennial Drive
    Peabody MA 01960

    Boston Children's Physicians South
    Stetson Medical Center
    541 Main Street
    Weymouth MA 02190

    Children's Hospital Physicians at Good Samaritan Medical Center
    830 Oak Street
    Brockton MA 02301

  • In-Depth


    Little League shoulder is usually caused by overuse or poor throwing technique, and most often occurs in pitchers, catchers and other athletes who do overhand activities, including volleyball and tennis players. There are three bones that make up a shoulder—the collar bone, the upper arm bone and the shoulder blade. The shoulder blade and the upper arm bone are connected by a joint, and very close to that joint is a growth plate. 

    Growth plates are small, soft parts of a bone that are located near both ends of long bones. In the case of Little League shoulder, doctors are most concerned with the growth plate that sits high on the upper arm bone, near the shoulder. If that growth plate is inflamed or irritated, it usually means the child has Little League shoulder.

    Signs and symptoms 

    If your child has the following symptoms, he should see a doctor:

    • Shoulder pain while throwing
    • Soreness that lasts a few days
    • Slower and less controlled throws than normal
    • Swelling or tenderness near the shoulder

    In general, your child should stop throwing for three months, and attend physical therapy to stretch and strengthen the shoulder muscles. Children usually return to sports in several months, with approval from their doctor and physical therapist. Read more about treatment and care.

    It’s important to note that Little League shoulder can be prevented. Talking to a child’s pitching coach about the way they throw, where they release the ball, and how they position their arm and wrist can help improve technique and protect from pain.

    Throwing guidelines 

    USA Baseball has put together guidelines for how much throwing an athlete should do on a regular basis: 

    9- to 10-year-old pitchers:

    • 50 pitches per game
    • 75 pitches per week
    • 1,000 pitches per season
    • 2,000 pitches per year 

    11- to 12-year-old pitchers:

    • 75 pitches per game
    • 100 pitches per week
    • 1,000 pitches per season
    • 3,000 pitches per year 

    13- to 14-year-old pitchers:

    • 75 pitches per game
    • 125 pitches per week
    • 1,000 pitches per season
    • 3,000 pitches per year 

    More guidelines have been established in order to ensure proper rest time between pitching as well:

    For pitchers age 7 to 16:

    Pitches in a day       Rest time

    61 or more                4 days

    41-60                          3 days

    21-40                          2 days

    1-20                            1 day 

    For pitchers age 17 to 18:

    Pitches in a day       Rest time

    76 or more                4 days

    51-75                          3 days

    26-50                          2 days

    1-25                            1 day 

    These pitch counts should also be applied to athletes who belong to multiple teams at a time, or play in multiple leagues per year. It’s recommended that athletes take three months each year off from their sport, and vary sports in order to diversify muscle groups and give their throwing muscles a break.

  • Tests

    At your appointment, your child’s doctor will ask about his history with sports and injuries, as well as how often he throws and whether he is on multiple teams. 

    The doctor will examine his arm to check for pain, swelling and tenderness along the upper arm and shoulder, and check to see if he has normal and full movement of the arm and shoulder. 

    Then the doctor will take X-rays of both shoulders in order to compare the throwing arm with the other arm. This helps to see differences and show any signs of change in the growth plate and surrounding bones.

  • Early treatment for Little League shoulder is important, because if your child ignores the injury and plays through the pain, he may make the injury more serious. In general, the earlier Little League shoulder is treated, the shorter the recovery time will be. 

    Rest is the most effective treatment for Little League shoulder. Your child should stop throwing completely, and later go to physical therapy. The physical therapist will work with your child to stretch out and strengthen the shoulder, which will help with the pain and help prevent the injury from happening again. 

    A player can usually return to sports after a proper recovery treatment when he has been fully cleared by his doctor and physical therapist. Getting back in the game too early is dangerous, and could draw out the injury even longer.

    Coping and support

    If your child is admitted to Boston Children's Hospital or needs more extensive care, your family may want to take advantage of our Center for Families, which can help connect you with resources, should you need them: 

  • Research & Innovation

    Treatment and management of Little League shoulder has not evolved in a long time, but more research is being done on how to prevent young athletes from becoming injured. 

    USA Baseball, the STOP Sports Injuries campaign, the American Academy of Pediatrics and the National Institutes of Health are all trying to learn more about how to prevent Little League shoulder and other overuse injuries.

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