Little League Shoulder

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.

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. Learn 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:

For pitchers age 17 to 18:

Pitches in a day               Rest time
61 or more                     4 days
41-60                               3 days
21-40                               2 days
1-20                                 1 day
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.

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.

You can have peace of mind knowing that the skilled experts in our Hand and Orthopedic Upper Extremity Program have treated thousands of babies and children with many arm conditions. We provide expert diagnosis, treatment and care, and we benefit from our advanced clinical and scientific research.

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.

In the News

Youth Baseball and Surgery for Overuse Injuries
The Wall Street Journal, June 6, 2016