Little League Shoulder

Symptoms of Little League shoulder often start out as tenderness and soreness that get worse over time.

If your child has any of the following symptoms they should see a doctor:

• Shoulder pain while throwing
• Shoulder soreness that lasts more than a day
• Slower and less controlled throws than usual
• Tenderness near the shoulder

To understand how Little League shoulder can happen, it helps to know a little bit about the anatomy of the shoulder.

The shoulder is made up of three bones:

• The upper arm bone (humerus), which contains the ‘ball’ (humeral head) of the balland-socket shoulder joint (glenohumeral joint)
• The shoulder blade (scapula), a part of which also contains the shoulder socket (glenoid)
• The collarbone (clavicle)

The glenohumeral joint allows the upper arm to rotate and provides extensive range of motion for the shoulder. But this extra mobility puts the shoulder joint at greater risk of instability. Therefore, the strength of the muscles around the shoulder is critical for normal function of the joint.

In the upper arm, just below the shoulder joint, is a growth plate. Growth plates are soft areas of specialized cartilage within and near the ends of the long bones of the arms and legs. As long as a child is growing, the growth plates are slightly softer than the surrounding bone. The growth plates eventually harden and turn into bone around the time kids finish puberty — usually between the ages of 13 and 15 for girls and between 15 and 17 for boys. Until then, growth plates are prone to injury from repetitive stress, such as frequent throwing.

Little League shoulder is usually caused by throwing too many pitches in a single game or pitching in too many games without rest, having poor throwing technique, or some combination of these factors.

During an overhand pitch or throw, an athlete’s arm moves through several extreme positions that put the upper arm under a great deal of pressure. Over time, the repeated stress of throwing can cause the growth plate at the top of the upper arm to become injured and inflamed. On an X-ray, the growth plate has the appearance of growing wider. If the athlete continues throwing, a type of a stress fracture may develop in the growth plate itself.

Coaches, parents, and athletes all a role to play in preventing Little League shoulder.

• Coaches: Teach proper technique with attention to throwing mechanics and conditioning of the lower body, core, shoulder, and elbow. To ensure proper rest, pitchers should not pitch on consecutive days and should follow specific pitch counts for their age. Be sure to factor in pitches that might be thrown on more than one team.
• Parents: Be aware of the risks that may come from specializing in only one sport. School-age athletes who play a variety of sports experience fewer injuries, are less prone to early burnout, and generally have more successful sports experiences overall.
• Athletes: Let your coach know when your shoulder or any other body part is painful. Do not try to play through shoulder or elbow pain.

Pitching guidelines:

To reduce the risk of Little League shoulder in young athletes, USA Baseball has issued guidelines for youth and adolescent pitchers by age group. These guidelines should be applied during practices and games and across multiple leagues.

Players in all age groups should not pitch in more than one game per day. 

Ages 7-8

• Typical pitching distance – 46 feet
• Maximum combined innings in a 12-month period – 60
• Minimum time off from throwing every year – 4 months
• Daily max pitches in a game – 50

Ages 9-12

• Typical pitching distance – 46-50 feet
• Maximum combined innings in a 12-month period – 80
• Minimum time off from throwing every year – 4 months
• Daily max pitches in a game – 75 (ages 9-10)
• Daily max pitches in a game – 85 (ages 11-12)

Ages 13-14

• Typical pitching distance – 60 feet
• Maximum combined innings in a 12-month period – 100
• Minimum time off from throwing every year – 4 months
• Daily max pitches in a game – 95

Ages 15-18

• Typical pitching distance – 60 feet
• Maximum combined innings in a 12-month period – 100
• Minimum time off from throwing every year – 4 months
• Daily max pitches in a game – 95 (ages 15-16)
• Daily max pitches in a game – 105 (ages 17-18)

Ages 19-22

• Maximum combined innings in a 12-month period – varies from player to player; be sure to monitor the number of pitches and the elbow for signs of injury
• Minimum time off from competitive pitching every year – 3 months
• Daily max pitches in a game – 120

Your child's doctor will ask about your child's sports history including:

• How many sports they play each year
• How many leagues they participate in
• How often they throw on a weekly basis

The doctor will examine your child's arm to check for pain and tenderness along the upper arm and shoulder. They’ll also check to see if your child has normal and full movement of the arm and shoulder.

The doctor will take X-rays of both shoulders in order to compare your child’s throwing arm with their other arm. This helps to see differences and any signs of change in the growth plate and surrounding bones.

Early treatment for Little League shoulder is important. Playing through the pain may make the injury more serious. In general, the earlier Little League shoulder is treated, the more reliable the recovery will be.

Rest — typically for three months — is the most effective treatment for Little League shoulder. Your child should stop throwing completely and go to physical therapy when their doctor says they are ready. The physical therapist will work with your child to stretch, strengthen, and balance the muscle forces in the shoulder. This will help decrease pain and prevent the injury from happening again.

Players can usually return to sports after proper recovery, treatment, and being fully cleared by their doctor and physical therapist. Getting back in the game too early could make the injury worse and require an even longer recovery period.

The skilled experts in our Sports Medicine Division and Hand and Orthopedic Upper Extremity Program have treated thousands of children with Little League shoulder and many other upper body conditions. Our multi-disciplinary team looks for signs that change with age and maturity level in order to make the most precise diagnosis possible and provide expert care to so that young athletes can return to playing the sports they love.

To prevent Little League shoulder and other throwing injuries, The Micheli Center for Injury Prevention (part of the Sports Medicine Division) offers throwing analysis services to help identify and correct an athlete’s throwing mechanics that put them at risk of injury.