Little Leaguer's Shoulder and Elbow

One of the more common injuries seen at all levels of baseball and other sports involving the overhead throwing motion are shoulder and elbow injuries. Types of over-use injuries that are unique to the growing athlete commonly seen in baseball and softball include Little Leaguer’s Elbow and Little Leaguer’s Shoulder. Injuries to the shoulder and elbow are more common in baseball than softball because of the over-hand throwing motion. These injuries are more commonly seen in pitchers.

Little Leaguer’s Elbow is an over-use injury seen in the elbows of adolescent pitchers. It is a result of the repetitive bending stress at the elbow during overhead throwing. This can result in a traction injury on the medial (inside) portion of the elbow. With the throwing motion, compression is placed on the lateral (outside) portion of the elbow as well. In it’s most severe form, permanent damage to the articular cartilage (joint) may result. In most cases the injury is not that severe.

The throwing child who complains of elbow pain should be evaluated carefully. Rest, followed by appropriate stretching, strengthening, and refinement of throwing technique may prevent long term problems.

Little Leaguer’s Shoulder is an over-use injury that also occurs with overhead throwing activities. In the most severe form, this can present as a stress fracture of the growth plate of the upper end of the humerus (upper arm bone). Other causes of shoulder pain such as rotator cuff inflammation or joint instability can cause similar pain in the young athlete.

In the rare case of a stress fracture, the young athlete would require at least six to eight weeks of a period of immobilization and rest before return to sports. In the more common case of rotator cuff inflammation or joint instability, a short period of rest and low doses of anti-inflammatory medication is needed. Stretching and strengthening exercises will allow the problem to resolve.

Problems with the upper extremity in baseball and all overhead sports can be avoided. A proper throwing technique is important and is occasionally evaluated using computerized biomechanical tests. Injuries can be prevented by warming up the arm before throwing at full speed and distance. In cold weather, long sleeves are recommended to keep the arm warm between periods of throwing. This is most important in young pitchers.

If arm pain persists more than 24 to 48 hours after throwing, the young athlete should be evaluated by an orthopedic physician and/or a certified athletic trainer.

BACK