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Throwing injuries in young pitchers can be serious and permanent

By Michael Angeline, MD, and Katelyn DeMus, ATC, Mercy Clinic East Sports Medicine and Rehabilitation Center

There are many ways to prevent and treat throwing injuries to a young pitcher’s elbow and shoulder.

What causes throwing injuries?

With the upcoming start of the baseball season, there is an increase in injuries to the shoulder and elbow in young athletes. The most common elbow injury suffered is to the ulnar collateral ligament (UCL) and is often caused when a pitcher throws too much. The UCL is the main stabilizer of the elbow during the pitching motion. In younger baseball players, an injury to the medial apophysis (the growth plate on the medial epicondyle) is more common and is commonly referred to as “Little Leaguer elbow” or “youth pitching elbow.”

The elbow joint is composed of three main bones: the humerus (upper arm bone), and the two bones in the forearm (radius and ulna). Tendons, ligaments and muscles hold the elbow joint together.


“Little Leaguer elbow”

An injury to the medial apophysis of the elbow can occur when repetitive throwing creates a strong pulling force on the tendons and ligaments of the inner elbow. If a young athlete is throwing too hard, too much, too early and without rest, they may feel pain at the prominence on the inside of the elbow.

Injury to the medial aspect of the elbow can become serious if aggravated, as repeated pulling can potentially tear the UCL or tendons away from the bone. Overtime, this tearing can disrupt normal bone growth and result in a deformity.

What are the symptoms?

An athlete should stop throwing if any of these following symptoms appear:

  • Elbow pain, especially on the inside of the elbow
  • Restricted range of motion
  • Locking or catching within the elbow joint

How is an overuse injury to the elbow treated?

Nonsurgical treatment includes rest. Continued throwing may lead to major complications and potentially jeopardize the athlete’s ability to return to a throwing sport. Ice should be used to reduce soreness and inflammation. If pain persists after a few days, it is critical that a physician be contacted, especially if the pain recurs when throwing is resumed. Under some circumstances, surgery may be necessary to correct a problem.

Ways to prevent overuse injuries

Overuse injuries to the elbow and shoulder can be prevented through these exercises and tips:

Dynamic warm-up: Dynamic warm-ups—warming the body up and stretching the muscles—should always start with slow, low-intensity movements and then progress to full-speed movements. Finish the warm-up with simulated baseball moves, such as, batting, throwing and catching. Examples of dynamic stretches include, side reaches, shoulder twists, arm circles and arm cross-overs.

Static cool-down: While doing a static cool-down, it is important to perform stretches while muscles are still warm. Unlike the dynamic warm-up, static stretches do not include bouncing movements. Slowly take muscles to their end range, hold for 20-30 seconds, then repeat 3-4 times. Examples of static stretches include triceps stretch and forearm stretch:


  • Rotate playing other positions besides pitcher.
  • Concentrate on age-appropriate pitching.
  • Adhere to pitch count guidelines.
  • Don’t pitch with elbow or shoulder pain. If the pitcher has pain, see the athletic trainer. If pain persists, it’s important to see a doctor.
  • Don’t pitch on consecutive days.
  • Emphasize control, accuracy and good mechanics.
  • Talk to a sports medicine professional or athletic trainer with concerns or about prevention strategies.


Sports Tips: Throwing Injuries in Children. American Orthopaedic Society for Sports Medicine. 2013

Little League Baseball. www.littleleague.org/Assets/old_assets/media/pitchcount_faq_08.pdf