Little Leaguer’s Shoulder


What is little leaguer’s shoulder? 

Little leaguer’s shoulder is an overuse injury caused by stress to the shoulder during repetitive overhead activities. 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. This stress causes widening of the growth plate, resulting in swelling and pain of the shoulder. It most commonly occurs in youth overhand pitchers between ages 11 and 16. If untreated, the condition can worsen, leading to bone damage. However, the good news is that little league shoulder will often heal completely with rest and a dedicated rehabilitation program.


What causes little leaguer’s shoulder?

Repeated overhead throwing causes stress to the growth plate, leading to inflammation. Little leaguer’s shoulder most commonly occurs in baseball players, but can occur in other athletes who do a lot of overhead arm movements, including volleyball or tennis players. The following factors contribute to the injury:

  • Repeated overhead throwing without proper rest (high pitch or throw count)
  • Pitching and throwing with improper mechanics
  • Lack of muscle strength, specifically in the shoulder and upper back 


What are the symptoms of little leaguer’s shoulder?

Young athletes with this condition typically complain of a gradual onset of pain in the throwing shoulder. Other symptoms include:

  • Pain in the shoulder with pitching or throwing (especially after an increased number or throws or trying to increase velocity)
  • Pain in shoulder at rest or with lifting the arm
  • Soreness that lasts a few days
  • Slower and less controlled throws than normal
  • Swelling or tenderness around the shoulder


How is this condition diagnosed?

Dr. Potts will complete a detailed physical exam may order imaging tests. The diagnosis of little leaguer’s shoulder, as well as its severity, can be typically be made with x-ray imaging while your child is in the clinic. X-ray can show a widened or irregular growth plate when compared to the uninjured arm. In certain cases, an MRI may be helpful – especially if the patient does not experience improvement with conservative therapy, or if another diagnosis is being considered.


How is little leaguer’s shoulder treated?

The mainstay of treatment for little leaguer’s shoulder include cessation of throwing, followed by physical therapy and a progressive throwing program after sufficient rest. Most athletes with this condition need to stop throwing for a minimum of three months. It is important to know that Little Leaguer’s shoulder can be prevented by making sure your child throws in a way that won’t hurt their arm, and by limiting the amount of throwing they are doing.

Conservative treatment options include:

  • Rest – avoid throwing activities for a period of time (typically 3 months)
  • Ice – helps to decrease swelling and pain in the shoulder
  • Physical therapy – under the guidance of a physical therapist, your child will undergo a specific regimen that focuses on strengthening and stretching the shoulder and arm muscles.  Strength of the core, legs and hip are also emphasized to enhance stability and overall ability to throw
  • Return-to-throwing program – once cleared to return to throwing, the athlete will undergo a progressive throwing program that slowly increases the forces and demands through the arm and shoulder, which are necessary for full return to competitive play. When returning to sport, athletes should start throwing at short distances with low velocity, as long as pain does not return.