Little League Shoulder
Overview
Healthcare providers, fitness experts, and developmental specialists usually encourage youth participation in sports. Such activities increase your child’s body strength, teach important lessons about teamwork, and, above all, are fun, positive, and productive outlets.
While young people are often noted for their toughness and the ability to heal quickly, they are not immune to physical injuries. One specific injury is known as Little League shoulder.
Anatomy
Your child’s shoulders contain structures called growth plates. They are collections of soft tissues found near the ends of bones that enable further physical growth and maturity.
Description
Athletic competition can sometimes cause growth plates to expand. As this expansion progresses, shoulders can become irritated or inflamed, resulting in uncomfortable and potentially activity-limiting symptoms.
Causes
Little League shoulder has several underlying causes, including:
- Improper throwing technique.
- Overuse of the shoulders.
- Inadequate rest between competition.
- Underdeveloped shoulder or upper back muscles.

Risk Factors
Little League shoulder is often seen in youths between the ages of 11 and 16. The injury is most common in sports that require repeated, forceful usage of the shoulders, such as baseball pitchers and football quarterbacks. The problem also frequently occurs in those competing in tennis and volleyball.
Symptoms
The most apparent sign of Little League shoulder is pain:
- Occurs while your child pitches, throws, or extends their shoulder.
- Develops gradually.
- May linger for days following the specific athletic competition.
- Worsens over time.
- Worsens when increasing activity such as a pitcher upping the speed at which they throw.
Your child might also experience swelling in the injured shoulder, decreased pitching, or throwing speeds, and throwing inaccuracy.

Complications
Untreated cases can result in minor to serious complications.
Occasionally, the condition could eventually damage your child’s arm bone (the humerus). Moreover, unchecked incidents could weaken the shoulder and its components. It might ultimately lay the foundation for potentially serious physical injuries like SLAP (Superior Labral tear from Anterior to Posterior) tears and rotator cuff problems later in your child’s life or athletic careers.
Diagnosis
In many instances, your child’s doctor can confirm a diagnosis by taking a careful medical history and performing a thorough visual and physical examination. Sometimes, they may order internal imaging tests like X-rays and MRI (Magnetic Resonance Imaging) to determine the condition’s severity and rule out other more serious concerns.
Treatment Overview
Most cases respond to basic self-care methods. Most uncomplicated incidents do not need any type of surgical intervention.
Non-Surgical Options
The most direct and effective course of treatment is rest. Once diagnosed, your child will likely be asked to stop or significantly reduce athletic participation over a period ranging from two to three months.
If your child experiences swelling, ice may bring it down and ease associated discomfort.
Your child may also need to undergo physical therapy. These are exercises specifically designed to help their shoulder maintain strength and its motion range during the healing process.
Your child’s return to competition should be slow and gradual. Upon throwing again, they are urged to use soft-tossing exercises at low speeds and progressively increase them. This takes pressure off their shoulder and limits the chances for re-injury.
Surgical Procedures
Little League shoulder does not usually need surgical correction unless the affected growth plates are severely injured. Untreated cases could lead to stress fractures of surrounding bones, SLAP tears, and rotator cuff issues. Any of these concerns may eventually need surgical intervention.
Recovery
With rest and physical therapy, most incidents of Little League shoulder heal on their own, and a return to routine physical activity should occur in roughly two to three months.
Prevention
Fortunately, the condition is preventable. Effective techniques include:
- Correcting Poor Throwing Motions: You might ask a coach or motion expert to analyze their throwing motion. If they notice poor technique, they should point them out and instruct your child on the proper technique.
- Working On Pitch Counts: As Little League shoulder often impacts baseball pitchers, the USA Baseball organization has developed pitch count guidelines to prevent overuse. These recommendations are geared towards specific age groups, including:
- Nine to 10 Years Old: They should only throw 50 pitches per game, 75 pitches a week, 1,000 a season, and 2,000 per year.
- 11 to 12 Years Old: No more than 75 pitches per game, 100 a week, 1,000 a season, and 3,000 per year.
- 13 to 14 Years Old: They should not exceed 75 pitches a game, 125 tosses a week, 1,000 pitches a season, and 3,000 per year.
USA Baseball has also established resting guidelines, which are as follows:
- Pitchers Age Seven To 16: If your child throws up to 20 pitches per day, they should rest for one day. 21 to 40 pitches a day should be followed by two rest days. 41 to 60 tosses should have three rest days. Four days of rest following 61 or more pitches.
- Pitchers Age 17 to 18: If your child throws up to 25 pitches a game (or bullpen session), one day of rest should follow. Two days of rest when they throw anywhere from 26 to 50 tosses. 51 to 75 pitches should have three days rest. If they make 76 or more throws, take the next four days off.

Next Steps
Talk to your Florida Orthopaedic Institute physician today to learn more about Little League Shoulder.
Areas of Focus
- Shoulder
- AC Joint Injuries
- Atraumatic Shoulder Instability
- Bankart Repair
- Bicep Tendon Tear
- Bicep Tenodesis
- Broken Collarbone
- Bursitis of the Shoulder (Subacromial Bursitis)
- Calcific Tendinitis of the Shoulder
- Clavicle Fractures
- Dislocated Shoulder
- Fractures Of The Shoulder Blade (Scapula)
- Glenoid Labrum Tear
- Impingement Syndrome of the Shoulder
- Little League Shoulder
- Reverse Total Shoulder Replacement
- Rheumatoid Arthritis (RA) of the Shoulder
- Rotator Cuff Tears
- Shoulder Arthritis
- Shoulder Arthroscopy
- Shoulder Injury: Pain In The Overhead Athlete
- Shoulder Replacement
- Shoulder Separations
- Shoulder Socket Fracture (Glenoid Fracture)
- SLAP Tears & Repairs
- Subacromial Decompression
- Trapezius Strain (Muscle Strain of The Upper Back)
- Traumatic Shoulder Instability
The following Florida Orthopaedic Institute physicians specialize in Little League Shoulder:
Specialties
- AC Joint Injuries
- Achilles Tendinitis - Achilles Insertional Calcific Tendinopathy (ACIT)
- Achilles Tendon Rupture
- Achilles Tendonitis
- ACL Injuries
- Ankle Fracture Surgery
- Ankle Fractures (Broken Ankle)
- Ankle Fusion Surgery
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- Arthroscopic Chondroplasty
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- Arthroscopy Of the Ankle
- Articular Cartilage Restoration
- Artificial Disk Replacement (ADR)
- Aspiration of the Olecranon Bursa
- Atraumatic Shoulder Instability
- Avascular Necrosis (Osteonecrosis)
- Bankart Repair
- Basal Joint Surgery
- Bicep Tendon Tear
- Bicep Tenodesis
- Bone Cement Injection
- Bone Growth Stimulation
- Bone Health Clinic
- Broken Collarbone
- Bunions
- Bursitis of the Shoulder (Subacromial Bursitis)
- Calcific Tendinitis of the Shoulder
- Carpal Tunnel Syndrome
- Charcot Joint
- Chiropractic
- Clavicle Fractures
- Colles’ Fractures (Broken Wrist)
- Common Foot Fractures in Athletes
- Community Outreach
- Cubital Tunnel Syndrome
- De Quervain's Tenosynovitis
- Degenerative Disk Disease
- Diffuse Idiopathic Skeletal Hyperostosis (DISH)
- Discectomy
- Discitis Treatment & Information
- Dislocated Shoulder
- Dupuytren’s Disease
- Elbow
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- Elbow Injuries in Throwing Athletes
- Epidural Injections for Spinal Pain
- Finger Dislocation
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- Foot Stress Fractures
- Foot, Ankle & Lower Leg
- Foraminotomy
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- Fractures Of The Shoulder Blade (Scapula)
- Fractures Of The Tibial Spine
- Functional Nerve Transfers of The Hand
- Ganglion Cysts
- General Orthopedics
- Glenoid Labrum Tear
- Golfer's Elbow
- Groin Strains and Pulls
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- Hip Arthroscopy
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- Hip Fractures
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- Hip Impingement Labral Tears
- Hip Muscle Strains
- Hip Pointers and Trochanteric Bursitis
- Hyperextension Injury of the Elbow
- Iliopsoas Tenotomy
- Iliotibial Band Syndrome
- Impingement Syndrome of the Shoulder
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- Little League Shoulder
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- Neurosurgery
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- Orthopaedic Total Wellness
- Orthopedic Physician Or A Podiatrist?
- Orthopedic Trauma
- Osteoarthritis of the Hip
- Osteoporosis
- Outpatient Spine Surgery
- Partial Knee Replacement
- Patellar Fracture
- Pelvic Ring Fractures
- Peripheral Nerve Surgery (Hand) Revision
- Pinched Nerve
- Piriformis Syndrome
- Piriformis Syndrome
- Plantar Fasciitis
- Podiatry
- Primary Care Sports Medicine
- Quadriceps Tendon Tear
- Radial Tunnel Syndrome (Entrapment of the Radial Nerve)
- Revascularization of the Hand
- Reverse Total Shoulder Replacement
- Rheumatoid Arthritis (RA) of the Shoulder
- Rheumatoid Arthritis Of The Hand
- Robotics
- Rotator Cuff Tears
- Runner's Knee
- Sacroiliac Joint Pain
- Sciatica
- Scoliosis
- Shin Splints
- Shoulder
- Shoulder Arthritis
- Shoulder Arthroscopy
- Shoulder Injury: Pain In The Overhead Athlete
- Shoulder Replacement
- Shoulder Separations
- Shoulder Socket Fracture (Glenoid Fracture)
- SLAP Tears & Repairs
- Spinal Fusion
- Spine
- Spondylolisthesis and Spondylolysis
- Sports Foot Injuries
- Sports Hernias (Athletic Pubalgia)
- Sports Medicine
- Sports Wrist and Hand Injuries
- Sprained Ankle
- Sprained Wrist Symptoms and Treatment
- Subacromial Decompression
- Sudden (Acute) Finger, Hand & Wrist Injuries
- Targeted Muscle Reinnervation (TMR)
- Tendon Transfers of The Hand
- Tennis Elbow
- Thigh Fractures
- Thigh Muscle Strains
- Thumb Ulnar Collateral Ligament Injuries
- Total Ankle Replacement
- Total Hip Arthroplasty
- Total Hip Replacement - Anterior Approach
- Total Knee Replacement Surgery
- Trapezius Strain (Muscle Strain of The Upper Back)
- Traumatic Shoulder Instability
- Triceps Tendonitis
- Trigger Finger
- Turf Toe
- UCL (Ulnar Collateral Ligament) Injuries
- Ulnar Neuritis
- Valgus Extension Overload
- Vertebroplasty
- WALANT (Wide Awake Local Anesthesia No Tourniquet)
- Whiplash and Whiplash Associated Disorder (WAD)
- Wound Care
- Wrist Arthroscopy
- Wrist Fractures
- Wrist Tendonitis
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