Little League Elbow & Shoulder: Warning Signs & Recovery Tips

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Little League elbow and Little League shoulder are overuse injuries affecting the growth plates in young throwing athletes — most commonly baseball pitchers.

Both conditions result from repetitive “microtrauma” — such as torn muscle fibers, strains or bruising that accumulate over time — due to overhead throwing during sports like baseball or softball. Other overhead sports can cause similar stress to the elbow or shoulder — just imagine a quarterback throwing the ball down field or a volleyball player spiking a ball over the net.

In the following article, we offer information about both conditions, common risk factors, when to seek medical attention and — importantly — when outpatient physical therapy can help someone prevent or recover from an injury.

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While these conditions can affect both boys and girls in sports at any age, Little League elbow (medial epicondyle apophysitis) is most common in baseball players between 9 and 13 years old.

Little League shoulder (proximal humeral epiphysiolysis) commonly occurs in young male pitchers between 11 and 16 years of age, with peak incidence at 13 years. This condition results from a fracture through the growth plate (known as a Salter-Harris fracture) of the proximal humerus, which is the upper end of the arm bone that forms the ball-and-socket joint in the shoulder.

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There are a number of risk factors that can lead to Little League elbow and/or shoulder, including:

• Age (typically affects adolescents due to periods of rapid growth and immature bones)
• Excessive throwing without adequate rest
• Inadequate shoulder flexibility
• Overuse
• Poor throwing mechanics causing excessive stress on the arm

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Persistent elbow pain should be evaluated by a medical professional to determine if you have (or if your child has) Little League elbow. Symptoms may include:

• Difficulty fully straightening the arm
• Locked or stiff elbow
• Pain within the elbow that worsens over time
• Popping or catching sensation while throwing
• Swelling around the elbow
• Unexplained loss of pitching velocity

Unsurprisingly, pain in your throwing arm may signal an overworked or injured tissue and can be a symptom of Little League shoulder. However, there are warning signs you shouldn’t ignore. Stop throwing and seek a medical evaluation if you or your child experience any of the following symptoms:

• Clicking, popping or catching sensations in the shoulder or elbow
• Diminished grip strength or inadvertently dropping objects
• Loss of range of motion
• Moderate pain lasting more than 72 hours despite rest
• Pain that doesn’t improve, or worsens, with warm-up
• Pain that wakes you at night
• Severe pain while throwing
• Significant loss of velocity (throwing speed) or accuracy
• Swelling or fullness in the elbow or shoulder

Additionally, numbness, temperature changes, tingling and weakness can signal neurological or vascular compression and injury, and it’s important to seek medical attention immediately.

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If you experience any of these symptoms, or if you are diagnosed with either Little League elbow or Little League shoulder, you may be referred to outpatient physical therapy.

A physical therapist can help you understand the anatomy and biomechanics involved with your diagnosis. They can guide you on best practices for rest and recommend exercises that target the muscles that support the joint. They can also discuss guidelines surrounding pitch count or throwing management, such as designing a structured plan and providing guidelines to manage load on the affected area(s) to reduce the risk of flare-ups and future injury.

Physical therapists are well-qualified to evaluate how your movement quality, flexibility, strength and injury history might be contributing to your symptoms. Based on the findings, they can provide an individualized treatment plan, including a home exercise program to support long-term management. Finally, they can help discern whether your elbow or shoulder pain necessitates further intervention and weigh the risk of continued throwing, while discussing guidelines for returning to your sport.

Learn more about our outpatient services and request an appointment.

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Chloe Miller, PT, DPT, CSCS, is a physical therapist and certified strength and conditioning specialist at Shirley Ryan AbilityLab. She has additional training in optimizing golf performance through the Titleist Performance Institute. She also has an extensive background in athletic performance with special interests in overhead athletes, return to sport, and sports rehabilitation. She has presented research, including “Elite Softball Athletes; Shoulder Force and ROM Affected By Time of Season and Arm Dominance,” used to determine how time of season and arm dominance affect strength and range of motion in Division I (D1) collegiate softball athletes. She also leads two shoulder courses to educate others about shoulder anatomical and biomechanical considerations for movement and pain.

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Malcolm White, PT, DPT, OCS, is a board-certified orthopedic physical therapist and senior physical therapist at Shirley Ryan AbilityLab. He specializes in evidence-based care for musculoskeletal injuries and has advanced training in mechanical diagnosis and therapy (MDT) and blood flow restriction rehabilitation. He also serves as an adjunct faculty at Northwestern University, where he teaches future clinicians the importance of psychosocial factors and equitable, patient-centered care. He was recently published in the American College of Rehabilitative Medicine for his contributions to a study examining healthcare provider knowledge and behaviors pertaining to social determinants of health. His clinical, teaching and research interests emphasize health equity, patient-centered care, empowered movement and long-term musculoskeletal health, through compassion, education and individualized treatment strategies.