Preventing Arm Injuries during Baseball Season

Tips for Little Leaguers and high school athletes

Joshua S. Dines, MD
Joshua S. Dines, MD

Associate Attending Sports Medicine Service, Hospital for Special Surgery
Associate Professor of Orthopaedic Surgery, Weill Cornell Medical College

With spring around the corner, Little League and High School baseball teams will be starting their practices very soon. It also means that baseball injuries will increase over the next few months.

Similar to most sports, acute injuries such as ankle sprains, concussions, and shoulder dislocations can occur during baseball games, but the significant stresses placed on the body during the throwing of a baseball subject kids to a separate group of injuries that are more unique to throwing sports.

Young African American Baseball Pitcher

Types of Injuries

The majority of overuse injuries that occur during baseball affect the shoulder and elbow, with shoulder injuries being slightly more common.

The shoulder joint is a ball (humerus) and socket (glenoid). The rotator cuff is a group of muscles that help stabilize the shoulder during the throwing motion, and the labrum is also a stabilizing structure that helps prevent the shoulder from dislocation. These soft-tissues can be injured in isolation, but more commonly, they are both injured in the thrower’s shoulder.

Partial tears of the rotator cuff and anterior labral tears are very common.

In younger athletes, a condition called Little Leaguer’s Shoulder can be a source of pain as well. In children, the bones grow from an area known as the growth plate. This area of the bone at the top of the humerus (upper arm) is more susceptible to injury, particularly in situations where the shoulder is overused. Little Leaguer’s Shoulder refers to inflammation of the growth plate due to throwing.

A similar condition may affect the growth plate at the elbow of young children, and it is referred to as Little Leaguer’s Elbow.

Other conditions that can cause elbow pain during throwing include ulnar collateral ligament injury and flexor-pronator tendonitis. The ulnar collateral ligament is one of the main stabilizers of the medial elbow (inside of the elbow) during throwing. Occasionally one throw will result in rupture of the ligament, but more commonly insufficiency of the ligament is the result of years of throwing. The flexor and pronator tendons are also located on the inner side of the elbow. These too can develop inflammation due to overuse.


While a variety of causes can lead to pain in the shoulder and elbow of baseball players, they often present with similar symptoms, including pain during throwing, decreased velocity, decreased accuracy, and difficulty warming up.

If these symptoms develop, the first line treatment is to stop the offending activity. Ice and anti-inflammatory medications may help as well. If the pain persists, evaluation by a medical professional is recommended.

As the adage goes, “an ounce of prevention is worth a pound of cure.” With regards to throwing, that means proper, gradual conditioning to make sure one’s muscles are strong enough and flexible enough to withstand the demands of a baseball season.

A rotator cuff and core strengthening program, in addition to a shoulder stretching program, can help prevent injuries and keep kids on the field. The Sports Rehabilitation and Performance Center at HSS can provide young athletes with a program that is age-appropriate and tailored for their specific needs.


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