Baseball season is upon us once again. It’s time to “play ball!” However, for a growing number of young athletes, injuries can derail a promising and enjoyable season. Two such injuries are the well known “little league elbow” and “little league shoulder”. These injuries are most commonly seen in individuals who are age 11-18 and participate in sports with repetitive overhead motions, such as baseball and softball. These injuries can also effect swimmers and tennis players due to the repetitive overhead motions. As parents, coaches, and fans it is important to understand the causes, symptoms, and proper treatment to keep our young athletes healthy and on the field.

Little League Shoulder

Little league shoulder is an overuse injury that affects the growth area of the humerus (upper arm) at the shoulder joint. The primary causes for developing Little League Shoulder include repeated overhead throwing without proper rest periods, throwing with improper mechanics, and deficiencies in muscular strength or range of motion. Repeated throwing places a high stress load on shoulder which can lead to wear and tear. During adolescence new bone is rapidly developing; impairing the ability to handle high stress loads.

Symptoms
• Pain with throwing
• Pain at the shoulder either at rest or with lifting activity
• Decreased throwing speed
• Decreased throwing accuracy
• Worse with continued throwing or use
• Change in throwing mechanics
• Overall arm weakness

Little League Elbow

Similarly to Little League Shoulder, the most common cause of the development of Little League Elbow is overuse. Throwing without adequate rest periods causes microtrauma at the elbow joint. These repeated microtraumas potentially lead to stress fractures, sprains, or tears. Poor throwing mechanics impose higher stress forces on the elbow. Most commonly excessive stress at the elbow will lead to sprains and tears at the UCL (ulnar collateral ligament). The UCL functions to stabilize the elbow between the middle portion of the upper and lower arm.

Symptoms
• Pain with throwing
• Pain at inner elbow (may be severe and immediate or slow and gradual)
• Swelling, redness, warmth at elbow
• Painful “pop” may be present
• Worse with continued throwing or use
• Change in throwing mechanics
• Pain with gripping or heavy lifting

Prevention

The best way of preventing these injuries is through the education of athletes, family members, and coaches. Make sure to look for the signs and symptoms of injury or fatigue. Catching and treating an injury early will promote faster recovery. The old mantra of “no pain, no gain” should be thrown out along with the mullets and shoulder pads of the 80’s. Young athletes may want to tough it out for their team, or push through as to not disappoint parents or coaches. However continuing to play on an overuse injury will cause more damage; potentially sidelining them for a whole season. Young athletes should be educated on the importance of resting when necessary to promote a full and long career in sports.

Certain leagues utilize pitch count limits and rest day requirements between pitching days. These limits are set in place for player safety, please adhere to these guidelines. Younger players should also avoid or limit throwing curve balls until they are physically able to handle the increased stressed placed on the elbow with proper mechanics. Playing pitcher and catcher is also not recommended, as this combination of positions leads to too many throws and increases the risk of injury.

Lastly, during the off-season, the player should take a rest period from overhead throwing. It is better for athletes to avoid specialization in one sport o allow for rest and cross training. The variety of sports can prevent the athlete from burning out. Furthermore, playing multiple sports leads to development of other skills that can be transferred between sports.

If an overuse injury to the elbow or shoulder is suspected, the first thing that the individual should do is stop throwing and rest their arm for several days. Anti-inflammatory medications and ice may be beneficial to reduce inflammation and swelling within the soft tissue. If after several days of treatment the symptoms remain the same upon return to use, the individual should schedule a visit with their doctor or physical therapist to examine the issue further. Working with a physical therapist can help to improve strength and range of motion while also promoting proper throwing mechanics to help prevent further injury.