As baseball play continues, some players may experience the potential for injuries such as proximal humeral epiphysiolysis, often called “Little League shoulder.” What is Little League shoulder, and how can it be prevented?

Published: July 31, 2020 | Updated: November 6, 2020

While an abbreviated major league season is just getting underway, much younger pitchers and catchers have been playing at baseball fields across the U.S. As baseball is one of the youth sports where it is somewhat easier to practice social distancing to prevent spread of the coronavirus, many programs have continued this summer. So have some baseball-related injuries, such as proximal humeral epiphysiolysis, often called “Little League shoulder.” What is Little League shoulder, and how can it be prevented?

What is Little League shoulder (proximal humeral epiphysiolysis)?

There are three bones that make up a shoulder — the collar bone, the upper arm bone and the shoulder blade. The shoulder blade and the upper arm bone are connected by a joint, and that joint is very close to a growth plate, a soft spot at the end of the bone that helps bones grow. In Little League shoulder, the growth plate that sits on the upper arm bone becomes inflamed or irritated.

How do kids get Little League shoulder?

Like other conditions related to pitching, throwing and overhand activities (such as Little League elbow), it is an overuse injury. This means a child is throwing or using their arm too often. The condition is also caused by throwing with improper technique, which can put more strain on the shoulder. The condition usually occurs in children 11 to 16 years old.

Little League shoulder symptoms

Symptoms of Little League shoulder include:

• Shoulder pain when throwing
• Soreness that lasts for a few days
• Decreased ability to throw with usual accuracy or speed
• Swelling or tenderness near the shoulder

“If a child gets Little League shoulder, the recommendation is to refrain from pitching for three months,” Kent L. Walker, D.O., pediatric orthopedist with Norton Children’s Orthopedics of Louisville, affiliated with the UofL School of Medicine. “That is why it’s important to follow these guidelines because if left untreated, it can cause permanent shoulder dysfunction and altered throwing mechanics.”

How to prevent Little League shoulder

Like any overuse injury, Little League shoulder can be prevented. You can talk to your child’s coaches about your child’s throwing technique, including the way they throw, where they release the ball and how they position their arm and wrist. This focus on proper technique can help a child improve as an athlete and help to protect them from pain and injury.

Focus on throwing and rest guidelines can help prevent injury, too. Major League Baseball (MLB) and USA Baseball partnered to create Pitch Smart, a comprehensive guide for parents and young athletes to understand safe pitching practices. Pitch Smart was developed with an advisory council of physicians from the American Sports Medicine Institute and various MLB franchises. Pitch Smart includes pitch count limits and required rest recommendations for youth pitchers by age group.

In addition, here are some other tips to help prevent overuse injuries in children and teens:

• Keep an eye on pitching type for younger ages. Breaking pitches, such as curveballs and sliders, can have an increased risk of injury for younger pitchers. There are age recommendations available for certain pitches, but parents should work with their child’s primary care provider to understand if their child is ready for advanced pitches. A child may be ready for these advanced pitches at a younger or older age due to their stage of development. Starting these advanced pitches can start a child on a path to pitch more frequently, which also can lead to overuse.
• Maintain overall fitness. A child should have a fitness routine appropriate for his or her age and the sport the child plays. Resistance training, aerobic conditioning and strength training all can be part of a well-rounded fitness routine.
• Play other sports in the offseason. Children are specializing in one sport at younger and younger ages, belong to multiple teams at a time or play in multiple leagues per year. It’s recommended that young athletes take three months each year off from their sport. Playing a different sport in an offseason can give a child a needed period of “active rest” from throwing. Playing a non-throwing sport can give a child three to six months of recovery time for their throwing arm.