Little League Shoulder: Arm Pain in Young Throwers

Little League shoulder is a stress injury to the growth plate at the top of the upper arm bone (proximal humeral epiphysis) in young throwers, usually aged about 11 to 16. Your child may have pain on the outer upper arm when throwing hard, often without a single injury. The usual treatment is a full break from throwing, often around 3 months, followed by a graded return over several more weeks. Most young players get back to throwing.

A growth plate is a layer of cartilage near the end of a bone where growth happens. During the growth years it is weaker than the tendons and ligaments around it. Repeated hard throwing twists and pulls on it, and over time the plate can become irritated and widen.

Key takeaways

What it is: an overuse injury to the growth plate at the top of the upper arm bone.
Who gets it: young pitchers and other throwers, typically aged about 11 to 16, often during a growth spurt.
Typical signs: pain on the outer upper arm during or after throwing, tenderness near the top of the arm, and sometimes lost speed or control.
Treatment: a full break from throwing, often around 3 months, then a graded throwing program.
Prevention: age-based pitch counts, rest days, one team at a time and a few months off throwing each year.

Where are you right now?

You have just noticed the pain: stop throwing and arrange for a doctor to check your child’s arm. Then read “Month by month”.
Weeks into the break and unsure: go to “If it isn’t going to plan”.
After an injection or surgery: neither is usually needed for Little League shoulder. Rest is the main treatment.
Getting back to throwing: the “When can I…” table and the pitch count section give typical ranges.

Month by month

The growth plate sits just below the ball of the shoulder joint. A doctor usually confirms the problem by examining the arm, and often with X-rays of both arms to compare the growth plates.

Weeks 0 to 2: no throwing at all, including fielding throws and warm-up catch. Running, leg and trunk training usually continue. Many doctors allow batting if it does not hurt.
Weeks 2 to 8: still no throwing. A physical therapist often starts rotator cuff, shoulder blade, trunk and hip strengthening.
Months 2 to 3: pain and tenderness have usually settled. The doctor reviews the arm before throwing restarts, sometimes with a repeat X-ray.
Month 3 onward: a graded interval throwing program, from short, easy tosses to longer, harder throws, often over 4 to 8 weeks. Many pitchers are back in games about 4 months or more after the pain began.

Pitch counts and rest

Widely used US youth baseball guidelines set daily pitch limits by age, from 75 pitches at ages 9 to 10 up to 95 at ages 13 to 16, with required rest days after higher counts. The same guidance advises against pitching on consecutive days, against pitching for more than one team in overlapping seasons, and for at least 2 to 3 months each year without overhead throwing. Count bullpen sessions and showcase throws too. Throwing shoulder pain in older players covers adult and senior-level problems.

Where else this could be coming from

A broken upper arm: a break near the top of the upper arm follows a fall or blow, with sudden severe pain and swelling, rather than an ache that builds with throwing.
Rotator cuff pain: rotator cuff tendinopathy is more common in older teens and adults, once the growth plates have closed.
Labral tear: a labral tear causes deep pain with catching, clicking or a dead arm, and is less common before the growth plates close.
A loose shoulder: a shoulder that feels as if it slips during the throw, more common in very flexible young athletes.
The elbow: pain on the inner side of the elbow in young pitchers often comes from the same overuse. The elbow, wrist or hand need their own assessment.

The arm stops hurting before the growth plate has finished healing.

Is this normal?

“The X-ray looked almost normal.” Changes at the growth plate can be subtle. Doctors often compare both arms, and some cases are diagnosed from the examination alone.
“After two weeks it does not hurt at all.” Common. Pain often settles well before the growth plate has healed, which is why the break lasts longer than the pain.
“Will this affect how the arm grows?” With rest from throwing, the growth plate usually heals without lasting effects. Throwing through ongoing pain raises the chance of the problem returning and, rarely, of a fracture through the growth plate.
“My child is upset about missing games.” Very common. Staying involved at practice through leg, trunk and batting work often helps.

If it isn’t going to plan

It is week five of no throwing. Your daughter says her arm feels fine, the playoffs start in two weeks, and the coach is asking whether she can pitch. The thought in your head is that if it no longer hurts, the rest has done its job.

Pain is a poor guide here. The growth plate settles more slowly than the soreness, often over about 3 months. Going straight back to full-effort pitching loads the plate before it is ready, and a sudden jump in throwing is the usual way the problem comes back.

What a young thrower’s shoulder needs is the full break, then a gradual build in throwing distance, effort and count, with strength work for the shoulder, trunk and legs alongside.

Before throwing restarts, have your child reviewed by their doctor, and ask a physical therapist to set the throwing program. Ask:

Healing: has the growth plate settled, and would a repeat X-ray help?
Timing: when can an interval throwing program start, and how long should it run?
Limits: what pitch count and rest days fit my child’s age when they return?
Contributors: are throwing mechanics, strength or the number of teams playing a part?

When can I…

Activity	Typical range
Sleep on that side	Usually not limited by Little League shoulder
Drive	For teens who drive, usually not limited
Reach overhead	Everyday reaching is usually fine throughout, if it does not hurt
Lift	School bags and light lifting usually fine; upper body weight training is often adjusted during the throwing break
Desk work	Schoolwork is not restricted
Manual work or sport	No throwing for often around 3 months; then interval throwing over about 4 to 8 weeks; games often 4 months or more from the start

If your child has had surgery, the surgeon’s protocol comes first.

Call your local emergency number or go to the emergency department if

Arm out of shape: after a fall or collision, the arm or shoulder looks deformed or your child cannot move it.
Circulation: the arm or hand turns cold, pale or blue.
After a collision: neck pain with numbness or weakness in the arms or legs.

See a doctor today if

Sudden pain while throwing: a sharp pain or pop during a throw, after which your child cannot throw or lift the arm.
Hot, swollen shoulder: the shoulder or upper arm is red, hot or swollen, especially with fever.
Severe night pain: pain that wakes your child and comes with fever or feeling unwell.

Get it checked soon if

Pain with throwing: any shoulder pain during or after throwing in a child or teenager, before the next throwing session.
Pain at rest: an ache in the upper arm at rest or at night that is not linked to throwing.
Elbow pain: pain on the inner side of the elbow with throwing.