The Risks of Shoulder and Elbow Injury from Participation in Youth Baseball
This Position Statement was developed as an educational tool based on the opinion of the authors. It is not a product of a systematic review. Readers are encouraged to consider the information presented and reach their own conclusions.
The American Academy of Orthopaedic Surgeons (AAOS) believes that parents should be informed about the risks and injuries which occur in youth baseball as a result of excessive throwing, and strongly urges compliance with the recommendations for throwing restriction in youth baseball to minimize such injuries.
Millions of children in the United States play youth baseball under the supervision of adult coaches, administrators, and parents. According to the U.S. Consumer Product Safety Commission, in 2009, nearly 280,000 children ages 18 and younger were treated in hospitals, doctor’s offices and emergency rooms for baseball-related injuries. Over 35 years ago, physicians recognized the risk to the upper extremity, particularly the shoulder and elbow, in the growing child. These significant risks include pain, which limits activity, loss of motion and strength, damage to the growth centers of the shoulder and elbow, and other X-ray changes that may be permanent.
According to the Sports Trauma and Overuse Prevention (STOP) Sports Injuries campaign, 20 percent of children ages 8 to 12 and 45 percent of children ages 13 to 14 will have arm pain during a single youth baseball season. Documentation of these injuries resulted in the institution of rules by youth baseball in the United States to limit the number of innings pitched by an individual player. In spite of these rules, there are growing concerns that parents and coaches avoid these restrictions by allowing children to play on multiple teams or in multiple leagues.
The AAOS recommends the following safety guidelines to decrease the risk of injury to the upper extremity in the growing athlete who participates in youth baseball:
- Follow the guidelines about the number of innings pitched based on the individual's participation, not by the number of teams played on:
Maximum Pitch Counts
Source: Little League Baseball
Rest Periods Required
Required # of
3 calendar days
2 calendar days
1 calendar day
Source: Little League Baseball
- Avoid pitching on consecutive days.
- Avoid playing baseball or softball year-round.
- Any persistent pain, loss of motion (especially extension) or documented X-ray abnormalities should disqualify a child from playing until these findings abate or are clarified by a physician.
- Coaches and players in youth baseball should be taught proper throwing technique and proper pitching technique. Skeletally immature players should only throw a fast ball and a change up and work on control. They should not be taught to throw a breaking ball (curve ball) until after puberty.
- Coaches should educate players to the importance of and techniques for stretching and strengthening the upper extremity. Five-minute stretching after play can help young players avoid throwing-arm pain. Pitchers and catchers under the age of 15 often experience tightness of a shoulder ligament known as the posterior-inferior glenohumeral ligament. If this ligament is not stretched, it will lead to pain or injury of the cuff and/or labrum as a player ages and continues to play baseball.
1. U.S. Consumer Product Safety Commission, NEISS 2009 Data
2. Sports Trauma and Overuse Prevention (STOP), Sports Injuries Campaign. www.STOPSportsInjuries.org:
a. Prevention and Emergency Management of Youth Baseball and Softball Injuries. American Orthopaedic Society for Sports Medicine. 2005.
b. Little League Baseball. www.littleleague.org/Assets/old_assets/media/pitchcount_faq_08.pdf.
c. American Sports Medicine Institute. www.asmi.org.
3. Purvis & Burke, Vol.9, #6, pp 265-374, Recreational Injuries in Children: Incidence and Prevention, Journal of the American Academy or Orthopaedic Surgeons.
4. J. Andy Sullivan, editor, Care of the Young Athlete, American Academy of Orthopaedic Surgeons.
May 1997 American Academy of Orthopaedic Surgeons.
Revised June 2005 and September 2010.
This material may not be modified without the express written permission of the American Academy of Orthopaedic Surgeons.
Position Statement 1145
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