Position Statement

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.

More than two and a half million children in the United States play youth baseball under the supervision of adult coaches, administrators, and parents. Approximately 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.

A number of studies have documented 20 percent of children eight to 12 years of age and 45 percent of those 13 to 14 years of age 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 that limit the number of innings pitched by an individual player. These rules allow the player to pitch six innings per week as a maximum. 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 (a maximum of six innings per week), not by the number of teams played on.
• While there is no concrete guideline for the number of pitches allowed, a reasonable approach is to count the number of pitches thrown and use 3 innings maximum per week and 75 pitches per game with a minimum of 3 days rest between starts for the skeletally immature athlete.
• 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.

References:

Purvis & Burke, Vol.9, #6, pp 265-374, Recreational Injuries in Children: Incidence and Prevention, Journal of the American Academy or Orthopaedic Surgeons

J. Andy Sullivan, editor, Care of the Young Athlete, American Academy of Orthopaedic Surgeons

© May 1997. Revised June 2005 American Academy of Orthopaedic Surgeons

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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