Little League Elbow and Shoulder: The Growth-Plate Injuries Parents Miss
In a still-growing arm, the weak link is not the ligament. It is the growth plate, and the early warning signs are easy to wave off as nothing.
The quick take
- In young, still-growing pitchers, repetitive throwing stresses the growth plates before it stresses the ligaments.
- Little League elbow is irritation of the growth plate on the inner elbow; Little League shoulder is a stress reaction of the growth plate at the top of the arm bone.
- The growth plates stay vulnerable until they fuse, the inner elbow around age 15 and the shoulder into the late teens or early twenties.
- Caught early, these injuries almost always heal with rest. Ignored, they can become a much longer problem.
A different weak link
In an adult arm, the headline throwing injury is the torn ligament. In a child's arm, the story is different. Before the bones finish growing, the softest spot in the throwing arm is the growth plate, a zone of cartilage where the bone is still lengthening. That cartilage is weaker than the surrounding tendon and ligament, so under repeated throwing stress it tends to give first.[1]
This is why two of the most common throwing injuries in youth baseball have nothing to do with the UCL. They happen at the growth plates, and they have earned the nicknames Little League elbow and Little League shoulder.
Little League elbow
The medical name is medial epicondyle apophysitis. Every hard throw pulls on the growth center on the inside of the elbow, and repeated pulling irritates and inflames it.[1][2] The growth center on the inner elbow typically appears around age 6 or 7 and fuses by about age 15, which defines the window of risk. It shows up most often in pitchers younger than 16.[2]
What you would notice: pain on the inner side of the elbow that comes on with throwing, tenderness right over that bony bump, and sometimes a drop in velocity or trouble fully straightening the arm.
Little League shoulder
The medical name is proximal humeral epiphysiolysis, a stress reaction of the growth plate at the top of the upper arm bone. It tends to appear in higher-volume pitchers between roughly 11 and 16, and the growth plate there does not fully fuse until the late teens or early twenties.[3] The complaint is usually shoulder pain with throwing, often most noticeable during the acceleration phase, sometimes felt as a vague ache at the top of the arm.
Why these injuries get missed
Both often begin as a dull ache that arrives with throwing and quietly fades with a few days of rest. So the natural response is to shrug it off, ice it, and keep playing. A young pitcher who wants to compete will rarely volunteer the information, and sometimes the first visible clue is a loss of velocity or command rather than a complaint of pain.
What to do about it
- 1Stop throwing. Rest is not optional with a growth-plate injury; it is the treatment.
- 2Get it evaluated. A sports medicine physician can examine the arm and may use imaging to confirm what is going on.
- 3Let it calm down fully before returning, which often takes weeks, not days.
- 4Come back through a gradual, structured throwing progression rather than straight back to the mound.
- 5Fix the cause. Look hard at the volume, the rest, and the year-round schedule that produced the injury in the first place.
Preventing them in the first place
The prevention playbook is the same one that protects the ligaments: respect age-based pitch counts and rest days, take a genuine off-season from throwing, watch for fatigue, and never let a child pitch through pain.[4] Growth plates are forgiving when you give them time and unforgiving when you do not.
Common questions
What are the symptoms of Little League elbow?+
Pain on the inner side of the elbow that comes with throwing, tenderness over the bony bump on the inside of the elbow, and sometimes reduced velocity or difficulty fully straightening the arm. It is most common in pitchers under 16.
How is Little League elbow treated?+
The core treatment is rest from throwing until the growth plate calms down, followed by a gradual, structured return. A sports medicine physician should evaluate it, and imaging is sometimes used to rule out a more serious injury.
What is Little League shoulder?+
It is a stress reaction of the growth plate at the top of the upper arm bone, common in higher-volume pitchers aged about 11 to 16. The main symptom is shoulder pain with throwing, especially during the acceleration phase.
Can my child keep throwing through it?+
No. Throwing through a growth-plate injury risks turning a problem that heals with rest into one that needs a much longer recovery. Stop throwing and get it evaluated.
Sources
This article is reviewed against the research below. Where findings are debated, we say so in the text rather than overstating the certainty.
- 1.American Academy of Orthopaedic Surgeons, OrthoInfo. Throwing Injuries in the Elbow in Children. AAOS OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/throwing-injuries-in-the-elbow-in-children/
- 2.Medial Epicondyle Apophysitis (Little League Elbow). StatPearls, NCBI Bookshelf. StatPearls / NCBI. https://www.ncbi.nlm.nih.gov/books/NBK570592/
- 3.Physical Therapy Guide to Little League Shoulder (Proximal Humeral Epiphysitis). ChoosePT / APTA. https://www.choosept.com/guide/physical-therapy-guide-little-league-shoulder-proximal-humeral-epiphysitis
- 4.MLB and USA Baseball, Pitch Smart: Pitching Guidelines (pitch limits, rest, and annual time off). Major League Baseball / USA Baseball. https://www.mlb.com/pitch-smart/pitching-guidelines
This article is education, not a medical diagnosis, injury prediction, or treatment plan. If your pitcher has pain or you have concerns about an injury, consult a qualified sports medicine professional.