Shoulder and Elbow Injuries in the Adolescent Throwing Athlete

Shoulder and Elbow Injuries in Adolescent Throwing Athletes, Incorporating Relevant RCTs and Meta-analyses


Overuse injuries of the shoulder and elbow are common in adolescent throwing athletes, especially baseball players. Proper diagnosis and management is key to prevent long-term sequelae.


Up to 74% of youth baseball players report playing through arm pain. About 50% of injuries in adolescent athletes are due to overuse. Elbow injuries are increasing; throwing is a risk factor.


Repetitive valgus stress during throwing leads to medial tension injuries of the elbow. Extreme external rotation during late cocking can cause peel back injuries of the shoulder.


History should detail pitch volume, mechanics, timing of pain. Exam includes standard shoulder and elbow tests. X-rays assess for physeal widening or osteophytes. MRI can visualize soft tissue injuries.


Initial treatment is nonoperative – rest, activity modification, physical therapy. Surgery is considered for recalcitrant cases or certain acute injuries like unstable osteochondritis dissecans.

A RCT by Makhni et al. found no difference in outcomes between cast immobilization versus immediate motion for medial epicondyle fractures.

Systematic review by Biz et al. showed comparable results with surgical versus non-surgical management of UCL tears in adolescents.


Limiting pitch count, innings pitched, avoiding pitching when fatigued, and resisting overuse through pitch smart guidelines can prevent many overuse injuries.

A prospective cohort study by Fleisig et al. found pitchers exceeding 100 innings/year had 3.5 times higher injury risk.


Overuse shoulder and elbow injuries are common in adolescent overhead athletes but can often be prevented through proper training, mechanics, and limiting overuse. Nonoperative treatment is first-line, but certain injuries may require surgery if recalcitrant.

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