Use Caution in Young Overhead Athletes with Shoulder Pain

Written by Dr. David Geier, American Orthopaedic Society for Sports Medicine

As participation in youth sports increases and younger children are playing a single sport year round, it is no wonder that more young athletes are being seen in doctors’ offices in this country. For throwing sports like baseball and overhead sports like swimming and tennis, shoulder pain is a common complaint.

Little League Shoulder (LLS) is an overuse injury to the proximal humerus (upper arm) originally described in young baseball players. In a presentation at the American Orthopaedic Society for Sports Medicine’s Annual Meeting*, researchers from Children’s Hospital Boston, Division of Sports Medicine presented the findings from cases of Little League Shoulder seen at their center between 1999 and 2013. They analyzed patients from that 15-year period to better understand the demographics, symptoms, risk factors and treatment outcomes of LLS.

Patient demographics

Of the 95 cases of Little League Shoulder, 93 of the patients (98%) were male, with an average age of 13.1 years. The ages of the patients ranged from 8 to 16 years old.

97% of the LLS patients were baseball players, and 86% of those were pitchers. 3% of the LLS patients were tennis players.

Presenting symptoms

As one might expect, shoulder pain was the predominant complain in the children seen for LLS. The pain affected the throwing arm or the arm holding the tennis racquet. Other shoulder complaints included shoulder weakness or fatigue, mechanical symptoms, such as ‘clicking’ in the shoulder, and instability.

Symptoms other than simply pain in the shoulder were not uncommon for the diagnosis of Little League Shoulder. “The data showed 13% of patients treated also reported elbow pain, 10% reported shoulder pain or weakness, and 8% reported other mechanical symptoms,” Benton E. Heyworth. MD, one of the authors, emphasized. “These related symptoms should be recognized as possible identifiers for injured athletes in the future.”

Also of note, 30% of the affected young athletes were diagnosed with glenohumeral internal rotation deficit (GIRD), a loss of total range of motion in the shoulder, in association with their diagnosis of LLS.


Fortunately LLS does not require surgery. It does often involve a prolonged period of rest from throwing and overhead sports. In addition to rest, almost 4 in 5 patients underwent physical therapy as well. The period of rest prior to return to sports averaged 4.2 months.

What can parents learn from this study for their children who play sports?

  • Remember that young athletes who play all overhead sports can develop Little League Shoulder. While this is largely an overuse injury among baseball pitchers, players at other positions, such as catchers, can develop it as well. Likewise, parents of young tennis players, football quarterbacks and swimmers should watch for shoulder pain in their kids.
  • Young baseball pitchers should not pitch through shoulder pain. LLS involves widening of the growth plate caused by repetitive stress over time. If a young overhead athlete has shoulder pain, he should rest from throwing or participating in the sport for a few days rather than push through pain and risk a serious injury that keeps him out for months.
  • If there is any question whether shoulder pain represents a serious injury, take the child to the doctor for examination. If shoulder pain in a young athlete is not improving, it can be a good idea to see a doctor or sports medicine orthopaedic surgeon. The physician can perform a physical exam, order x-rays or other studies, and prescribe treatments that could resolve the injury and prevent further damage.

*Heyworth BE, Kramer D, Martin DJ, Kocher MS, Micheli LJ, Bae DS. Trends in the Presentation, Management, and Outcomes of Little League Shoulder. Presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine.