Common Pitching Injuries in the Elbow and Shoulder

Pitchers from the pros on down to Little League are at risk of injury from repetitive use. In fact, 64% of parents recalled their children having arm pain as a result of pitching. Learn more about the common injuries caused by pitching. And learn how they can be prevented.


There are few feelings as natural as tossing a baseball. But the act of throwing, particularly with pitching in baseball and softball, is hardly natural at all.

It requires your arm to create a lot of torque, the force needed to rotate the ball. From fastballs to sliders, each pitch has its own velocity and breaking motion.  Your arm has to deal with a lot of angles and pressure points.

It’s easy to see why many pitchers, from Little League to the pros, face injuries. In fact, a 2015 study found that 64% of parents recalled their children having arm pain as a result of pitching.1

While there are other areas on the body where pitching injuries occur, let’s focus on the elbow and shoulder. Let’s review some common pitching injuries.

Elbow injuries for pitchers

Learn about preventing the most common types of pitching injuries.

Pitching places intense pressure on your elbow joint. As you go from your wind-up to your stride, your elbow cocks back by about 90 degrees and then (snap!) accelerates toward home plate with the throw. Repeating this movement again and again through pitching puts you at risk for a few common elbow injuries.

Forearm tendinitis

One of the most common pitching injuries is tendinits in the flexor and pronator tendons of the forearm. These tendons connect the wrist to the palm and stretch back to the bony bump on the elbow. If you have forearm tendinitis, then you may feel soreness or locking on the inside of your elbow, and the pitching motion may come with an irritating popping sensation. This injury often comes from overuse or from improper mechanics.

Ulnar collateral ligament injury a.k.a “Little League Elbow”

The ulnar collateral ligament attaches the humerus and ulna bones of your arm at the outside of your elbow. Injuries here can come from many microtears, a big tear or even a full rupture. Because the UCL stabilizes your elbow, injuring it can feel like dislocating your elbow. Overuse is a big cause for this injury. It’s sometimes called “Little League elbow,” because young arms, with weaker supporting muscles, are especially vulnerable to it.

Valgus extension overload a.k.a. “Pitcher’s Elbow”

This condition, which gets the name “pitcher’s elbow,” is an injury commonly caused by strenuous pitching mechanics. As you deliver a pitch, your forearm and hand snap to the lateral side of your elbow. That movement, called valgus force, can wear out the cartilage in your olecranon bone and cause that bone to twist and push into the humerus bone. It leads to pain and swelling, and it can mean that you need to change your pitching motion.

Olecranon stress fracture

Your olecranon, the bony part of your elbow, is a common area for stress fractures from pitching. You are more likely to experience this fracture if the muscles surrounding your elbow aren’t strong enough to adequately absorb the shock of your arm motion.

Ulnar neuritis

The ulnar nerve wraps around the bony bump of the elbow. It is the largest unprotected nerve in the body. Pain here can seem like a shock — it’s the sensitive area we call the “funny bone.” Ulnar neuritis comes when the snapping motion of pitching irritates the nerve. This may be due to your arm angle as your arm goes from being cocked back to accelerating toward the plate.

Shoulder injuries for pitchers

Proper mechanics can help prevent pitching arm injuries.

Your shoulder may not have to snap forward quite like your elbow does for each pitch, but it does extend and constrict in ways that can cause tendinitis, tears and other injuries.

SLAP tears

It’s been called the most feared injury in baseball. Your biceps attaches to your labrum at two points. A SLAP tear (the acronym stands for “superior labrum anterior to posterior”) is a rip to both of those attachment points. This is often an overuse injury that develops over time.

Biceps tendinitis and tears

Your pitching motion can put a repeated strain on your biceps tendon, which leads up to your shoulder, and it can irritate the tendon enough to form tendinitis. This creates pain and weakness in the front of the shoulder. In severe cases, the tendinitis worsens until the tendon tears — creating a sharp pain, sometimes accompanied by a snapping sound, in the upper arm.

Rotator cuff tendinitis and tears

As it does with the bicep tendon, the repeated motion of pitching can cause irritation in the rotator cuff, the foursome of muscles between your collarbone and your arm. Tendinitis in this spot can be felt both during pitching and at rest, depending on severity. It can also limit the shoulder’s range of motion. When any one of the rotator cuff’s tendons begin to fray, the likelihood of a full tear goes up.

Internal impingement

Another rotator cuff injury comes about from elevating your arm as you likely do when you go from your wind-up to cocking the baseball. This motion narrows the gap between your rotator cuff and your shoulder blade, and it creates a painful rub, or impingement. Without treatment, this injury can develop into a tear.

Glenohumeral internal rotation deficit (GIRD)

Your pitching motion requires you to rotate your arm abnormally fast and abnormally far from your torso. To do this, the ligaments at the front of your shoulder have to be loose. This makes many pitchers experience a bizarre phenomenon: your back shoulder ligaments become less flexible, and the stiffness there limits your range of motion. The issue, GIRD (glenohumeral internal rotation deficit) is more of a condition than an injury. Back shoulder stiffness does, however, boost your chances of labral or rotator cuff tears.

How to prevent pitching injuries

A baseball on a pitcher's mound. Practicing the right mechanics can prevent pitching injuries.

Limit the pitch count

Many of the pitching arm injuries mentioned above are a result of overuse. The MLB offers a list of recommended pitch counts for youth pitchers. Follow these guidelines to reduce your child’s risk for overuse injuries.

Learn proper mechanics

Along with overuse, poor mechanics is a leading cause of pitching injuries in children. Poor mechanics can lead to increased stress on the throwing arm. Every pitcher has his or her own style. However, there are some core mechanical elements that must be kept to prevent injury.

Conditioning and strength training

Conditioning helps prevent arm injuries. Pitchers should be working on building strength in their shoulder, back and leg muscles. Strength in these areas help reduce the amount of strain put on ligaments and tendons during the pitching motion.

Rest in the offseason

Even the pros take a break. Studies of elbow injuries in high school pitchers recommend that pitchers should not compete for more than 9 months in a year. 3 months of rest from any sort of overhand throwing is also recommended.2

How Motus can help

If you fear that you experienced one of these injuries, don’t let it worsen. If you don’t address pain in your arm, you could be headed for a serious injury. Talk with a specialist to find the best treatment plan so you can recover, retake the mound and dominate batters again. Contact us for more information on treating a sore pitching arm.




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