Little League Shoulder (Proximal Humeral Epiphysitis)

“Little League Shoulder” (Proximal Humeral Epiphysitis) is pain in the upper arm or shoulder. The upper arm bone is called the humerus. In a child, the bones grow from areas called growth plates. The growth plate is made up of cartilage cells, which are softer and more vulnerable to injury than mature bones. There is a growth plate at the part of the humerus closest to the shoulder. In Little League Shoulder, the growth plate is irritated or inflamed.

It usually gets better if properly treated, but if ignored, can limit a young athlete’s throwing career and cause chronic shoulder pain as an adult.

Why Does Little League Shoulder Happen?

Little League Shoulder is caused by lots of throwing. Repetitive throwing puts stress on the growth plate, and the growth plate becomes irritated. In severe cases, the stress may lead to a small break in the growth plate.

It occurs most often in pitchers but can occur in other baseball players and other athletes who do repetitive overhead movements with their arms, such as tennis and volleyball players.

What Are the Signs of Little League Shoulder?

Your child will have shoulder pain when throwing. He or she may be sore for a few days afterward. You may notice that his or her pitches are slower or less controlled. There may be swelling or tenderness around the upper arm or shoulder.

How Is Little League Shoulder Diagnosed?

Your doctor will examine your child’s shoulder and arm. There may be tenderness along the upper arm or shoulder. X-Rays may show widening or a break in the growth plate.

How Is Little League Shoulder Treated?

The most effective treatment for Little League Shoulder is rest from throwing so that the growth plate can heal. Your child may need physical therapy to improve strength in their shoulder muscles and prevent re-injury.

Little League Shoulder usually gets better if properly treated, but if ignored, can limit a young athlete’s throwing career and cause chronic shoulder pain as an adult.

When Can My Child Return to His or Her Activity After Little League Shoulder?

The goal is to return your child to his or her sport as quickly and safely as possible. If your child returns to play too early or plays with pain, he or she is at risk for chronic shoulder injury. Your child will be allowed to throw again when he or she has full strength and a full range of motion in the shoulder. He or she should not have any pain when throwing. Once the shoulder has healed, your child should slowly increase the number, speed, and distance of throws under the guidance of a qualified professional such as a physical therapist or athletic trainer. Your child should stop throwing if the shoulder becomes painful.

How Can Little League Shoulder Be Prevented?

The best way to prevent Little League Shoulder is to follow recommended guidelines for appropriate pitch count limits and proper rest between pitching appearances.

Most importantly, remember that children should not play through pain.

All pitchers should have rest periods between pitching appearances:

For pitchers age 7 to 16:

Pitches in a day

Rest time

61 or more

4 days


3 days


2 days


1 day


For pitchers age 17 to 18:

Pitches in a day 

Rest time

76 or more

4 days


2 days


3 days


1 day

Source: Little League International, 2006

Download a PDF of this information: English | Español

Related Specialties