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Summer is here, with all it’s outdoor activities and sports. Injuries associated with sports can be prevented with attention to proper form and warm-ups. To play strong all season long, here is what you need to know about repetitive throwing injuries: causes, associated conditions, and prevention.

Repetitive Throwing Injuries

doctor helping elbowRepetitive throwing in some cases can be detrimental to the shoulder and elbow in all age groups. This includes the professional athlete as well as the ‘Little Leaguer’. Throwing too frequently in the growing athlete can result in permanent damage that can slow down or possibly end a playing career. Injuries to the young shoulder can include tendonitis, fractures, injuries to the growth plate, and damage to bone circulation. Often muscle imbalance is a factor that can reduce performance and lead to permanent damage. 

Although throwing injuries in the elbow most commonly occur in pitchers, they can be seen in any athlete who participates in repetitive overhand throwing. Other associated injuries such as Achilles tendonitis, low back strain, and hamstring strain can also disrupt the rhythm necessary for effective pitching and increase the potential for injury. A comprehensive approach to training can help prevent problems. It must include proper flexibility exercises and cardiopulmonary endurance training.  Additionally, properly supervised strength training for the lower extremities, trunk, shoulders, elbows, and wrists is recommended. 

Shoulder Injuries

Your shoulder relies on strong tendons and muscles to keep your shoulder stable. Some of these muscles are called the rotator cuff. The rotator cuff is made up of four muscles that come together as tendons to form a covering or cuff of tissue around the head of the humerus. Because of the nature of sports such as baseball, volleyball, tennis, and even track and field, athletes challenge the stability of their shoulders though repetitive overhand activity. Some of the common shoulder injuries in throwing athletes are:

  • Rotator Cuff Tendinitis and Tears Throwing athletes place tremendous performance expectations on their shoulders, particularly on the rotator cuff. Initially many athletes may dismiss beginning symptoms because they are typically mild, involving minor pain during activity or rest. When the rotator cuff tendons are overworked, they become irritated and inflamed. As tendinitis progresses, the tendons are worn down, often resulting in fraying. When unaddressed, damage may continue to the point of a tear.
  • SLAP Tears

A SLAP Tear injury involves the top section of the labrum, which is the cup-shaped cartilage rim that lines and reinforces the ball and socket joint of the shoulder. This injury is             common among throwing athletes because it typically caused by repetitive shoulder motion. While rapid overheard movement is the usual culprit, this injury can also develop over time as a   result of straining, tearing or fraying the labrum (or naturally through the aging process). Pitchers are particularly susceptible to SLAP Tears.

Internal impingement is often called “The Thrower’s Shoulder”, and primarily affects the younger athletes. During the “cocking” phase of throwing (like that of a baseball pitcher), internal impingement occurs. As the athlete cocks their shoulder and arm back, the rotator cuff tendons get pinched between the glenoid labrum and the humeral head. With time, this may lead to a partial rotator cuff tendon tear, or it may damage the labrum.

If you feel you need an evaluation for a shoulder injury, please contact KSF Orthopaedic  Center at (281)440-6960 and schedule an appointment with Dr. Michael George.

‘Little League’ Elbow

“Little League Elbow” may refer to a variety of painful conditions in the growing elbow. The acceleration and follow-through phases of pitching place great stress on the elbow and can result in a variety of injuries. When athletes throw repeatedly at high speed, the repetitive stresses can lead to a wide range of overuse injuries. Problems most often occur at the inside of the elbow because considerable force is concentrated over the inner elbow during throwing. These can include stress injuries of the medial epicondyle epiphysis (bony growth center area where muscles and ligaments attach medially at the elbow). Several muscles, nerves, and tendons (connective tissues between muscles and bones) cross at the elbow. The flexor/pronator muscles of the forearm and wrist begin at the elbow, and are also important stabilizers of the elbow during throwing. Injuries here involve the bone and/or ligament and usually occur as an acute injury or an acute episode of pain. Occasionally surgical repair of the bone or ligament avulsion is indicated but rest alone suffices in many cases. The most common elbow injuries associated with throwing include:

  • Flexor Tendinitis

    Repetitive throwing can irritate and inflame the flexor/pronator tendons where they attach to the humerus bone on the inner side of the elbow. Athletes will have pain on the inside of the elbow when throwing, and if the tendinitis is severe, pain will also occur during rest.

  • Ulnar Collateral Ligament (UCL) Injury

    The ulnar collateral ligament (UCL) is the most commonly injured ligament in throwers. Injuries of the UCL can range from minor damage and inflammation to a complete tear of the ligament. Athletes will have pain on the inside of the elbow, and frequently notice decreased throwing velocity.

  • Valgus Extension Overload (VEO)

    During the throwing motion, the olecranon and humerus bones are twisted and forced against each other. Over time, this can lead to valgus extension overload (VEO), a condition in which the protective cartilage on the olecranon is worn away and abnormal overgrowth of bone — called bone spurs or osteophytes — develop. Athletes with VEO experience swelling and pain at the site of maximum contact between the bones.

    If you feel you have an elbow injury that needs evaluation, please call KSF Orthopaedic Center at (281) 440-6960 and schedule an appointment with Dr. Melissa Arief.


In summary, injuries to the growing shoulder and elbow can often be prevented. Proper muscle conditioning and stretching, as well as attention to sound throwing mechanics can help prevent injury.  Attention to sound instruction on pitching mechanics balanced with limitations on pitching frequency in games and practices are a start. Equally important is a proper program of total body conditioning to include flexibility and balanced strength training. 






This website may contain general information relating to various medical conditions and their treatment. Such information is provided for informational purposes only and is not meant to be a substitute for advice provided by a doctor or other qualified healthcare professional. Patients should not use the information contained herein for diagnosing a health or fitness problem or disease. Patients should always consult with a  doctor or other healthcare professional for medical advice or information about diagnosing and treatment. 

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