American Academy of Orthopaedic Surgeons
Position Statement

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The Risks of Shoulder and Elbow Injury from Participation in Youth Baseball

The American Academy of Orthopaedic Surgeons believes that parents should be informed about the risks and injuries which occur in youth baseball as a result of excessive throwing, and strongly urges compliance with the recommendations for throwing restriction in youth baseball to minimize such injuries.

More than 4.6 million children in the United States play youth baseball under the supervision of adult coaches, administrators and parents. More than 30 years ago, physicians recognized the risk to the upper extremity, particularly the shoulder and elbow, in the growing child. These significant risks include pain which limits activity, loss of motion and strength, damage to the growth centers of the shoulder and elbow, and other X-ray changes that may be permanent.

A number of studies have documented 20 percent of children eight to 12 years of age and 45 percent of those 13 to 14 years of age will have arm pain during a single youth baseball season. Documentation of these injuries resulted in the institution of rules by youth baseball in the United States which control the number of innings pitched by an individual player. These rules allow the player to pitch from four to 10 innings per week as a maximum. In spite of these rules, there are growing concerns that parents and coaches avoid these restrictions by allowing children to play on multiple teams or in multiple leagues.

The American Academy of Orthopaedic Surgeons recommends the following safety guidelines to decrease the risk of injury to the upper extremity in the growing athlete who participates in youth baseball:

• Follow the guidelines about the number of innings pitched as specified by the individualís baseball association (a maximum of four to 10 innings a week) not by the number of teams played on.
• While there is no concrete guideline for the number of pitches allowed, a reasonable approach is to count the number of pitches thrown and use 80 to 100 pitches as a maximum in a game, and 30 to 40 pitches in a practice.
• Any persistent pain, loss of motion (especially extension) or documented X-ray abnormalities should disqualify a child from playing until these findings abate or are clarified by a physician.
• Coaches and players in youth baseball should be taught proper throwing technique.
• Coaches should educate players to the importance of and techniques for stretching and strengthening the upper extremity.
  

© May 1997 American Academy of Orthopaedic Surgeons
This material may not be modified without the express written permission of the American Academy of Orthopaedic Surgeons.

Document Number: 1141

For additional information, contact Alvin Nagelberg at (847) 384-4138 or email nagelberg@mac.aaos.org