Take Me out to the Ball Game


Take Me out to the Ball Game

It’s time for peanuts and cracker jacks, with America’s favorite pastime, baseball, just getting going this month. Whether you are a Little League player, professional player, coach, or a dad looking to play catch with your child, ProEx would like to offer you an introduction to the common shoulder and elbow throwing injuries experienced in baseball, in addition to some tips for preventing injury while participating in the sport.

Anatomy of the Shoulder

The humerus (upper arm that has the “ball” side of the joint), scapula (shoulder blade that has the “socket” side of the joint) and clavicle (collarbone) make up the bony anatomy of the shoulder. By design, this “ball and socket” joint has a great degree of motion to allow us to do many things with our hands like reach, push, pull, eat and throw a ball. As a result of this excessive range of motion that we have with this joint, a variety of injuries can occur, affecting both the shoulder and elbow.  The rotator cuff is a group of 4 small muscles that help keep the shoulder “stable” and keeps the ball smoothly spinning in the socket when we use our hands for activities such as throwing. The 4 rotator cuff muscles are the subscapularis, infraspinatus, teres minor, and the most common one for injuries, the supraspinatus. In addition to the ligaments around the shoulder there is a small rim of cartilage (called the labrum) around the socket that gives the shoulder joint stability.

Common Injuries

• Tendinitis - inflammation of a tendon (the fibrous end part of a muscle that attaches muscle to the bone)
• Sprain - injury to a ligament (strong fibrous tissue that holds bones of a joint together)
• Strain - injury to a muscle or tendon
• Tear - complete rupture of a soft tissue (muscle/tendon, cartilage, or ligament) that may result in need for surgery
• Instability - looseness (laxity) of the shoulder joint
• Subluxation - shoulder slides out of joint and returns back to it’s original position
• Dislocation - shoulder remains out of the joint until put back into place by a medical professional

Tommy John Surgery

Throwing hard or with abnormal mechanics (i.e. curve balls) can put a tremendous amount of stress on the inside of the elbow. One of the major stabilizing ligaments of the elbow is the ulnar collateral ligament (UCL). Continued stress to the UCL can result in a sprain, or tear (partial or complete). A complete tear of this ligament may result in the need for reconstructive surgery, also known as Tommy John Surgery.

Youth Pitchers

Most injuries to young throwing athletes affect the muscles/tendons, where the tendon attaches to the bone and the adjacent growth plates of the highly stressed area. Avoiding high pitch counts decreases the chance of injury, so it is important to maintain pitch counts. Recommendations for pitch count for youth pitchers are: 50-75 pitches per game, 75-100 pitches per week, not to exceed 1000 pitches per season. The throwing of various pitches should be avoided until skeletal maturity increases, and once a variety of pitches is utilized, decreasing the number of breaking pitches such as curves and sliders may decrease risk of injury.


The best treatment for any shoulder and elbow injury is early recognition. Pain will present, followed by a decrease in throwing accuracy, velocity, and stamina. Initially the treatment for any injury should be rest then evaluation and treatment by a sports medicine professional.

Returning to baseball activities after injury

When returning after injury, it is important to begin with a pain-free and gradual increase of throwing activities. It is ideal to start at a throwing distance of 30 feet, increasing the distance by 15 foot intervals when appropriate. Focus on proper throwing and pitching mechanics, and if possible, work with a coach or specialist who can observe and correct your mechanics. Full body stretches, with an emphasis on the shoulder, elbow, and forearm should be performed before and after activity.

Tips for Coaches and Dads

Remember, throwing is very strenuous on the shoulder, specifically your rotator cuff muscles/tendons. It is important to gradually work into throwing (warm up) with short distances and slower velocity and then increase the distance and velocity. Mixing up your throws to your players or child can help too. For example, make sure you do some grounders and “pop ups” during your practice sessions. It is much less stressful on the shoulder to throw pop ups under hand so keep this in mind next time you are playing catch. If you experience shoulder pain then stop and take a break. If it persists then see a sports medicine professional. It also may be a good idea to see a physical therapist and get some shoulder stretching and rotator cuff strengthening exercises. Remember, if you take care of your shoulder you can enjoy many years of coaching or playing ball with your children!

 The content on this page is intended to provide information to the general public in regards to care of acute injuries. It is meant to supplementand not replace the the advice of medical professionals. In the event of an injury or illness you should always consult your physician and discuss options and treatment pertinent to your individual case.

Take Me out to the Ball Game