Growth-Plate Injuries of the Shoulder and Elbow in Baseball and Softball Players

Growth-Plate Injuries of the Shoulder and Elbow in Baseball and Softball Players


By Dr. John Mishock, PT, DPT, DC 

Are Growth-plate injuries common in youth and adolescent baseball and softball players?

Growth-plate shoulder and elbow injuries are common in youth and adolescent baseball and softball players.  The growth plate (epiphyseal plate or physis) is an area of cartilage at the end of a bone that is responsible for the bone’s growth. The growth plates close after bone growth during maturation. There are two essential growth plates in the arm bone (humerus): one near the shoulder and one near the medial (inside) elbow near the “Tommy John Ligament” (ulnar collateral ligament). Because the growth plate is an open zone of soft cartilage, it is a weak spot vulnerable to injury. The growth plate is often injured in children and adolescents instead of spraining or tearing the “Tommy John Ligament,” as seen in adult baseball throwers.


Overhand throwing, by nature, puts valgus stress on the elbow. Valgus stress is a fancy term that means that the elbow is bending in an unnatural direction in which the forearm (ulna) and arm (humerus) attempt to detach. The 2-inch “Tommy John Ligament” holds the elbow together during this throwing motion.  Forces at the elbow (growth plate and or “Tommy John Ligament”) can reach up to 75% of the pitcher’s body weight during throwing. Overuse or excessive throwing without adequate rest and recovery can lead to pain, growth plate inflammation, adaptive growth plate widening, fragmentation, or avulsion fractures (small pieces of bone rip away).


At the shoulder, the growth-plate injury is felt in the front or outside of the shoulder. In both elbow and shoulder injuries, there is often limited range of motion, weakness, and pain with throwing. Growth-plate injury is diagnosed via medical history, physical exam, and x-ray. X-rays are used to determine if there is growth –plate widening or avulsion fracture.


What is the treatment for growth plate injuries?

Treatment for this injury requires rest and possibly immobilization (sling or casting). Once the growth plate inflammation has reduced, physical therapy is done to reduce pain, restore range of motion, strengthen the surrounding musculature, and begin a progressive baseball throwing program. Ultimately, the physical therapist will guide the patient in their attempt to return to all baseball activities. In extreme cases, the athlete may not be able to return to baseball for up to six months.

How can baseball related arm injuries be prevented?

Early detection of this type of injury is essential to minimize its progression. If a young athlete has pain in the elbow and shoulder, it is essential that the athlete stop all throwing immediately and rest the arm.  


Ideally, the coach or parent would be vigilant in preventing the injury in the first place.  Avoiding fatigue while throwing is the most significant preventable risk factor in reducing all arm injuries. Fatigue is the number one risk factor for an arm injury—an astounding 36 times more likely to develop an arm injury when throwing through fatigue.


Fatigue can be defined in three ways: event fatigue, seasonal fatigue, and year-round fatigue. During a game, it is critical to recognize the pitcher’s signs of fatigue and get that athlete out of the game. Seasonal fatigue can be excessive throwing during a given time period. This is often due to playing on multiple teams. Year-round fatigue is pitching all year without the recommended three months off from throwing.


There is not one way to reduce all baseball-related arm injuries; however, the evidence has shown that arm injuries can be reduced by developing sound, scientifically based pitch mechanics, not allowing pitchers to throw with arm or body fatigue (game, season, or yearly), following pitch count rules, throwing the fastball less than 50% of the time when pitching, and optimizing the mobility, flexibility, strength, and power of crucial throwing muscle groups.

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If pain or limited function limits you from doing the activities you enjoy, call Mishock Physical Therapy for a Free Phone Consultation (610)327-2600.  Email your questions to

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Dr. Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania. He has authored two books; “Fundamental Training Principles: Essential Knowledge for Building the Elite Athlete”, and “The Rubber Arm; Using Science to Increase Pitch Control, Improve Velocity, and Prevent Elbow and Shoulder Injury” both can be bought on Amazon and

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