Youth baseball injury guide

What is a Tommy John injury?

• The ulnar collateral ligament, or UCL, stabilizes the inside of the elbow during throwing. Repetitive stress can stretch or tear the ligament.
• Common symptoms: pain on the inside of the elbow, loss of velocity or throwing control, pain with acceleration or release, a pop followed by immediate pain, and tingling into the ring or small finger.

Tommy John refers to both the injury and the reconstruction surgery. Not every UCL injury requires surgery.

Common youth baseball injuries beyond the UCL

• Little League elbow: overuse irritation or injury near the inner elbow growth plate.
• Little League shoulder: stress injury to the upper arm growth plate from repetitive throwing.
• Rotator cuff irritation: shoulder pain, weakness or fatigue during repetitive throwing.
• Flexor strain: pain in the muscles and tendons that support the inner elbow.
• Wrist and hand injuries: jammed fingers, sprains, fractures and impact injuries.
• Lower-body injuries: ankle sprains, knee pain and hamstring strains affect the entire kinetic chain.

Why overuse matters

• Young athletes are still growing. Repetitive throwing without sufficient rest can overload the elbow and shoulder before the body fully recovers.
• Track workload across every team. League play, travel ball, showcases, private instruction and bullpen sessions all count.

Protective habits

• Follow age-based pitch-count and required-rest guidelines.
• Stop pitching when mechanics change or fatigue appears.
• Take at least four months away from throwing each year for most youth age groups.
• Avoid playing for multiple teams at the same time.
• Do not pitch through elbow or shoulder pain.
• Warm up gradually and build preseason throwing volume.
• Strengthen the legs, core, back and shoulder complex.
• Encourage participation in other sports.

Daily pitch-count limits vary by age. Use MLB Pitch Smart or your league's approved guidelines and track pitches across all teams and events.

Know the warning signs: when arm pain is not just soreness

• Persistent inner elbow pain, especially during or after throwing.
• Loss of velocity or control, a sudden or progressive drop in performance.
• Difficulty straightening the arm, with stiffness, swelling or reduced range of motion.
• Popping, tingling or numbness, especially into the ring or small finger.

Stop throwing and schedule an evaluation. Early assessment may prevent a minor problem from becoming a season-ending injury.

SLMA sports medicine services

• Injury evaluation and diagnosis
• Non-surgical treatment and rehabilitation
• Return-to-play planning
• Sports physicals and injury prevention

Joseph M. Garcia, MD, is board certified in Family Medicine and in Primary Care Sports Medicine.