The number of skeletally immature athletes participating in organized sport is near an all-time high. For nearly half a century, the medical community has investigated the link between shoulder and elbow injuries with repetitive throwing. Despite substantial literature and research, several controversies still exist, including when to begin throwing breaking pitches. Furthermore, despite introduction of pitch recommendations for youth baseball, misconceptions, poor understanding of, and adherence to these guidelines persist. High-velocity and high-volume throwing and throwing while fatigued are significant risk factors for injury. Improved awareness and adherence to throwing guidelines should limit the number of injuries. Proper identification and treatment of injuries when they do occur can allow our skeletally immature athletes to safely return to overhead sports activities.
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