With baseball season underway, orthopedic specialists at Rush University Medical Center in Chicago are urging players, parents and coaches to take precautions against throwing injuries in young pitchers.

"Throwing a baseball is one of the fastest and most violent maneuvers that any joint in the body is subjected to. The violent and rapid motion places numerous structures in the shoulder at risk for injury," cautions Dr. Shane Seroyer, sports medicine fellow at Rush and lead author of a report on pitching injuries published in the latest issue of the journal Sports Health.

"Attention to throwing mechanics and appropriate stretching, strength and conditioning programs may reduce the risk of injury in this highly demanding activity," Seroyer and colleagues note in their report.

Another way to cut the risk of injury to pitchers, especially young pitchers, is to limit the number and types of pitches they throw.

"For pitchers under 14 years old, we encourage fast ball and change-up pitches and discourage the use of a curveball to prevent injury," said Dr. Charles Bush-Joseph, sports medicine specialist at Rush and a co-author of the report said in a prepared statement.

Only when a young pitcher reaches age 14 should he begin throwing a curveball pitch, the authors advise, and it's best to wait until age 17 to begin throwing a slider pitch.

Nine- and 10-year-old pitchers should throw no more than 50 pitches per game and 75 pitches per week, Seroyer and Bush-Joseph say. Eleven- and 12-year-olds should throw no more than 75 pitches per game and 100 pitches per week. For 13- to 14-year olds, the maximum number should be 75 pitches per game and 125 pitches per week.

Injury or tears to cartilage that surrounds the shoulder joint are among the most common injuries for pitchers and generally result from the cocking and acceleration phases of overhead throwing. Cartilage also wears down with age and overuse.

Damage to the rotator cuff — the group of muscles and their tendons that stabilize the shoulder — can also occur and can lead to tendonitis and muscle tears. Although one specific movement could cause injury to the rotator cuff, this type of injury is often the result of the "wear and tear" from the overhead throwing motion.

Another type of injury seen in baseball pitchers is "impingement" resulting from pressure on the rotator cuff from part of the shoulder blade as the arm is lifted. Impingement can cause local swelling and tenderness in the front of the shoulder, and pain and stiffness may be felt when the arm is lifted or lowered from an elevated position.

Early identification of a pitching injury, or symptoms suggestive of an injury, followed by conservative management with rest and rehabilitation, can help to decrease the need for surgery down the road, Seroyer, Bush-Joseph, and colleagues emphasize.