Written by the Phoenix Rehab physiotherapy and hand therapy teams. Clinically reviewed by Louise Yow, Principal Physiotherapist & Director, AHPC A1300363H; hand, wrist and elbow sections by Nigel Chua, Principal Hand Occupational Therapist & Director, AHPC A1300362Z. Last reviewed 6 October 2026.
Most baseball and softball injuries we see are in the throwing arm, at the shoulder and the inner elbow, followed by fingers and hands from fielding, batting and sliding. The movement behind most of them is the throw, repeated, often at full effort after a week of no throwing at all.
Many adult players in Singapore throw once a week. Saturday league game, Sunday practice at the field, then nothing until the next weekend. The arm is asked for a hundred throws, some of them hard, without the days of lighter throwing in between that a pitcher on a team schedule gets.
The throw puts the shoulder at the edge of its range and then whips it forward. The inner elbow takes the strain in between. A study of Major League Baseball found upper-limb injuries more common in pitchers than in position players.1 In softball, the windmill pitch loads the front of the shoulder instead, where the biceps tendon runs.
Then there is everything else. The ball that hits the end of a finger. The head-first slide. The catcher who squats more than a hundred times a game. The bat handle against the heel of the hand on every swing. Each of these has its own injury, and they are all below.
The movements, and what they load
| Movement | What it loads | What it most often irritates |
|---|---|---|
| Overhand pitching and throwing | Shoulder at the end of its range, inner elbow | Rotator cuff, the labrum, the inner elbow ligament, the back of the elbow |
| Windmill pitching (softball) | Front of the shoulder, biceps | The biceps tendon at the front of the shoulder |
| Batting | Trunk rotation, lead wrist, the heel of the bottom hand | Side strain, lower back, the hook of the hamate bone in the palm |
| Catching behind the plate | Knees in a deep squat, the palm of the glove hand | Meniscus, front of the knee, the palm and its blood vessels |
| Fielding | Fingers meeting the ball | Jammed fingers, mallet finger, finger fractures |
| Base running and sliding | Hamstrings, knees, ankles, an outstretched thumb | Hamstring strain, ACL, ankle sprain, the thumb ligament |
Every baseball and softball injury, by body part
Start from where it hurts. Each linked row goes to the page that covers that injury in full.
| Where | Injury | How baseball or softball usually causes it |
|---|---|---|
| Hand and finger | Catcher’s palm (hypothenar hammer syndrome) | Pitches landing in the catcher’s glove, on the heel of the hand, game after game |
| Hand and finger | Mallet finger | The ball striking the end of a straight finger |
| Hand and finger | Jammed finger (PIP sprain or volar plate injury) | Fielding a ball that bends the middle finger joint back |
| Hand and finger | Finger fracture | Fielding, or a hand caught under you in a head-first slide |
| Hand and finger | Thumb ligament tear (skier’s or gamekeeper’s thumb) | A head-first slide that bends the thumb back on the base |
| Wrist | Hook of hamate fracture | The bat handle driven into the heel of the bottom hand on a swing |
| Wrist | Scaphoid fracture | A slide or a fall onto an outstretched hand |
| Elbow | Inner elbow ligament sprain or tear (UCL) | The pitching arm, as the elbow bends outward under load in the throw |
| Elbow | Back of the elbow impingement (valgus extension overload) | The elbow snapping straight at the end of every pitch |
| Elbow | Outer elbow cartilage injury in young pitchers (capitellar OCD) | Repeated pitching in growing players |
| Elbow | Ulnar nerve irritation (cubital tunnel syndrome) | The nerve on the inner elbow stretched with every throw |
| Elbow | Inner elbow tendon pain (golfer’s elbow) | Throwing volume |
| Elbow | Olecranon stress or avulsion fracture | The triceps pulling on the point of the elbow in pitchers |
| Shoulder | Internal impingement and lost inward rotation (GIRD) | The arm cocked back before the throw |
| Shoulder | SLAP (labral) tear | Throwing |
| Shoulder | Rotator cuff tendon pain | Throwing volume, and slowing the arm down after release |
| Shoulder | Growth plate stress in young throwers (proximal humeral physeal stress) | Repeated pitching in growing players |
| Shoulder | Shoulder blade control problems (scapular dyskinesis) | Throwing, when the shoulder blade stops keeping up with the arm |
| Shoulder | Biceps tendon pain at the front of the shoulder | Windmill pitching in softball |
| Trunk | Side strain (oblique or rectus abdominis strain) | The swing, or the pitch, rotating hard against the lead side |
| Lower back | Lower back strain | Rotation in the swing, rep after rep in the batting cage |
| Thigh | Hamstring strain | Sprinting from the box to first base |
| Knee | ACL tear | Cutting or stopping hard on the bases |
| Knee | Meniscus tear | The catcher’s deep squat, and twisting up out of it |
| Ankle | Ankle sprain | Sliding into base and catching the foot |
Not on the list, or not sure which row is yours? That is what the first visit is for.
The injuries we see most from baseball and softball
The throwing shoulder
What it feels like. A deep ache at the back or the top of the shoulder as the arm cocks back, or a sharp pain as the ball leaves the hand. Sometimes a catch or a clunk. Often a “dead arm” feeling where the throw just has nothing in it.
What is usually going on. Throwing shoulders gain outward rotation and lose inward rotation over time. When the inward range drops too far, the tendon and the labrum at the back of the shoulder get pinched at full cock (internal impingement). Volume on top of that irritates the rotator cuff. A catching or clunking shoulder can be a SLAP tear.
What we measure. Inward and outward rotation in degrees on both shoulders, and the total arc compared side to side. Rotation strength with a handheld dynamometer. How the shoulder blade moves as the arm goes up.
This week. Count your throws, including warm-up and between innings, and drop the total by about half. Throw at reduced effort until it settles. Build the rotator cuff with light band work on non-throwing days. Pain relief and anti-inflammatory medication are a decision for your doctor or pharmacist.
The inner elbow
What it feels like. Pain on the inside of the elbow during the throw, worst just as the arm comes forward. Sometimes tingling into the ring and little fingers.
What is usually going on. Every overhand throw bends the elbow outward under load. The ligament on the inside (the UCL) resists that, and the tendons of the forearm help it. Over-volume irritates the tendons first (golfer’s elbow). The ulnar nerve runs right beside the ligament, which is why tingling can come with it (cubital tunnel). A sudden pop with pain on one throw is a different story, and sits under “When to see a doctor first”.
What we measure. Grip strength in kilograms against the other hand, pain on resisted wrist and finger bending, elbow range, nerve sensation in the ring and little fingers, and how many throws at what effort bring the pain on.
This week. Stop pitching and stop long throws. Keep the forearm working with grip and wrist exercises that do not hurt. Tingling that stays after you stop throwing needs a look.
Fingers: jammed, dropped and broken
What it feels like. A swollen middle finger joint after a ball came off the glove. Or a fingertip that droops and will not straighten on its own.
What is usually going on. A ball that bends the middle joint backward strains the plate of tissue on its palm side (volar plate injury). A ball that strikes the end of a straight finger can pull the tendon off the last bone (mallet finger). Both get taped and played on more often than they should.
What we measure. Range at each finger joint in degrees, the angle of any droop at the tip, swelling, and grip strength. Our hand therapists make the splint for a mallet finger and check its fit each visit, because the tip has to stay straight the whole time it is healing.
This week. A drooping fingertip needs a doctor and a splint in the first days. A jammed finger that is still swollen after a week is worth having checked. Buddy taping protects it while you play.
Pain in the heel of the hand after batting
What it feels like. Pain at the base of the palm on the little-finger side, on the bottom hand, that started with one swing or a foul tip. Gripping the bat hurts. It can feel like a bruise that will not settle.
What is usually going on. A small hook of bone in the palm (the hook of the hamate) sits right where the bat handle presses. A hard swing can crack it. It is easy to miss on a first look, so the pattern of symptoms matters. Catchers get a different palm problem: repeated pitches into the glove can damage the blood vessel at the heel of the hand (hypothenar hammer syndrome), with cold or color-changing fingers.
What we measure. We press over the hook of the hamate and test grip. If the pattern fits, we send you to a doctor before we treat it.
This week. Stop batting. Fingers that turn white, blue or cold need a doctor.
Side strain from the swing
What it feels like. A sharp pain low on the side of the trunk, usually on the side facing the pitcher, during a swing. Coughing, laughing and getting out of bed hurt for days.
What is usually going on. The swing and the pitch both rotate the trunk hard while the lead side braces. The muscles of the side and the front of the abdomen take the stretch and can tear.
What we measure. Trunk rotation range each way, strength on side planks against the other side, and which part of the swing still hurts.
This week. No swinging at full effort. Walk, keep the trunk moving gently, and start rotation with dry swings at half effort once laughing and coughing stop hurting.
Back to full play on tests, not dates
The next league game is a date. It does not tell you whether the arm is ready. Before full play, we look for these:
- Throwing. Inward and outward rotation strength within 10% of the other side, and total rotation arc within 5 degrees of the other side. Then a staged throwing program: short distance at low effort, then longer, then harder, with no pain during or the next morning.
- Pitching. Comes back after position throwing is fully tolerated, with a pitch count that builds over several weeks.
- Batting. Grip strength within 10% of the other hand, no pain on pressure over the palm, and full-effort swings off a tee before live pitching.
- Running the bases. Hamstring strength against the other side and repeated sprints at full speed without symptoms.
- Fingers. A mallet finger stays splinted for the full period your doctor and hand therapist set, then returns to catching in steps.
Pain is the first thing to leave. Strength is the last to train and recover.
Is this normal?
Usually expected: general soreness in the shoulder and forearm muscles 24 to 48 hours after the first hard throwing day of the season, on the throwing side, that eases with light movement.
Worth getting checked: pain at one spot that is there at the start of the next game, a throw that has lost speed or accuracy, tingling into the fingers, or a finger that is still swollen a week later.
When to see a doctor first
- Call 995 if a player collapses after being hit in the chest by a ball. Start CPR and use the nearest AED. Also call 995 for a head strike followed by loss of consciousness, a seizure, repeated vomiting or confusion.
- Go to the emergency department now for a shoulder, elbow or finger that looks out of place, or a fall onto the arm with deformity.
- See a doctor the same day for a fingertip that droops and will not straighten on its own after a ball strike, a sudden pop on the inside of the elbow during a throw, pain at the base of the thumb after a fall onto the hand, pain in the heel of the hand that started with one swing and is sharp to press, fingers that turn white, blue or cold, or any head knock in the game. A player with a suspected concussion stops for the day and sees a doctor before playing again.
- See a doctor soon for pain in the heel of the hand that builds over weeks of batting, tingling into the ring and little fingers that stays, or elbow or shoulder pain in a young pitcher that does not settle with rest from throwing.
Questions people ask
What are the most common baseball and softball injuries?
Most baseball and softball injuries are in the throwing arm, at the shoulder and the inner elbow. Fingers and hands come next, from fielding, batting and sliding. In softball, the windmill pitch loads the biceps tendon at the front of the shoulder. Hamstring, knee and ankle injuries come from running the bases.
What our patients say
Google reviews from our clinics in Singapore.
Why does the inside of my elbow hurt when I throw?
Every overhand throw bends the elbow outward under load. The ligament on the inside of the elbow, the UCL, resists that, with help from the forearm tendons. Too much throwing irritates the tendons first. The ulnar nerve runs beside the ligament, so tingling into the ring and little fingers can come with it.
What is a hook of hamate fracture?
The hook of the hamate is a small hook of bone in the palm, on the little-finger side, right where the bat handle presses on the bottom hand. A hard swing or a foul tip can crack it, and gripping the bat then hurts. It is easy to miss on a first look, and a doctor diagnoses it.
When can I throw again after a shoulder or elbow injury?
Throwing returns on tests rather than dates. Shoulder rotation strength and range are compared with the other side first. A staged throwing program then starts at short distance and low effort, moving to longer and harder throws only with no pain during or the next morning. Pitching comes back after position throwing.
Where are you with this right now?
1. It is settling on its own
If it eases week by week while you throw less and at lower effort, you are on the right road. Build the throws back in small steps, distance first and effort last. You do not need us for this, and we would rather say so.
2. It has stopped improving
It settles in the week and comes back by the third inning. You have started throwing sidearm to protect it, letting someone else take the long throws, or hitting a few swings short of a full turn. That pattern is usually a strength and range problem, and rest alone rarely changes it. It is worth measuring. If it has been months, the Stalled Recovery Review runs over three weeks with the same therapist.
3. You have had surgery, or you have a date
A shoulder labral repair, an elbow ligament reconstruction, an ACL reconstruction or a finger fracture fixation each has a shape, with protected weeks before throwing or batting comes back. See physiotherapy after surgery, hand therapy after surgery and the recovery programs. All of it runs on the four stages of the Phoenix Recovery Protocol: Calm & Protect, Move & Mobilize, Rebuild & Strengthen, and Return & Perform.
Next step
Find out which stage you are in
Pain is the first thing to leave. Movement and strength are the last things trained back, and most people stop before that part is done. One Assessment and Treatment is a single 45-minute appointment at $230, nett, no GST. Your therapist finds what is actually limiting you, treats it in the same appointment, and you leave with your current stage and a written plan.
Prefer to phone? Each of our five clinics has its own number on the clinics page. No referral needed to book.
Related reading
Sources
- Posner M, Cameron KL, Wolf JM, Belmont PJ, Owens BD. Epidemiology of Major League Baseball injuries. Am J Sports Med. 2011;39(8):1676-1680.
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