With a rise in pediatric sports participation and single-sport specialization over the past three decades, there has been a steady increase in the number of acute and overuse injuries seen in adolescent throwing athletes. The repetitive forces experienced by the elbow of a skeletally immature pitcher predispose a unique subset of injuries, which has been referred to as “little league elbow.” These injuries present significant diagnostic and treatment challenges. Judicious use of surgical intervention when required can prevent undesired outcomes and allow successful return to play. Overuse has been identified as a risk factor for pediatric elbow injuries in pitchers and has likely contributed to the recent rise in prevalence. Biomechanical and epidemiological studies have supported the use of pitching guidelines to diminish this rapidly increasing problem for youth athletes.