Repetitive overhead throwing exerts significant mechanical stress on the shoulder and elbow joint; this stress can lead to developmental anatomic changes in the young thrower. Asymptomatic pathology in the shoulder and elbow joint is prevalent and, with overuse, can progress to disabling injury. Joint injury occurs as a result of the body's inability to properly coordinate motion segments during the pitching delivery, leading to further structural damage. Identifying and preventing overuse is the key to avoiding injury, particularly in the young pitcher. Injury prevention and rehabilitation should center on optimizing pitching mechanics, core strength, scapular control, and joint range of motion.