ARM STRAIN, FOREARM
DEFINITION--Injury to the muscles or tendons connected to the bones in the lower arm. Forearm strain is common because of the many tendons that glide together in the same or separate sheaths. Muscles, tendons and bones comprise units. These units stabilize the elbow and wrist joints and allow their motion. A strain occurs at the weakest part of a unit. Strains are of 3 types:Mild (Grade I)--Slightly pulled muscle without tearing of muscle or tendon fibers. There is no loss of strength.
Moderate (Grade II)--Tearing of fibers in a muscle, tendon or at the attachment to bone. Strength is diminished.
Severe (Grade III)--Rupture of the muscle-tendon-bone attachment with separation of fibers. Severe strain requires surgical repair. Chronic strains are caused by overuse. Acute strains are caused by direct injury or overstress.
BODY PARTS INVOLVED
Muscles and tendons of the forearm.
Ulna and radius, the bones attached to lower-arm muscles and tendons.
Soft tissue surrounding the strain including nerves, periosteum (covering to bone), blood vessels and lymph vessels.
SIGNS & SYMPTOMS
Pain when moving or stretching the forearm.
Muscle spasm in the forearm.
Swelling over the injury.
Loss of strength (moderate or severe strain).
Crepitation ("crackling") feeling and sound when the injured area is pressed with fingers.
Calcification of the muscle or tendon (visible with X-rays).
Inflammation of the sheath covering the tendon.
Prolonged overuse of muscle-tendon units in the forearm and wrist.
Single violent injury or force applied to the lower arm.
RISK INCREASES WITH
Contact sports such as football, wrestling or hockey.
Any cardiovascular medical problem that results in decreased circulation.
Medical history of any bleeding disorder.
Previous injury to the forearm, wrist or elbow.
Poor muscle conditioning.
HOW TO PREVENT
Participate in a strengthening and conditioning program appropriate for your sport.
Warm up before practice or competition.
Decrease repetitive forearm and hand movements when pain or soreness begins.
Use proper protective equipment.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Application of tape, plaster splints or casts (sometimes).
Self-care during rehabilitation.
Physical therapy (moderate or severe strain).
Surgery (severe strain).
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the forearm, wrist and elbow to rule out fractures.
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
Unstable or arthritic elbow or wrist following repeated injury.
Inflammation at the attachment to bone (periostitis).
Prolonged disability (sometimes).
PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Torn ligaments and tendons require as long to heal as fractured bones do. Average healing times are:
Mild strain--2 to 10 days.
Moderate strain--10 days to 6 weeks.
Severe strain--6 to 10 weeks. If this is a repeat injury, complications listed above are more likely to occur.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDFollow instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
IF CASTS OR SPLINTS ARE NECESSARY:
Keep fingers free and exercise them frequently.
Begin daily rehabilitation exercises when casts or splints are no longer needed. Use ice massage for 10 minutes prior to exercise.
See Appendix 2 (Care of Casts).
IF CAST OR SPLINTS ARE NOT NECESSARY:
Use ice massage 3 or 4 times a day for 15 minutes at a time. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
After the first 24 hours, apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Wrap the injured forearm with an elasticized bandage between treatments.
Begin daily rehabilitation exercises when supportive wrapping is no longer needed. Use ice massage for 10 minutes prior to exercise.
Massage gently and often to provide comfort and decrease swelling.
For minor discomfort, you may use:
Aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger pain relievers.
Injection of a long-acting local anesthetic to reduce pain (rare).
Injections of a corticosteroid, such as triamcinolone, to reduce inflammation (rare).
For a moderate or severe strain, use a sling for at least 72 hours--longer with a cast or splints.
Resume your normal activities gradually.
DIETEat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONSee section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a moderate or severe forearm strain, or a mild strain persists longer than 10 days.
Pain or swelling worsens despite treatment.
The following occurs with a cast or splints:
Pain, numbness or coldness below the injury.
Dusky, blue or gray fingernails.