Forearm pain
Forearm pain is a specific sensation caused by damage to the bones, soft tissues or nerve structures of the forearm. It can be acute, blunt, local, widespread, periodic, constant, pulling, pressing, burning, shooting, aching. Sometimes it has an irradiating character, provoked by injuries, limb overloads and other circumstances. The cause of pain is determined by means of a survey, examination, data from imaging techniques (radiography, CT, MRI), electrophysiological methods. Until the diagnosis is clarified, the arm is provided with rest. Sometimes it is permissible to take analgesics.
Causes of Forearm pain
Traumatic injuries
Inflammatory diseases
Bone infections
Infections of soft tissues and blood vessels
Compression of tissues
Oncological diseases
Neurological causes
Diagnostics
Treatment
Help before diagnosis
Conservative therapy
Surgical treatment
Prices for treatment
Causes of Forearm pain
Traumatic injuries
A bruise occurs due to a fall or a direct blow to the arm, manifested by sharp pain. The intensity of the pain syndrome decreases rapidly, the pain becomes dull, aching, increases during movements, when feeling the forearm. The hand is slightly or moderately swollen, bruising is possible. Movements are somewhat limited due to pain, the function of the limb is usually preserved.
Hematomas on the forearm are rarely formed, as a rule, they are the result of a very strong blow or forced local compression of the limb. They are manifested by constant bursting pain, local dense edema. Subsequently, the pain decreases, a cavity filled with blood forms at the site of edema. Spontaneous resorption of large cavities is uncharacteristic.
Fractures of the forearm bones are characterized by unbearable explosive pain at the time of injury. Then the pain syndrome decreases somewhat, but remains very intense, increases with groping, movements, axial load. The limb swells quickly. Crepitation, deformation, and pathological mobility are often detected. The symptoms differ somewhat depending on the type of lesion:
Fracture of both forearm bones. The pain is diffuse with the involvement of the entire forearm and a maximum at the point of injury. The forearm is deformed, pronounced pathological mobility is revealed, the distal part of the segment easily shifts in relation to the proximal one.
Fracture of the diaphysis of the ulna. The pain is localized mainly on the elbow side (from the side of the 5th finger). On the same side, during examination and palpation, an angular protrusion is often found in the fracture area.
Fracture of the diaphysis of the radius. The pain syndrome is more pronounced on the radial side (side of 1 finger). The forearm is deformed, usually there is pathological mobility. Rotation of the brush is not possible.
Monteggi fracture. The patient complains of pain along the ulnar edge of the forearm and in the ulnar fossa. The forearm is shortened, deformed, in the projection of the fracture of the ulna, a sinking is determined, when trying to bend the elbow joint, a springy resistance occurs.
Galeazzi fracture. The maximum soreness is felt in the lower parts of the forearm and the wrist joint. The forearm is deformed, bulging is detected on the palmar surface of the segment, and a depression is detected on the back.
A beam fracture in a typical place. The patient is concerned about pain in the lower part of the forearm, just above the wrist joint. Possible curvature in the back or palm side.
Forearm pain
Forearm pain
Inflammatory diseases
Myositis of the forearm muscles develops more often after unusual physical exertion – the first classes in the gym, work in the country, etc. It is manifested by aching pain that spreads throughout the entire muscle or muscle group, increases with muscle tension, combined with limb weakness. The general condition remains satisfactory. Inflamed muscles are compacted, slight swelling is possible.
With repeated microtrauma or chronic overload, tendinitis and tendovaginitis sometimes develop – inflammation of the tendons and tendon sheaths of the forearm muscles. Initially, pathologies are characterized by transient weak pulling, aching or aching localized pains in the lower third of the segment. Subsequently, the pain becomes constant, increases with movements, worries at night, supplemented by muscle weakness.
Myositis and tendovaginitis are sometimes diagnosed in patients with rheumatoid arthritis. There is a clinic of a typical lesion of the muscles and tendons of the forearm with pain and muscle weakness in combination with a symmetrical lesion of the joints of the hands. Tendovaginitis occurs chronically, may be complicated by carpal tunnel syndrome, in which the pain becomes shooting in nature, supplemented by paresthesia.
A special form of tendovaginitis is inflammation of the tendons in de Quervain’s disease. Pressing or aching pains on the radial side of the lower third of the forearm are noted with wide-amplitude movements of 1 finger, deviation of the brush towards the 5th finger. Initially, the pain syndrome is not intense, quickly transient. Subsequently, in some patients, the pain becomes constant, increases with the slightest movements. Possible irradiation in the hand, upper third of the forearm and elbow joint.
Bone infections
Aseptic periostitis occurs after injuries, inflammatory diseases. It develops more often in areas of bone that are poorly covered with soft tissues (just below the ulnar process, along the lateral surfaces of the forearm), manifested by moderate aching pain, relieved within 1-2 weeks. During the transition to the serous form, the pain increases, becomes bursting, accompanied by deformity of the limb due to a significant accumulation of fluid under the periosteum.
With purulent periostitis, the pain is intense, rapidly increasing. They appear against the background of purulent lesions of the forearm (furuncle, phlegmon, abscess). Palpation of the bone is sharply painful. The hand is swollen, the skin is hyperemic, movements are limited. Symptoms of general intoxication are revealed: fever, headache, weakness, chills.
Forearm bones with hematogenous osteomyelitis suffer relatively rarely. Pathology is manifested by unbearable pains of a twitching, bursting or drilling nature, arising against the background of a pronounced violation of the general condition, significant hyperthermia, chills, bruising, nausea, headache. The pain is so severe that the patient avoids even the slightest movements.
In postoperative and posttraumatic osteomyelitis, the symptoms are similar, but the disease develops against the background of trauma or after surgery, has certain differences in dynamics. The pain syndrome usually increases more slowly than with the hematogenic type of the disease, does not reach such intensity. In chronic osteomyelitis, the course is undulating, during periods of exacerbations, the manifestations resemble acute osteomyelitis, then the pain subsides, a fistula forms in the affected area.
Infections of soft tissues and blood vessels
Pain in the forearm occurs with purulent diseases of soft tissues. The pain is initially pressing or bursting, quickly intensifies, becomes twitching, pulsating, prevents any movements, deprives night sleep. It is accompanied by edema, an increase in local temperature, disorders of the general condition of varying degrees of severity – from minor hyperthermia to severe fever. Pain syndrome can be provoked by the following purulent pathologies:
A boil. The focus is small, limited, with a black rod in the center, the general condition is not disturbed or slightly disturbed.
Carbuncle. It rarely forms on the forearm. It consists of several foci with black rods, which subsequently merge into a large spherical infiltrate. Causes severe fever, severe intoxication.
Abscess. It is a limited focus of inflammation without a rod. The size of the hearth usually reaches several centimeters. Hyperthermia, weakness, and bruising are noted.
Phlegmon. A large purulent focus without clear contours. The pain spreads throughout the segment, the general condition is severe.
Pain in the forearm against the background of purulent processes and infected wounds may be caused by lymphangitis and stem lymphangitis. With lymphangoitis, soreness in the area of inflammation increases, the general condition worsens, a marble pattern appears on the skin around the purulent focus. With stem lymphangitis, pain, swelling and hyperemia spread along the forearm in the form of a strip, pass to the shoulder.
Phlebitis of the forearm veins develops in infectious diseases, after the administration of drugs (post-injection phlebitis). It is characterized by sharp pain in the area of the focus of inflammation or the administration of the drug, spreading along the vein. When feeling, a dense painful weight is revealed. The general condition is usually not disturbed. In injecting drug addicts, phlebitis becomes recurrent. The pain is less pronounced due to fibrous degeneration of tissues, the skin over the linear cord is dense, cyanotic.
Compression of tissues
Intense growing pains, not relieved by non-narcotic analgesics, are noted in myofascial compartment syndrome, which is a complication of injuries, inflammatory processes, snake bites, prolonged use of a tourniquet. The pain increases with palpation of the forearm, combined with significant swelling, compaction of soft tissues, pallor and coldness of the skin.
A special case of compartment syndrome is the initial stage of Volkman’s contracture, which occurs in children with fractures of the shoulder and forearm. Develops in the first hours or days after the injury. The pain increases rapidly, increases with finger movements, is complemented by dense shiny swelling, pallor of the skin, weakening or disappearance of the pulse on the arteries of the forearm.
Oncological diseases
Benign tumors of the forearm bones occur quite rarely, mainly represented by chondromes. They are manifested by non-intense intermittent pain of indistinct localization, persisting for several months or years. With the growth of neoplasia, the pain syndrome gradually increases, a tumor-like formation of bone density is determined in the affected area.
Osteogenic sarcoma is more common among malignant neoplasms of the forearm bones. The defeat of the ulna prevails. The pain is initially unclear, dull. They rapidly intensify, constantly disturb, reach the degree of unbearable, progress against the background of thickening of the bone, the appearance of a venous pattern, pasty soft tissues, disorders of the general condition.
Neurological causes
Pain in the forearm area occurs with neuritis and neuropathies of nerve trunks, including compression-ischemic compression of nerves in their anatomical tunnels. For neurological pathologies, burning or shooting pains are typical, combined with paresthesia, local trophic disorders, decreased sensitivity and muscle strength in the innervated zone. Pain syndrome is caused by the following diseases:
Neuropathy of the median nerve. It is characterized by intense pain on the medial surface of the forearm, extending to the hand and 1-3 fingers.
Carpal tunnel syndrome. Occurs when the median nerve is compressed at the level of the wrist joint. Pain often appears on the palm surface of the hand, but can radiate into the forearm.
Neuropathy of the radial nerve. The maximum soreness is observed on the back of the hand or 1 finger, a number of patients have irradiation on the back surface of the forearm.
Ulnar nerve neuropathy. Patients complain of pain in the elbow joint, radiating along the elbow surface of the forearm. Pain syndrome often increases in the morning, which is explained by nerve compression during sleep.
Diagnostics
Patients with pain in the forearm are examined by orthopedic traumatologists. With purulent lesions, patients are referred to surgeons, with pain syndrome of neurological etiology – to neurologists. The diagnostic program includes a survey and a physical examination, during which the condition and functions of the limb are assessed, deformity, pathological mobility, edema and other symptoms are detected. The following procedures may be prescribed:
Radiography of the forearm. It is performed for severe traumatic injuries, suspected osteomyelitis, periostitis, benign and malignant tumors. In other conditions, it is often carried out to exclude changes in bone tissue. Detects violations of the integrity of the bone, areas of compaction, rarefaction, etc.
CT of the bone. It is effective in the examination of solid structures. It is carried out with ambiguous radiography results. Allows you to specify the size and location of the pathological focus, detect even minor changes, build a three-dimensional model of the affected area.
MRI. Like computed tomography, it is used at the final stages of the examination. Changes in the periosteum are clearly visible on the MRI of the bone. On MRI of soft tissues, signs of inflammation or degeneration in muscles and tendons are visualized.
Electrophysiological studies. EMG, ENG and ENMG are indicated for suspected neurological etiology of pain syndrome. They make it possible to determine the level of nerve damage, assess nerve conduction, and the condition of innervated muscles.
Laboratory tests. With purulent lesions, it is possible to assess the severity of inflammation. In rheumatoid arthritis, specific markers are identified. In oncological processes, they are prescribed to assess the general condition of the body, the degree of dysfunction of various organs.
Treatment
Help before diagnosis
With minor injuries, the hand is fixed with a kerchief bandage, cold is applied. In case of fractures, a splint is applied from the fingers to the upper third of the shoulder, an analgesic is given. All manipulations with the damaged limb are carried out carefully and carefully to prevent the aggravation of the injury. In inflammatory diseases, local remedies with analgesic and anti-inflammatory effects are applied. If there are signs of purulent inflammation, sharp pains, increasing edema, you should immediately consult a doctor.
Conservative therapy
Treatment of fractures of the radius in a typical place is usually conservative. For other types of forearm fractures, therapeutic measures, depending on the characteristics and severity of the injury, can be both conservative and operative. The fracture site is anesthetized, repositioning is carried out if necessary, a plaster cast is applied.
Conservative treatment of forearm diseases usually includes a change in the mode of motor activity, drug and non-drug therapy. The following methods are used:
Protective mode. The patient is recommended to limit the load on the limb. Sometimes a plaster splint or a kerchief bandage is applied. Some patients are shown orthopedic devices that can be used constantly, during work or at night.
Medical treatment. In most cases, NSAIDs are used in tablets, gels and ointments. With persistent pain syndrome, blockades with corticosteroids are carried out. With purulent processes, antibiotic therapy is prescribed.
Non-drug methods of exposure. Massage, physical therapy and physiotherapy procedures are widely used: UHF, magnetic therapy, electrophoresis, etc.
Surgical treatment
Taking into account the nature of pathology in case of injuries and diseases of the forearm , the following operations are performed:
Traumatic injuries: opening of a hematoma, osteosynthesis of both segment bones, ulna or radius.
Infectious processes: autopsy, drainage of boils, carbuncles, abscesses and phlegmon, sequestrectomy.
Tumors: removal of neoplasms, bone resection, amputation or exarticulation of the shoulder.
Neurological diseases: nerve decompression.
In the postoperative period, antibiotics are prescribed, rehabilitation measures are carried out. In case of malignant tumors, surgical treatment is supplemented with chemotherapy, radiation therapy.
