Pain in the forearm muscles

The forearm is the area of the upper limb (arm), starting from the elbow and ending with the wrist. The bones of the forearm are surrounded by muscle tissue, tendons and ligaments that control the motor activity of the hand and fingers. Almost all tissue structures of the forearm, including the periosteum, contain many sensitive receptors, so pain in the muscles of the forearm can be caused by any factor affecting this part of the body.

In order to understand what can hurt in the antebachium – forearm, it is necessary to understand which muscles are involved in its work.

The muscles of the forearm are innervated by the median ulnar and radial nerves. In the outer fascial space are the brachioradialis muscle, as well as the long, short muscle, extensor carpi. Also in the anterior zone are muscles that form four connecting layers:

• The muscle that rotates the wrist or pronator teres (m. pronator teres), as well as the muscle that flexes the wrist (radial flexor), palmar muscle.
• Muscle - flexor of the fingers (superficial muscle - m. flexor digitorum superficialis), flexor of the wrist, proximal and middle phalanges of the index finger and little finger.
• Deep flexor of the fingers, flexor of the thumb (m. flexor pollicis longus), nail phalanges and hand.
• The pronator quadratus is a muscle that controls rotation and inward movement of the hand.

The posterior fascial space of the forearm contains 2 layers of muscles:

• The elbow muscle, the muscle that extends the elbow, wrist, hand with its abduction towards the elbow, as well as the extensor muscle of the little finger, index finger.
• The muscle that rotates the hand outward is the supinator, the extensor muscle of the index finger, the long and short extensor muscles of the thumb, the long muscle that controls the abduction of the thumb.

Pain in the forearm muscles can be caused by traumatic injury, diseases of the musculoskeletal system, muscle-tonic syndromes, and neurogenic causes.

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Causes of Forearm Muscle Pain

The main causes of forearm muscle pain are provoking factors that directly concern muscle tissue, not joints or the vascular system. It is believed that muscle strain, ligament strain, and rupture are most often accompanied by typical pain sensations characteristic of muscle injury symptoms. It should be noted that in recent decades, other conditions and diseases have also become quite common etiological causes that doctors encounter as part of complex diagnostic measures.

If previously traumatic muscle injuries were in the lead, then currently the list of factors that provoke pain in the forearm looks like this:

• Degenerative processes in the spinal column (osteochondrosis), mainly in the cervical-thoracic region.
• Staying in a static position for a long time leads to postural overstrain of the forearm muscles and corresponding muscle-tonic syndromes.
• Immobilization of the arm for a long period.
• Dynamic pressure of any intensity on muscles over a long period of time.
• Hypothermia results in muscle inflammation - myositis.
• Forearm injuries.
• Stretching of muscle tissue, ligaments.

The following causes of pain in the forearm muscles are identified:

• Pain is caused by forearm muscle injuries, mainly bruises. Also, pain in muscle tissue can occur with fractures, dislocations of the elbow joint, wrist joint. If the bruise is severe and accompanied by a muscle rupture, a subfascial hematoma may develop, which not only aggravates the pain, but can lead to dysfunction of the hand and fingers. Forearm tendons are injured extremely rarely, damage can cause severe local pain and require surgical treatment. Untimely diagnosis of traumatic muscle injuries, especially bone tissue of the forearm, can lead to such a serious complication as Volkmann's contracture.
• Chronic hypertonicity of the forearm muscles, overstrain associated with workloads is often accompanied by muscle tissue dystrophy. The condition causes aching, prolonged pain, which can intensify with even greater tension, such as clenching a fist.
• Aseptic and infectious tendovaginitis caused by monotonous, rhythmic movements or phlegmon, abscesses of the hand. The disease affects the tendons, but the muscles also hurt, especially when working with the fingers. There are complicated forms of tendovaginitis - crepitant and purulent tendovaginitis. The crepitant form in 90% of cases ends in myositis - inflammation of the muscles of the forearm
• Carpal tunnel syndrome is also a pathological condition of the ligaments (compaction), compression of the nerve, in which the pain is felt most intensely at night. The syndrome is a typical "companion" of almost all office professions
• Myofascial pain syndrome is a complex of symptoms that mainly affects women. The diagnostic criteria for MFPS are certain trigger pain zones, where spasmodic muscle areas are palpated as small seals. Myofascial syndrome develops independently without visible organic damage, diseases of internal organs and is an independent nosological unit, poorly studied, quite difficult to determine and difficult to treat.
• Neurovascular, dystrophic syndromes caused by the transmission of pain impulses from the fibrous ring of the spinal disc or from the receptors of the joint capsule. The pain is aching, radiates to the shoulder, forearm, muscle pain appears with postural, static tension 7.
• Plexopathy associated with dysfunction of the brachial plexus. Traumatic or tumor injuries are most often accompanied by pain in the muscles of the forearm, then the hand, in which paresis develops
• Neuropathic lesion of the radial nerve, the consequence of which is a typical sports syndrome - "tennis elbow" or tunnel syndrome, epicondylitis. Overstrain of the forearm muscles - supinators and extensors, provokes an acute pain symptom in the epicondyle, then a nagging pain in the muscles that does not subside at rest
• Inflammation of muscle tissue – myositis. The inflammatory process can be provoked by an infectious disease, banal hypothermia or injury, there is also a form of “professional” myositis, when pathological damage to the muscle is caused by constant static-dynamic load on the forearm

The causes of pain in the forearm muscles are often rooted in muscle-tonic syndromes, such as:

• Scalenus syndrome (anterior scalene syndrome).
• Pectalgic syndrome or chest muscle syndrome.
• Ischemic contracture or Volkmann syndrome, muscle bed syndrome. The disease is caused by long-term wearing of a too tight bandage, splint, plaster, which causes significant compression of the muscle bed and, at the same time, hemorrhage, edema, hemorrhagic diathesis of the bed. Disruption of blood supply, microcirculation, venous blood stasis lead to increasing pain, loss of mobility of the hand and fingers.

Causes of pain in the forearm muscle tissue can also be as follows:

• Spontaneous muscle hematoma.
• Diffuse fasciitis.
• Joint diseases – arthritis, arthrosis, including rheumatic.
• Osteomyelitis, osteoporosis, osteoarthritis.
• Vascular insufficiency, thrombosis.
• Osteochondrosis, including protrusions and hernias (radicular syndromes).
• Disruption of metabolism, water-salt balance.
• Inflammatory process in the subcutaneous tissue.
• Gout.
• Cardiovascular diseases. In addition to the above reasons, factors, a pain symptom in the forearm can be a reflected signal, the source of which is in the internal organs. An example of this is an attack of angina pectoris, when the irradiation of pain is felt in the left hand, often in the forearm area.

In general, it can be said that pain in the antebachium (forearm) muscles occurs as a result of traumatic, neurological, vertebrogenic, neuroreflexive, vascular, infectious diseases and disorders.

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Symptoms of Forearm Muscle Pain

Signs of pain in the body can be of different nature, everything depends on the location of the pain, its causes and accompanying complications. Symptoms of pain in the muscles of the forearm are no exception, which can be independent, for example, with myofascial syndrome, but can also be secondary signs of the underlying pathology.

1. Muscle strain (training, physical work). The pain starts in the round muscle (pronator), it is aching, intensifies with any load on the arm, when lifting weights and even when clenching the fingers into a fist. The pain symptom often goes away on its own without complications if the muscles are given rest.
2. Paratenoitis (tendonitis) of the forearm. At the first stage, crepitus is expressed in imperceptible, transient aching pains that subside. The second stage develops rapidly, tendonitis practically occurs in an acute form. Intense muscle pain is accompanied by painful swelling in the projection of the abductor muscle. The most characteristic symptom of tendonitis is a specific sound, similar to a weak creak, crackling (figurative comparison - snow crunching underfoot).
3. Infectious, purulent tendovaginitis, in addition to myalgia, is accompanied by elevated body temperature, swelling of the forearm at the site of phlegmon or abscess, and limited mobility of the hand and fingers.
4. Neurogenic syndromes, like other radiculoalgias, are characterized by a stabbing, sharp pain radiating above the forearm - to the shoulder, neck. After a while, the pain turns into aching sensations that intensify with movement. Epicondylitis is characterized by pain symptoms that do not subside at rest, and at the same time, there is no paresthesia and numbness. The pain is localized in the epicondyle, its palpation is very painful, so the person tries to limit the movement of the hand, especially extension. The hand gradually weakens, sometimes to such an extent that grasping and holding a small object becomes a big problem.
5. Rheumatic joint lesions are typically characterized by aching, "twisting" pain that comes from the periosteum affected by inflammation. Muscle pain manifests itself as a secondary signal of a nagging nature, most often the tissues around the swollen joint are damaged.
6. Dysesthesia - a burning, tingling sensation is more characteristic of vascular disorders, the muscles of the forearm hurt in a certain position, at rest or when changing the position of the hand, the symptom most often subsides.

In general, the symptoms of forearm muscle pain are very typical for myogenic sensations. The muscle becomes denser from overexertion, more often this manifests itself as aching pain, but the symptom is not felt on its own. It can intensify with palpation, squeezing the hand, with flexion or extension, work of the hand, from additional load on it. If the muscles do not relax, chronic nagging pain develops and an inflammatory process can develop - myositis. In addition, with myalgia provoked by a vertebrogenic factor, there may be sensations of numbness, cold, weakness in the fingers of the injured hand. It should be noted that among all types of pain, muscle pain is the least studied, therefore, to differentiate symptoms and make an accurate diagnosis, the doctor is required not only knowledge, but also practical experience, as well as mastery of all modern methods and diagnostic methods.

Diagnosis of pain in the muscles of the forearm

Due to the non-specificity of the symptoms, diagnosis of pain in the muscles of the forearm should first of all be differential. It is easiest to determine a traumatic injury to the hand - dislocation, fracture, since their signs are obvious, in addition, the injury is confirmed by X-ray.

Unfortunately, a diagnostic standard - a system of "red flags of pain" for the forearm - has not been developed; the doctor has to rely on his own experience and use all possible methods to determine the root cause of the symptom.

First of all, cardiovascular diseases are excluded - angina, heart attack, especially if the patient complains of pain in the left arm. It is also necessary to exclude or confirm radicular syndrome, in which pain in the forearm can be secondary, reflected.

The main research methods that are used to diagnose pain in the forearm are:

• Questioning the patient, including identifying the provoking professional factors to determine possible muscle strain syndrome. Also, the characteristics of the pain are identified - intensity, sensations, localization, duration and dependence on changes in body posture, hand movements that the patient notices.
• Visual examination of the patient's upper body, not only the diseased forearm is examined, but also the other arm.
• Assessment and examination of the neurological status, palpation of the affected arm, segmented areas of the spine.
• Study of rotation movements - in the elbow and wrist joint.
• X-ray of the spine. The cervical region is examined with functional tests.
• To clarify the diagnosis, it is possible to prescribe a computed tomography scan or MRI to specify the nature of compression injuries (protrusions, hernias).
• Electromyography, which provides an assessment of the bioelectric potential of muscle tissue, its conductivity level (the speed of pain signal conduction).

Diagnosis of pain in the muscles of the forearm directly depends on the clinical signs, their specificity, so the doctor often conducts various motor tests, which are especially effective for identifying tunnel syndrome, epicondylitis, tendovaginitis, rheumatic joint lesions.

Poorly studied muscle syndromes, too variable terminology describing the pain symptom in muscles, the absence of verification standards in the clinical diagnosis of muscle diseases make it extremely difficult for a doctor to act. That is why diagnostic measures for myalgia affecting the forearm are carried out according to schemes similar to the diagnosis of periarticular pathologies in the shoulder area. Fortunately, 21st century medicine has an excellent arsenal of various modern diagnostic technologies that allow us to give a three-dimensional image of any structure of the human body, to determine almost all of its characteristics. If all the signs are clarified, identifying the root cause of pain helps to determine the tactics of effective therapy, according to a well-known medical proverb

"Qui bene diagnoscit – bene curat" – whoever diagnoses correctly, treats correctly.

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Treatment for Forearm Muscle Pain

As a rule, forearm pain caused by simple overexertion after training or a single physical activity goes away on its own, without the intervention of a doctor. However, more serious conditions often remain undiagnosed for a long time, and therefore without adequate therapy. This significantly complicates the treatment of muscle pain, since the symptoms are smoothed out, the pain becomes low-intensity, and the disease becomes chronic.

As a rule, a patient comes to a medical facility when a symptom worsens, so the doctor’s primary task is to relieve the pain.

Treatment of forearm muscle pain, standard steps:

• Pain relief using various options - from applying a local anesthetic to local injection anesthesia.
• Local injections of corticosteroids into trigger zones are possible (for MFBS – myofascial syndrome).
• Arm immobilization. The forearm is left at rest, less often orthoses, bandages, splints, and supports are applied. Splinting is performed only if indicated.
• Prescription of non-steroidal anti-inflammatory drugs can only be done in the presence of signs of an inflammatory process - purulent tendovaginitis, myositis, phlegmon, and so on.
• Prescription of muscle relaxants to relieve spasms.
• Massage using warming or anesthetic drugs.
• Application therapy.
• Prescription of local physiotherapeutic procedures, most often electrophoresis.
• Kinesiotherapy.
• Surgical operations are performed rarely, only in cases of tumor processes, displaced fractures, rupture of tendons and muscle tissue.

Rehabilitation measures such as physiotherapy are not relevant for the forearm; rather, its injuries are treated with immobilization and actions aimed at eliminating the etiological cause of pain.

Prevention of Forearm Muscle Pain

It is impossible to foresee literally all provoking factors, however, prevention of pain in the forearm muscles, in contrast to the classification of muscle diseases and diagnostic criteria, has been developed for quite a long time.

This is due to the fact that a significant portion of the causes of pain in the arm are associated with professional risks. Stereotypical, monotonous hand movements are typical for many professions, as well as for some sports. In order to ensure that work productivity and sports performance do not decrease, measures to prevent tunnel syndrome, tendovaginitis, scalenus syndrome, and other characteristic pains in the forearm and hand have been developed since the Soviet Union. General recommendations and excerpts from guidelines for the prevention of occupational diseases are provided below:

1. In work, in the process of activity, it is necessary to observe the laws of ergonomics, that is, to monitor the correct posture, comfortable position of the hand, forearm 2.
2. To reduce the risk of muscle overload, it is necessary to properly organize the workplace.
3. Regular relaxation exercises, which should be done every 45 minutes, or at most every hour, will help avoid muscle pain. It is necessary to systematically change the muscle stereotype, give the hand other types of movements.
4. If the first discomfort in the forearm appears, the arm should be immobilized for at least 12 hours, the muscles should be given rest. Massage is permissible after 24 hours, earlier it can activate the pain, provoke swelling.

Pain in the forearm muscles is a complex polyetiological symptom. Timely identification of the cause of the pain sensation, accurate diagnostics and correct treatment tactics help a person maintain working capacity and a full range of hand movements. In this sense, a person can create the health of the forearm and hands with “his own hands” and a responsible attitude towards them, observing all possible rules for disease prevention.