Pain in the muscles of the forearm

The forearm is a zone of the upper limb (arms), 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. Practically in all tissue structures of the forearm, including the periosteum, there are many sensitive receptors, respectively, pain in the muscles of the forearm can be caused by any factor relating to this part of the body.

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

Muscles of the forearm are innervated by the medial ulnar and radial nerve. In the outer fascial space there is a brachial muscle, as well as a long, short muscle, extending the wrist. Also in the front zone are the muscles that form four connecting layers: 

• A muscle that rotates a hand or a round pronator (m. Pronator teres), as well as a flexor muscle of the wrist (radial flexor), palmar muscle.
• The muscle is the flexor of the fingers (the superficial muscle is m. Flexor digitorum superficialis), the flexor of the hand, the proximal and middle phalanx of the index finger and the little finger.
• Deep flexor of the fingers, flexor pollicis longus, nail phalanges and brushes.
• A square pronator (m. Pronator quadratus), a muscle that controls the rotation, the movement of the brush inside.

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

• The muscle of the elbow, the muscle that extends the elbow, the wrist, the wrist with its retraction toward the elbow, and also the extensor muscle of the little finger, the index finger.
• The muscle that rotates the wrist to the outside is the arch support, the extensor muscle of the index finger, the long and short extensor muscle of the thumb, the long muscle that controls the tapping of the thumb.

The pain in the muscles of the forearm can be triggered as a traumatic injury, diseases of the musculoskeletal system, muscular-tonic syndromes, and neurogenic causes.

[1], [2]

Causes of pain in the muscles of the forearm

The main causes of pain in the muscles of the forearm are provoking factors that directly affect the muscle tissue, rather than the joints or vascular system. It is believed that the stretching of the muscles, ligaments, their rupture, is most often accompanied by typical pain sensations, characteristic of the symptoms of muscle damage. It should be noted that over the past decades, other conditions and diseases have also become quite common etiologic causes faced by physicians in complex diagnostic activities.

If previously traumatic injuries of muscles were leading, the list of factors provoking pain in the forearm now looks like this: 

• Degenerative processes in the spine (osteochondrosis), mainly in the cervico-thoracic region.
• Long-term presence in a static posture - postural overstrain of the muscles of the forearm and the corresponding muscular-tonic syndromes.
• Immobilization of the hand for a long period.
• Dynamic pressure of any intensity on the muscles for a long time.
• Subcooling, as a consequence of inflammation of the muscles - myositis.
• Injuries to the forearm.
• Stretching of the muscle tissue, ligaments.

The following causes of pain in the muscles of the forearm distinguish: 

• Pain causes injuries to the muscles of the forearm, mostly bruises. Also, a pain symptom in the muscle tissue can occur with fractures, dislocations of the elbow joint, wrist joint. If the bruise is strong and accompanied by muscle rupture, subfascial hematoma may develop, which not only aggravates the pain, but can lead to impaired function of the hand and fingers. Tendons of the forearm are extremely scarred, 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 hypertension of the muscles of the forearm, overstrain associated with workloads is often accompanied by dystrophy of the muscle tissue. The condition causes aching, prolonged pain, which can intensify with even greater stress, for example, compression of the fist. 
• Aseptic and infectious tenosynovitis caused by monotonous, rhythmic movements or phlegmon, abscesses of the hand. The disease affects the tendons, but the muscles also ache, especially when working with the fingers. There are complicated forms of tendovaginitis - crepitating and purulent tendovaginitis. The crepitus form in 90% of cases ends with myositis - inflammation of the muscles of the forearm 
• Carpal tunnel syndrome is also a pathological condition of ligaments (compression), nerve compression, in which pain is most intensively felt at night. Syndrome is a typical "satellite" of almost all office professions 
• Myofascial pain syndrome is a complex symptom complex, manifested mainly in women. Diagnostic criteria of MFBS are certain trigger pain zones, where spasmodic muscular 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 understood, rather difficult to determine and difficult to treat 
• Neurovascular, dystrophic syndromes caused by transmission of pain from the fibrous ring of the spinal disc or from the receptors of the joint capsule. The pain is aching, it radiates to the shoulder, the forearm, muscle pain occurs with postural, static tension 7.
• Plexopathy associated with dysfunction of the brachial plexus. Traumatic or tumor damage is most often accompanied by pain in the muscles of the forearm, then the brush in which the paresis develops 
• Neuropathic lesion of the radial nerve, the consequence of which is typically a sports syndrome - "tennis elbow" or tunnel syndrome, epicondylitis. Overexertion of the muscles of the forearm - insteps and extensors, provokes a sharp pain symptom in the epicondyle, then aching, not abating pain in the muscles 
• Inflammation of muscle tissue - myositis. The inflammatory process can be triggered by an infectious disease, banal supercooling or trauma, there is also a form of "professional" myositis, when pathological muscle damage is caused by a constant statodynamic load on the forearm 

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

• Scalenius syndrome (a syndrome of anterior staircase muscle).
• Pectalgic syndrome or pectoral muscle syndrome.
• Ischemic contracture or Volkmann syndrome, muscle box syndrome. The disease is caused by the prolonged wearing of an overly tight bandage, a tire, a gypsum, with a significant compression of the muscle bed and at the same time hemorrhage, edema, hemorrhagic diathesis of the bed. Violation of blood supply, microcirculation, stasis of venous blood leads to an increasing pain sensation, loss of mobility of the hand and fingers.

The causes of pain in the muscle tissue of the forearm can also be: 

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

Generalizing it can be said that the pain in the muscles of the antebachium (forearm) occurs as a result of traumatic, neurological, vertebrogenic, neuroreflex, vasculature, infectious diseases and disorders.

[3], [4]

Symptoms of pain in the muscles of the forearm

Signs of pain in the body can have a different character, it all depends on the location of the pain, its causes and accompanying complications. No exception and the symptoms of pain in the muscles of the forearm, which are independent, for example, with myofascial syndrome, but also may be secondary signs of the underlying pathology. 

1. Muscular overstrain (training, physical work). The pain begins in the round muscle (pronator), it is aching, it increases with any load on the hand, when lifting weights and even when the fingers are squeezed into a fist. The pain symptom often goes away without complications, if the muscles are given rest.
2. Paratenoid (tenosynovitis) of the forearm. At the first stage, crepitation is expressed in imperceptible, transient, lomiting pains, which subside. The second stage develops rapidly, tendovaginitis practically proceeds in acute form. Intensive muscular pain is accompanied by a painful swelling in the projection of the abduction muscle. The most characteristic symptom of tendovaginitis is a specific sound, similar to a weak creaking, crackling (figurative comparison - crunchy under the feet of the snow).
3. Infectious, purulent tendovaginitis, in addition to myalgia, accompanied by an increased body temperature, swelling of the forearm in place of phlegmon or abscess, restriction of mobility of the hand and fingers.
4. Neurogenic syndromes, like other radiculoalgias, are characterized by a dagger, acute pain that rises above the forearm - in the shoulder, neck. After a while, the pain passes into the aching sensations, which increase with movement. Epicondylitis is characterized by painful symptoms that do not subside in rest, and at the same time, absence of paresthesia and numbness. The pain is localized in the epicondyle, its palpation is very painful, so the person seeks to limit the movement of the hand, especially the extension. The hand gradually weakens, at times to such an extent that capturing and holding a small object becomes a big problem.
5. Rheumatic affections of the joints are typical of a lumbent, "twisting" pain, which comes from an inflammation of the periosteum. Muscle pain manifests itself as a secondary signal of a noisy character, most often damaged tissues around the swollen joint.
6. Dysaesthesia is a burning sensation, a tingling sensation is more characteristic of vascular disorders, the muscles of the forearm are painful in a certain position, at rest or when the position of the hand changes, the symptom usually subsides.

In general, the symptoms of pain in the muscles of the forearm are very typical for myogenic sensations. The muscle is tightened from overexertion, more often it manifests as aching pain, but it does not feel the symptom itself. It can be strengthened by palpation, squeezing the hand, flexing or flexing, brushing, from the additional load on it. If the muscles do not get relaxed, chronic pain can develop and the inflammatory process, myositis, may develop. In addition, with myalgia, provoked vertebrogenic factor, there may be sensations of numbness, coldness, weakness in the fingers of the injured arm. It should be noted that among all types of pain, the muscles are the least studied, therefore, in order to differentiate symptoms and make an accurate diagnosis from a doctor, it is required not only knowledge, but also practical experience, as well as possession of all modern methods and methods of diagnosis.

Diagnosis of pain in the muscles of the forearm

Due to the nonspecific symptoms, the diagnosis of pain in the muscles of the forearm must first of all be differential. The easiest way to identify a traumatic hand injury is a dislocation, a fracture, because their signs are obvious, in addition the injury is confirmed by an X-ray.

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

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

The main methods of research, which involves the diagnosis of pain in the forearm, are as follows: 

• Interrogation of the patient, including the elucidation of provoking professional factors to determine the possible syndrome of muscle strain. Also, the characteristics of pain - intensity, sensations, localization, duration and dependence on the change in body posture, movements of the hand, which the patient notices, are elucidated.
• Visual inspection of the upper body of the patient, not only the patient's forearm is examined, but also the second arm.
• Evaluation and study of neurological status, palpation of the patient arm, segmented spine.
• The study of rotation movements - in the elbow and wrist joint.
• Roentgen of the spinal column. The cervical region is examined with functional samples.
• To clarify the diagnosis, the appointment of a computer tomography, MRI to specify the nature of compression injuries (protrusion, hernia).
• Electromyography, which evaluates the bioelectrical potential of muscle tissue, the level of its conductivity (the rate of pain signal).

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, especially effective for detecting tunnel syndrome, epicondylitis, tendovaginitis, rheumatic joint damage.

Little knowledge of muscle syndromes, too variable terminology describing the pain symptom in the muscles, the lack of verification standards in the clinical diagnosis of muscle diseases make it extremely difficult for the doctor to act. That is why the diagnostic measures of myalgia concerning the forearm are carried out according to the schemes similar to the diagnosis of periarticular pathologies in the shoulder region. Fortunately, medicine of the XXI century has a magnificent arsenal of various modern diagnostic technologies that allow to give a three-dimensional image of any structure of the human body, to determine almost all its characteristics. If all the signs are refined, revealing the root cause of pain helps determine the tactics of effective therapy, according to the famous medical proverb

"Qui bene diagnoscit - bene curat" - who correctly diagnoses, he correctly treats.

[5], [6], [7]

Treatment of pain in the muscles of the forearm

As a rule, pain in the forearm, caused by simple overstrain after training or a single physical exertion, pass independently, without the intervention of a doctor. However, often more serious conditions remain for a long time without diagnosis, hence, without adequate therapy. This greatly complicates the treatment of pain in muscles, since the symptoms are smoothed, the pains become less intense, the disease becomes chronic.

As a rule, a patient comes to a medical institution with an exacerbation of a symptom, therefore the primary task of a doctor is to stop the pain sensation.

Treatment of pain in the muscles of the forearm, standard stages: 

• Anesthesia with the help of various options - from applying a local anesthetic, to local injection anesthesia.
• There are local injections of corticosteroids in trigger zones (with MFBS - myofascial syndrome).
• Immobilization of the hand. The forearm is provided with rest, rarely orthoses, bandages, langets, calipers. Shinning is carried out only on indications.
• The purpose of anti-inflammatory non-steroid drugs can be only in the presence of signs of an inflammatory process - purulent tendovaginitis, myositis, phlegmon and so on.
• Purpose of mielorelaxants to relieve spasms.
• Massage with warming or anesthetic preparations.
• Applikation therapy.
• The appointment of local physiotherapy procedures, most often - electrophoresis.
• Kinesiotherapy.
• Surgical operations are rare, only in case of tumor processes, displaced fractures, rupture of tendons and muscle tissue.

Rehabilitation measures, such as physiotherapy exercises, are irrelevant for the forearm, rather, its damage is treated with immobilization and actions aimed at eliminating the etiologic cause of pain.

Prevention of pain in the muscles of the forearm

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

This is due to the fact that a significant part of the causes that cause a pain symptom in the hand is associated with occupational risks. Stereotype, monotonous hand movements are typical for many professions, as well as for some sports. In order to ensure that labor productivity and the effectiveness of sports achievements are not reduced, measures to prevent tunnel syndrome, tendovaginitis, scalenus syndrome, and other characteristic pains in the forearm and hand have been developed since the times of the Soviet Union. General recommendations and extracts from the guidelines for the prevention of occupational diseases are given below: 

1. In the work, in the process of activity, one should observe the laws of ergonomics, that is, follow the correct posture, comfortable position of the arm, forearm 2.
2. To reduce the risk of muscle overload, you need to properly organize the workplace.
3. To avoid pain in the muscles will help regular relaxation exercises, which need to be done every 45 minutes, in extreme cases, in an hour. It is necessary to systematically change the muscular stereotype, to give the hand other types of movements.
4. If there are first uncomfortable sensations in the forearm, the arm should be immobilized for at least 12 hours, the muscles should be at rest. Massage is permissible after a day, before it can intensify the pain, provoke swelling.

Pain in the muscles of the forearm is a complex polyethological symptom. Timely detection of the cause of pain, accurate diagnosis and correct therapeutic tactics help a person to maintain the ability to work and a full range of hand movements. In this sense, the health of the forearm, hands of a person can create "own hands" and a responsible attitude towards them, observing all possible rules for the prevention of diseases.