Anterior Forearm
ANTERIOR FOREARM
Dull Ache / Sharp Pain
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Wrist flexor mild strains / hypertonicity
(Brachioradialis, Pronator teres, Flexor carpi radialis, Palmaris longus, Flexor carpi ulnaris, Flexor digitorum superficialis, Flexor pollicis longus, Flexor digitorum profundus)
- Constant dull ache
- Ache can travel down to wrist
- May ache when carrying groceries
- Can ache when shaking hands
- Feels better with rest, heat
- Can ache when playing sports where gripping is required (hockey, golf, tennis)
- Diagnosed through palpation and active resisted muscle testing
- Severe strains (tears) may present with increased pain, swelling, bruising, and loss of function (ultrasound / MRI)
- Treatment through manual therapy and rehab exercises
Interosseous membrane hypertonicity
- Dull deep ache in forearm
- Local pain
- May be caused by increased gym activity, computer work, or repetitive overuse of work tools
- Diagnosed through articulating radius with ulna and comparing restrictions with opposite arm
- Treatment through manual therapy and rehab exercises
Delayed onset muscle soreness (DOMS)
- Pain on lateral elbow felt after gym sessions, exercise, or repetitive activities
- Exercise routine may have included bicep curls (machine or free weights)
- Self resolves within a week
Foraminal / Central canal stenosis with nerve root compression at Cervical / Thoracic vertebra C6,T1
Symptoms:
- may present as deep dull ache on front of arm
- Unrelenting neck pain with neurological symptoms down arm
- Radiculopathy down arm – burning, pins and needles, numbness, tingling
- Painful to turn neck
- Weakness in arm
- Muscle atrophy in shoulder and arm muscles
A) Cervical Disc herniation (M>F 40-60)
Caused by:
- trauma
- poor posture,
- repetitive activity
- overweight
Diagnosed by:
- Neck compression test (Spurling’s) Positive when peripheral pain, numbness and radiculopathy increases down the arm
- Sensitivity approximately 55% Specificity approximately 87%
- MRI
Treatment:
- Surgery
- Cortisone injection
- Conservative – medication, rest, manual therapy to surrounding musculature
- Disc herniations can heal on their own in 6-9 months
B) Vertebral spurs
Caused by:
- Osteoarthritis
- Trauma / Injury / fractures
Diagnosed by:
- X-ray
Treatment:
- Medication to reduce inflammation and pain
- Cortisone injection
- Surgery
- Manual therapy to surrounding musculature
C) Anterior longitudinal ligament ossification (Thickening)
Caused by:
- Unknown
- Hereditary
- Diffuse idiopathic skeletal hyperostosis (DISH)
- Trauma
Diagnosed by:
- X-ray / MRI
Treatment:
- Medication to reduce inflammation and pain
- Manual therapy to surrounding musculature
- Cortisone injection
- Surgery indicated when airways are potentially being blocked
D) Space occupying lesion (Cyst)
Caused by:
- Genetics
- Chronic inflammatory conditions
- Trauma / Injury to arteries, veins, lymphatics
- Blockages to ducts
Diagnosed by:
- MRI
Treatment:
- Surgery
- Drainage
- Injecting cyst to reduce swelling and pain
- Laser removal
E) Space occupying lesion (Tumour)
May include systemic signs such as night pain, night sweats, fever, or enlarged lymph nodes
Caused by:
- Genetics
- Trauma / Injury
- Infectious disease
- Obesity
- Cigarette smoking / Excessive alcohol
Diagnosed by:
- MRI
Treatment:
- Surgery
- Radiation / Chemotherapy
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ANTERIOR FOREARM
Numbness, Tingling, Weakness, Burning or Muscle atrophy
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Thoracic outlet syndrome (F>M 20–50)
Blood vessels or nerves being compressed between the collar bone and first rib causing neck and shoulder pain with neurological symptoms in the shoulder and upper limb.
Potential structures compressed: scalene strain, elevated rib 1, clavicle (arthritis, fracture), pec minor strain
Neurological (Upper trunk C5,6,7 – less common)
- Painful in neck, chest, shoulder, triceps, forearm,
- Numbness, tingling, pins, and needles
- Caused by constant compression, traction, irritation of brachial plexus
- Caused by bony / soft tissue abnormalities
Neurological (Lower trunk C7,8,T1 – more common)
- Pain in medial forearm, hand
- Numbness, tingling, pins, and needles
- Caused by constant compression, traction, irritation of brachial plexus
- Caused by bony / soft tissue abnormalities
Vascular (Emergency, Hospital)
- Swelling, stiffness, heaviness, coldness in arm
- Discoloured limb, decreased pulse, cramping in arm
- Diffuse paraesthesia
- Aggravated with arm elevation, exercise
Similar diagnoses: Cervical disc herniation, cervical arthritis causing IVF narrowing, Carpal tunnel syndrome, compression of ulnar nerve at elbow
Adson’s test: Sensitivity 50% Specificity 74 – 100%
Roo’s test: Sensitivity 82% Specificity 100%
Doppler arteriography
Prognosis: Fair to good depending on Neurological or vascular cause
Treatment: Aim is to release the structures causing symptoms. Manual therapy techniques to Scalene muscles, rib 1, clavicle, and pec minor muscle. Surgery may be performed in vascular causes
Foraminal / Central canal stenosis with nerve root compression at Cervical / Thoracic vertebra C6,T1
Symptoms:
- Numbness, tingling, or burning sensation with radiculopathy down arm
- May also present only locally in anterior forearm with similiar neurological symptoms
- Painful to turn or extend neck
- Weakness in arm
- Muscle atrophy in shoulder and arm muscles
- Patient may at times sleep in a chair or recliner to prevent neck extension leading to symptoms
A) Cervical Disc herniation (M>F 40-60)
Caused by:
- trauma
- poor posture,
- repetitive activity
- overweight
Diagnosed by:
- Neck compression test (Spurling’s) Positive when peripheral pain, numbness and radiculopathy increases down the arm
- Sensitivity approximately 55% Specificity approximately 87%
- MRI
Treatment:
- Surgery
- Cortisone injection
- Conservative – medication, rest, manual therapy to surrounding musculature
- Disc herniations can heal on their own in 6-9 months
B) Vertebral spurs
Caused by:
- Osteoarthritis
- Trauma / Injury / fractures
Diagnosed by:
- X-ray
Treatment:
- Medication to reduce inflammation and pain
- Cortisone injection
- Surgery
- Manual therapy to surrounding musculature
C) Anterior longitudinal ligament ossification (Thickening)
Caused by:
- Unknown
- Hereditary
- Diffuse idiopathic skeletal hyperostosis (DISH)
- Trauma
Diagnosed by:
- X-ray / MRI
Treatment:
- Medication to reduce inflammation and pain
- Manual therapy to surrounding musculature
- Cortisone injection
- Surgery indicated when airways are potentially being blocked
D) Space occupying lesion (Cyst)
Caused by:
- Genetics
- Chronic inflammatory conditions
- Trauma / Injury to arteries, veins, lymphatics
- Blockages to ducts
Diagnosed by:
- MRI
Treatment:
- Surgery
- Drainage
- Injecting cyst to reduce swelling and pain
- Laser removal
E) Space occupying lesion (Tumour)
Symptoms:
- May include systemic signs such as night pain, night sweats, fever, or enlarged lymph nodes
Caused by:
- Genetics
- Trauma / Injury
- Infectious disease
- Obesity
- Cigarette smoking / Excessive alcohol
Diagnosed by:
- MRI
Treatment:
- Surgery
- Radiation / Chemotherapy
Local peripheral nerve damage (Musculocutaneous, lateral / medial antebrachial)
- Numbness and tingling
- Sharp, jabbing, or throbbing pain
- Sensitive to touch
- Gradual onset of symptoms
- Caused by local trauma, repetitive movements, crushed, or cut nerves (surgery),
- Medical causes: Diabetes, Multiple sclerosis, Guillain-Barre syndrome
- Electromyography (EMG test), Ultrasound, Nerve conduction test
- Treatment: self-resolving in 12 months, Surgery, or may not fully resolve
Multiple sclerosis (F>M 20-40)
- Peripheral neuropathies
- Commonly unilateral
- Blurred or loss of vision in one eye
- May cause atrophy of muscles or loss of motor control
- May cause tremors
- Weakness in one or both arms
- Clumsiness of limb
- Diagnosed through MRI (looking for lesions on brain or spinal cord), Lumbar puncture looking for abnormalities in antibodies in cerebrospinal fluid associated with MS)
- Often a diagnosis of exclusion as other conditions produce similar symptoms
- Treatment: medication
Diabetes
- Feeling of thirst
- Losing weight
- Urinating often
- Blurry vision
- Hunger
- Numbness and tingling
- Tiredness
- Dry skin
- Wounds may have trouble healing
- Prolonged bruising
Type 1
- Condition where the pancreas produces little or no insulin
Caused by:
- Unknown, has genetic links
Diagnostic tests:
- Random blood-sugar test
- Glycated Hemoglobin A1C blood test measures your blood sugar level over 2–3-month period to determine if it is consistently high
Management:
- Insulin injections
- Insulin pump
Type 2 (more common)
- Condition where the pancreas does not produce enough insulin
- Insulin that is produced in the pancreas does not work effectively
- Insulin is produced in the pancreas, but the body’s cells do not respond effectively
Caused by:
- Family history
- Age 45+
- Overweight
- High blood pressure
- Polycystic ovarian syndrome
- Gestational diabetes
- Giving birth to baby over 4.5kg (9lbs)
Diagnostic tests:
- Glycated Hemoglobin A1C blood test measures your blood sugar level over 2-3 month period to determine if it is consistently high
- Fasting glucose test
Management:
- Medication
- Lifestyle changes
Reflex sympathetic dystrophy (Complex regional pain syndrome)
- Chronic limb pain
- Pain is greater than expected than injury that may have caused it
- Continuous throbbing, burning, numbness and tingling
- Sensitive to touch (painful)
- Skin colour and temperature changes
- Not well understood
- May be post-surgery, injury, stroke, or heart attack
- May involve abnormal inflammation or nerve dysfunction
![](https://www.diagnostica.education/wp-content/uploads/2024/05/Diagnostica-anatomy-page-inset-11-anterior-forearm-02.jpg)
ANTERIOR FOREARM
Medical Considerations
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Deep Vein Thrombosis (DVT)
- Blood clots forming in a deep vein
- Swelling and bruising
- Arm colour changing to blue
- Painful
- Increase in temperature
- May have NO painful symptoms
- Caused by: stationary for long periods, pregnancy, injury to vein, obesity, post-surgery, increased age, blood disorders
- Duplex ultrasonography: an imaging test that uses sound waves to look at blood flow in the veins
- Compression stocking and anti-coagulants (blood thinners given orally or by injection, typically do not break up clots, but prevent new ones from forming)
Fracture (Ulna / Radius)
- History of trauma
- Immediate swelling
- Tender to touch
- Bruising
- Unable to lift or turn arm
- May have visible signs of deformity
- Diagnosed via X-ray
Reflex sympathetic disorder / Complex regional pain syndrome (CRPS)
- Chronic limb pain
- Pain is greater than expected than injury that may have caused it
- Continuous throbbing, burning, numbness and tingling
- Sensitive to touch (painful)
- Skin colour and temperature changes
- Not well understood
- May be post-surgery, injury, stroke, or heart attack
- May involve abnormal inflammation or nerve dysfunction
Treatment: Challenging to manage as results vary between patients. Some options may include:
- Acupuncture
- Pain relief medication, anti inflammatory medication
- Nerve block injection, morphine
- Intravenous Ketamine
- Manual / Physical / Exercise therapy
- Meditation, relaxation therapies
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