The forearm is the area of ​​the upper limb (arm), starting from the elbow and ending at the wrist. The bones of the forearm are surrounded by muscle tissue, tendons and ligaments that control the movement of the hand and fingers. Almost all tissue structures of the forearm, including the periosteum, contain many sensitive receptors; therefore, 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 – the 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. The external fascial space contains the brachioradialis muscle and the extensor carpi longus and brevis muscles. Also in the anterior zone are muscles that form four connecting layers:

  • The rotator cuff muscle or pronator teres (m. pronator teres), as well as the wrist flexor muscle (flexor radialis), palmaris muscle.
  • Muscle – flexor of the fingers (superficial muscle – m. flexor digitorum superficialis), flexor of the hand, 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.
  • Square pronator (m. pronator quadratus), a muscle that controls rotation, inward movement of the hand.

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

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

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

Causes of pain in the muscles of the forearm

The main causes of pain in the muscles of the forearm are provoking factors related directly to the muscle tissue, and not to the joints or vascular system. It is believed that stretching of muscles and 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 etiological causes that doctors encounter as part of complex diagnostic measures.

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

  • Degenerative processes in the spinal column (osteochondrosis), mainly in the cervicothoracic region.
  • Prolonged stay in a static position – postural overstrain of the forearm muscles and corresponding muscular-tonic syndromes.
  • Immobilization of the hand for a long period.
  • Dynamic pressure of any intensity on the muscles for a long time.
  • Hypothermia, as a result, muscle inflammation – myositis.
  • Forearm injuries.
  • Stretching of muscle tissue, ligaments.

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

  • Pain is caused by injuries to the muscles of the forearm, mainly bruises. Also, a pain symptom in muscle tissue can occur with fractures, dislocations of the elbow joint, or wrist joint. If the bruise is severe and accompanied by muscle rupture, a subfascial hematoma may develop, which not only aggravates the pain, but can lead to dysfunction of the hand and fingers. The tendons of the forearm are injured extremely rarely; injuries can cause severe local pain and require surgical treatment. Late diagnosis of traumatic muscle injuries, especially the 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 work loads is often accompanied by degeneration of muscle tissue. The condition causes aching, long-lasting pain that can intensify with even greater strain, 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 tenosynovitis – crepitating and purulent tenosynovitis. The crepitant form in 90% of cases ends in myositis – inflammation of the forearm muscles
  • Carpal tunnel syndrome is also a pathological condition of the ligaments (hardening), nerve compression, 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 symptom complex that manifests itself mainly in women. The diagnostic criteria for MFPS are certain trigger pain zones, where spasmodic muscle areas are palpated as small compactions. Myofascial syndrome develops independently without visible organic damage, diseases of internal organs and is an independent nosological unit, poorly studied, quite difficult to identify 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 in nature, radiating to the shoulder, forearm, muscle pain appears with postural, static tension 7.
  • Plexopathies associated with brachial plexus dysfunction. Traumatic or tumor injuries are most often accompanied by pain in the muscles of the forearm, then the hand, in which paresis develops
  • Neuropathic damage to the radial nerve, which results in 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 aching muscle pain that does not subside with rest
  • Inflammation of muscle tissue – myositis. The inflammatory process can be triggered by an infectious disease, banal hypothermia or injury; there is also a form of “occupational” myositis, when pathological muscle damage is caused by constant static-dynamic load on the forearm

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

  • Scalenus syndrome (anterior scalene muscle syndrome).
  • Pectalgic syndrome or pectoral muscle syndrome.
  • Ischemic contracture or Volkmann’s syndrome, muscle lodge syndrome. The disease is caused by prolonged wearing of a too tight bandage, splint, or plaster, which causes significant compression of the muscle bed and, at the same time, hemorrhage, swelling, and hemorrhagic diathesis of the bed. Impaired blood supply, microcirculation, and stasis of venous blood lead to increasing pain and 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.
  • Joint diseases – arthritis, arthrosis, including rheumatic.
  • Osteomyelitis, osteoporosis, osteoarthritis.
  • Vascular insufficiency, thrombosis.
  • Osteochondrosis, including protrusions and hernias (radicular syndromes).
  • Metabolic disorders, water-salt balance.
  • Inflammatory process in the subcutaneous tissue.
  • Gout.
  • Cardiovascular diseases. In addition to the above reasons and factors, a pain symptom in the forearm can be a reflected signal, the source of which is located in the internal organs. An example of this is an attack of angina pectoris, when irradiation of pain is felt in the left arm, often in the forearm area.

To summarize, we can say that pain in the muscles of the antebachium (forearm) occurs as a result of traumatic, neurological, vertebrogenic, neuroreflex, vascular, infectious diseases and disorders.

Symptoms of pain in the muscles of the forearm

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

  • Muscle strain (training, physical work). The pain begins in the round muscle (pronator), it is aching, intensifies with any load on the arm, when lifting heavy objects, 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.
  • Paratenoitis (tenosynovitis) of the forearm. At the first stage, crepitus is expressed in imperceptible, transient aching pains that subside. The second stage develops rapidly, tendovaginitis 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 tenosynovitis is a specific sound, similar to a faint creaking or crackling (figurative comparison – snow crunching underfoot).
  • 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.
  • Neurogenic syndromes, like other radiculoalgia, are characterized by dagger-like, sharp pain, radiating above the forearm – into 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 with rest, and at the same time the absence of 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 arm, especially extension. The hand gradually weakens, sometimes to such an extent that grasping and holding a small object becomes a big problem.
  • Rheumatic joint lesions are typical of aching, “twisting” pain that comes from the periosteum affected by inflammation. Muscle pain manifests itself as a secondary signal of an aching nature, most often the tissue around the swollen joint is damaged.
  • Dysesthesia – burning, tingling sensation is more typical for 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 pain in the forearm muscles are very typical of myogenic sensations. The muscle becomes thicker from overexertion, more often this is manifested by aching pain, but the symptom is not felt on its own. It can intensify with palpation, squeezing the hand, flexion or extension, work of the hand, or from additional load on it. If the muscles do not relax, chronic nagging pain develops and an inflammatory process – myositis – can develop. In addition, with myalgia provoked by a vertebrogenic factor, sensations of numbness, coldness, and weakness in the fingers of the injured hand are possible. 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 requires not only knowledge, but also practical experience, as well as knowledge of all modern diagnostic methods and techniques.

    Diagnosis of pain in the muscles of the forearm

    Due to the non-specificity of symptoms, the diagnosis of pain in the muscles of the forearm should first of all be differential. The easiest way to determine a traumatic injury to the arm is a dislocation, a fracture, since their signs are obvious, and an x-ray confirms the injury.

    Unfortunately, a diagnostic standard – a system of “red pain flags” 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 pectoris, 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 may be secondary, referred.

    The main research methods that involve the diagnosis of pain in the forearm are as follows:

    • Questioning the patient, including clarification of provoking occupational factors to determine possible muscle strain syndrome. The characteristics of pain are also determined – intensity, sensations, localization, duration and dependence on changes in body posture and hand movements that the patient notices.
    • Visual examination of the patient’s upper body, not only the sore forearm, but also the second arm is examined.
    • Assessment and examination of neurological status, palpation of the sore arm, segmented areas of the spine.
    • Study of rotational movements – in the elbow and wrist joint.
    • X-ray of the spinal column. The cervical region is examined with functional tests.
    • To clarify the diagnosis, it is possible to prescribe a computed tomography or MRI to specify the nature of compression injuries (protrusion, hernia).
    • Electromyography, which assesses the bioelectric potential of muscle tissue and the level of its conductivity (the speed of pain signal).

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

    Little knowledge of muscle syndromes, too variable terminology describing a pain symptom in the muscles, and the lack 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, medicine of the 21st century has an excellent arsenal of various modern diagnostic technologies that make it possible to provide a three-dimensional image of any structure of the human body and determine almost all its characteristics. If all the signs are clarified, identifying the root cause of pain helps determine the tactics of effective therapy, according to the well-known medical proverb

    “Qui bene diagnoscit – bene curat” – whoever diagnoses correctly treats correctly.

    Treatment of pain in the muscles of the forearm

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

    As a rule, a patient comes to a medical facility with an exacerbation of a symptom, so the doctor’s first priority is to relieve pain.

    Treatment of pain in the muscles of the forearm, 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 MFPS – myofascial syndrome).
    • Immobilization of the hand. The forearm is given rest; orthoses, bandages, splints, and supports are less commonly applied. Splinting is carried out only when indicated.
    • Anti-inflammatory nonsteroidal drugs can be prescribed only if there are signs of an inflammatory process – purulent tendovaginitis, myositis, phlegmon, and so on.
    • Prescribing milorelaxants to relieve spasms.
    • Massage using warming or anesthetic drugs.
    • Application therapy.
    • Prescription of local physiotherapeutic procedures, most often electrophoresis.
    • Kinesiotherapy.
    • Surgical operations are rarely performed, only in the case of tumor processes, displaced fractures, rupture of tendons and muscle tissue.

    Rehabilitation measures, such as physical therapy, are not relevant for the forearm; rather, its damage is treated with the help of immobilization and actions aimed at eliminating the etiological cause of pain.

    Prevention of pain in the forearm muscles

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

    This is due to the fact that a significant part of the causes of pain in the hand is associated with occupational risks. Stereotypical, 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 do not decrease, measures to prevent carpal tunnel syndrome, tendovaginitis, scalenus syndrome, and other characteristic pain in the forearm and hand have been developed since the times of the Soviet Union. We provide general recommendations and excerpts from guidelines for the prevention of occupational diseases below:

  • When working, during activities, you should follow the laws of ergonomics, that is, monitor the correct posture, comfortable position of the hand and forearm 2.
  • To reduce the risk of muscle overload, it is necessary to properly organize the workplace.
  • Regular relaxation exercises, which should be done every 45 minutes, or at least every hour, will help avoid muscle pain. It is necessary to systematically change the muscle stereotype and give the hand other types of movements.
  • If the first discomfort appears in the forearm, the arm should be immobilized for at least 12 hours and the muscles should be given rest. Massage is acceptable after a day; earlier it can intensify pain and provoke swelling.

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

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