Elbow and forearm pain
Elbow and forearm pain – conditions treated are listed and then discussed below.
FSM, Active release techniques and dry needling are particularly effective.
Extensor tendinopathy (‘tennis elbow’)
What is it?
Commonly referred to as ‘tennis elbow’, extensor tendinopathy refers to degeneration and inflammation
within the tendons on the outside of the elbow. These tendons connect the forearm muscles to the arm
bone. These muscles function to move the wrist, hand and fingers.
How does it happen?
Extensor tendinopathy is a common injury associated with activities requiring repetitive use of the wrist and
hand, and results from overuse of the tendons on the outside of the forearm. The function of these tendons
is to transmit forces produced by the forearm muscles to their origin from the arm bone. Repetitive use of
the forearm muscles and, therefore, the forearm tendons can lead to microscopic tears within the tendons
and degeneration or breakdown of the tendons. To repair this degeneration the body commences an
inflammatory response.
How does it feel?
The primary sensation with extensor tendinopathy is pain felt on the outside of the elbow and forearm. This
pain typically develops gradually. Initially, it may only be painful following exercise. Associated with the pain
may be stiffness or tightness in the elbow and forearm region. Typically, these initial signs of extensor
tendinopathy are ignored, as they disappear quickly with use of the arm or applying heat (i.e. a hot shower)
over the elbow and forearm region. However, as you continue to exercise, the tendinopathy progresses and
the pain within the tendon becomes more intense and more frequent. In the earlier stages, this pain during
exercise may initially disappear as you warm up, only to return when you cool down. However, as you
continue to exercise, the tendinopathy worsens and your pain may begin to be present for longer periods
during exercise until it is present all of the time. This may interfere with your performance.
What should you do?
Extensor tendinopathy generally does not get better on its own if the cause is not addressed and you
continue to exercise. If you have or suspect you have extensor tendinopathy, you should consult your
nearest sports medicine professional. In the meantime, you can begin initial treatment. This should consist
of icing following exercise and regular gentle stretching of the forearm muscles. Icing should consist of
crushed ice wrapped in a moist towel applied for 15–20 minutes or ice in a paper cup massaged over the
outside of the elbow until the skin is numb.
What shouldn’t you do?
If you have or suspect you have extensor tendinopathy you shouldn’t ignore the problem. Your pain may get
better as you exercise; however, the exercise you are doing may be interfering with the healing process and
causing further damage. This can lead to your injury getting worse such that your pain does not ‘warm up’
and you feel it throughout exercise. If this occurs, your recovery may be prolonged and it may take a
number of weeks or months for you to return to exercise and sport.
Could there be any long-term effects?
Extensor tendinopathy does not produce any long-term effects, as long as it is properly diagnosed and
appropriately treated. If not, it can lead to prolonged pain on the outside of the elbow and a prolonged lay-off
from exercise and sport.
Management
The assistance of a sports medicine professional is important in the treatment of extensor tendinopathy.
Initially, they can assist in diagnosing the problem and establishing its severity. An ultrasound examination
may be required to confirm the diagnosis. From this, the sports medicine professional will be able to
determine an appropriate treatment plan. This may involve activity modification, soft tissue treatment such
as massage and stretching, and the progression through a series of specific strengthening exercises. The
sports medicine professional will also be able to assess and determine why you developed extensor
tendinopathy and address this during your recovery to prevent a re-occurrence when you return to full
activity.
BRUKNER AND KHAN, CLINICAL SPORTS MEDICINE 3E, MCGRAW-HILL PROFESSIONAL
Entrapment of the posterior interosseous nerve
What is it?
Entrapment of the posterior interosseous nerve refers to when the posterior interosseous nerve becomes
caught as it travels through the supinator muscle on the outside of the elbow and forearm.
How does it happen?
Entrapment of the posterior interosseous nerve may result from adhesions developing between the nerve
and the supinator muscle through which it passes to gain entry to the forearm. These adhesions may restrict
how much the nerve can slide forwards and backwards as the arm is moved. This may cause overstretching
of the nerve at the site of the adhesions resulting in the interference of signals being transmitted by the
nerve. Alternatively, the posterior interosseous nerve may be entrapped if the supinator muscle through
which it passes is excessively large or tight. This may compress the nerve and interfere with the
transmission of its signals.
How does it feel?
When the posterior interosseous nerve is entrapped, the most common sensation felt is pain. This is usually
experienced on the outside of the forearm about four finger breadths down from the elbow joint. It is often
made worse by turning the forearm so that the palm of the hand faces upwards.
What should you do?
Entrapment of the posterior interosseous nerve generally does not get better on its own if the cause of the
entrapment is not treated. If you have or suspect that you have posterior interosseous nerve entrapment,
you should consult your nearest sports medicine professional. In the meantime, you should avoid activities
which aggravate or provoke your pain. These may lead to the further entrapment and worsening of your
pain.
What shouldn’t you do?
If you have or suspect you have entrapment of the posterior interosseous nerve, you shouldn’t ignore the
problem. This can lead to your injury getting worse which may prolong your recovery.
Could there be any long-term effects?
Entrapment of the posterior interosseous nerve does not usually produce any long-term effects, as long as it
is properly diagnosed and appropriately treated. If not, it can lead to ongoing pain in the elbow and a
prolonged lay-off from exercise and sport. In some situations, this may occur despite appropriate treatment.
In these cases surgery may be required to remove the structures which have entrapped the nerve, so as to
alleviate your pain.
Management
The assistance of a sports medicine professional is important in the treatment of an entrapped posterior
interosseous nerve. Initially, they can assist in diagnosing the cause of the problem and establishing its
severity. This may require the use of special nerve conduction tests which assess the transmission of
signals along the nerve. From their assessment, the sports medicine professional will be able to determine
an appropriate treatment plan. This may involve activity modification and soft tissue treatment such as
massage and stretching. The sports medicine professional will also be able to assess and determine why
you developed entrapment of the posterior interosseous nerve and address this during your recovery to
prevent a re-occurrence when you return to exercise and sport.
BRUKNER AND KHAN, CLINICAL SPORTS MEDICINE 3E, MCGRAW-HILL PROFESSIONAL
Flexor tendinopathy (‘golfer’s elbow’)
What is it?
Commonly referred to as ‘golfer’s elbow’, flexor tendinopathy refers to degeneration and inflammation within
the tendons on the inside of the elbow. These tendons connect the forearm muscles to their origin from the
arm bone. These muscles function to move the wrist, hand and fingers.
How does it happen?
Flexor tendinopathy is a common injury in activities requiring a lot of use of the wrist and hand, and results
from overuse of the tendons on the inside of the forearm. The function of these tendons are to transmit
forces produced by the forearm muscles to their origin from the arm bone. Repetitive use of the forearm
muscles and, therefore, the forearm tendons can lead to microscopic tears within the tendons and
degeneration or breakdown of the tendons. To repair this damage the body commences an inflammatory
response.
How does it feel?
The primary sensation with flexor tendinopathy is pain felt along the inside of the elbow and forearm. This
pain typically develops gradually. Initially it may only be painful following exercise. Associated with the pain
may be stiffness or tightness in the elbow and forearm region. Typically, these initial signs of flexor
tendinopathy are ignored as they disappear quickly with use of the arm or applying heat (i.e. a hot shower)
over the elbow and forearm region. However, as you continue to exercise, the tendinopathy progresses and
the pain within the tendon becomes more intense and more frequent. In the earlier stages, this pain during
exercise may initially disappear as you warm up only to return when you cool down. However, as you
continue to exercise, the tendinopathy worsens and your pain may begin to be present for longer periods
during exercise until it is present all of the time. This may interfere with your performance.
What should you do?
Flexor tendinopathy generally does not get better on its own if the cause is not addressed and you continue
to exercise. If you have or suspect you have flexor tendinopathy, you should consult your nearest sports
medicine professional. In the meantime you can begin initial treatment. This should consist of icing
following exercise and regular gentle stretching of the forearm muscles. Icing should consist of crushed ice
wrapped in a moist towel applied for 15–20 minutes or ice in a paper cup massaged over the inside of the
elbow until the skin is numb.
What shouldn’t you do?
If you have or suspect that you have flexor tendinopathy, you shouldn’t ignore the problem. Your pain may
get better as you exercise; however, the exercise you are doing may be interfering with the healing process
and causing further damage. This can lead to your injury getting worse such that your pain does not ‘warm
up’ and you feel it throughout exercise. If this occurs, your recovery may be prolonged and it may take a
number of weeks or months for you to return to exercise and sport.
Could there be any long-term effects?
Flexor tendinopathy does not produce any long-term effects, as long as it is properly diagnosed and
appropriately treated. If not, it can lead to prolonged pain along the inside of the elbow and a prolonged lay-
off from exercise and sport.
Management
The assistance of a sports medicine professional is important in the treatment of flexor tendinopathy.
Initially, they can assist in diagnosing the problem and establishing its severity. This may require the use of
imaging techniques such as ultrasound. From this, the sports medicine professional will be able to
determine an appropriate treatment plan. This may involve activity modification, soft tissue treatment such
as massage and stretching, and the progression through a series of specific strengthening exercises. The
sports medicine professional will also be able to assess and determine why you developed flexor
tendinopathy and address this during your recovery to prevent a re-occurrence when you return to exercise
and sport.
BRUKNER AND KHAN, CLINICAL SPORTS MEDICINE 3E, MCGRAW-HILL PROFESSIONAL
Medial collateral ligament sprain
What is it?
A medial collateral ligament sprain refers to when the ligament which runs down and supports the inner
aspect of the elbow joint is overstretched and injured.
How does it happen?
The medial collateral ligament may be overstretched following a single incident such as when your elbow is
bent the wrong way or, more commonly, as a result of continuous stretching of the ligament over a period of
time. The latter frequently occurs in sports involving throwing. When the arm is ‘wound up’ or ‘cocked’ prior
to throwing, a lot of stress is placed on the medial collateral ligament of the elbow. When performed
repeatedly over a period of time, this may cause overstretching of the ligament and subsequent inflammation
and scarring within the ligament.
How does it feel?
When the medial collateral ligament is overstretched, the most common sensation felt is pain. This is usually
felt along the inside surface of the elbow. If the medial collateral ligament is injured following a single
incident, this pain will be felt at the time of the injury. However, if the collateral ligament is injured due to
repeated stretching of the ligament, it may develop more gradually. Initially, the pain may only be present
following a session of hard throwing. However, as you throw more, the pain may progress to become
present during throwing. In the earlier stages, this pain during exercise may initially disappear as you warm
up, only to return when you cool down. As it progresses further, the pain may begin to be present for longer
periods during exercise until it is present all the time.
What should you do?
To limit the severity of a medial collateral ligament injury it is advised that you stop your activity immediately
and start initial treatment. The most important time in the treatment of any injury is the first 24–48 hours.
Swelling is a necessary step in the healing process; however too much swelling can delay healing and cause
further tissue damage. To control the amount of swelling and limit the degree of damage to the elbow, the
RICE regime should be commenced (Rest, Ice, Compression, Elevation). This will help to reduce blood flow
to the injured area, thereby, reducing the extent of swelling and tissue damage.
If your medial collateral ligament has developed due to repeated minor trauma to the ligament, the
inflammatory process taking place may have become chronic. Therefore, it may not respond as well to the
RICE regime. However, it is still advised you follow this regime. This will help control the inflammation and
swelling, and help reduce your pain. In addition, it is advised you avoid the activities you think may have
caused your injury, such as throwing. Following this, you should consult your nearest sports medicine
professional for specific treatment.
What shouldn’t you do?
If you have or suspect you have injured your medial collateral ligament, you shouldn’t undertake activities
which increase blood flow to the injured area. These include hot showers, heat rubs, the consumption of
alcohol and excessive activity. These may increase the bleeding and swelling around the injured ligament
and potentially prolong your recovery. In addition, you shouldn’t continue to exercise until you have seen a
sports medicine professional. This may lead to further stretching and injury to the ligament.
Could there be any long-term effects?
Medial collateral ligament injuries generally heal without complication or long-term effects within a matter of
weeks. However, a proportion of injuries can result in longer-term effects, depending on the severity of the
injury and extent of damage. When the medial collateral ligament is injured, it is not uncommon to also
injure surrounding structures. Injury to these structures may prolong your recovery. Similarly, recovery may
be delayed if the injury is not appropriately diagnosed and managed. This may result in a poorly healed
ligament which is susceptible to reinjury when you return to exercise and sport.
Management
The assistance of a sports medicine professional is important in the treatment of a medial collateral ligament
injury. Initially, they can assist in diagnosing the problem and its severity. This may require the use of
imaging techniques such as ultrasound, X-ray or MRI. From this, the sports medicine professional will be
able to determine an appropriate treatment plan. This may involve activity modification, soft tissue treatment
such as massage and stretching, and the progression through a series of specific strengthening exercises.
The sports medicine professional will also be able to assess why you developed a medial collateral ligament
injury and address this during your recovery to prevent a re-occurrence when you return to full activity.
BRUKNER AND KHAN, CLINICAL SPORTS MEDICINE 3E, MCGRAW-HILL PROFESSIONAL
Ulnar nerve compression at the elbow
What is it?
Ulnar nerve compression refers to when the ulnar nerve is compressed as it passes behind the bony bump
on the inside of the elbow. This bony bump is often referred to as the ‘funny bone’.
How does it happen?
Ulnar nerve compression typically occurs following a direct blow to the nerve as it passes behind the inside
of the elbow. This can occur when you use your elbow to break your fall and when you bang your elbow on
a hard surface such as a table. This may injure the nerve directly and interfere with the transmission of
signals along it. Alternatively, it may injure structures surrounding the nerve. To repair damage to these
structures, the body commences an inflammatory response. This inflammation around the nerve may
compress it and interfere with the transmission of signals.
How does it feel?
When the ulnar nerve is compressed, you may experience changes in sensation in the area of skin the nerve
supplies. This area includes the inside of the forearm, the palm of the hand on the little finger side, the little
finger and half of the ring finger. In these areas, sensory changes may include a feeling of pins and needles
or numbness. In addition to sensory changes, you may also experience some tenderness if you touch the
nerve where it is compressed or inflamed. This is usually behind the inside of the elbow.
What should you do?
Ulnar nerve compression generally does not get better on its own if the cause of the compression is not
treated. If you have or suspect you have compression of the ulnar nerve, you should consult your nearest
sports medicine professional. If you have numbness in your forearm or hand, you should be careful near hot
objects. Contact of these with the numb area of skin may result in a burn.
What shouldn’t you do?
If you have or suspect that you have ulnar nerve compression, you shouldn’t ignore the problem. This can
lead to your injury getting worse which may prolong your recovery.
Could there be any long-term effects?
Ulnar nerve compression does not usually produce any long-term effects, as long as it is properly diagnosed
and appropriately treated. If not, it can lead to ongoing altered sensation in the forearm and hand, and a
prolonged lay-off from exercise and sport. In some situations, this may occur despite appropriate treatment.
In these cases, surgery may be required to remove the structures which are compressing the nerve, so as to
alleviate your symptoms.
Management
The assistance of a sports medicine professional is important in the treatment of ulnar nerve compression.
Initially, they can assist in diagnosing the cause of the problem and establishing its severity. This may
require the use of special nerve conduction tests which assess the transmission of signals along the nerve.
From their assessment, the sports medicine professional will be able to determine an appropriate treatment
plan. This may involve activity modification and soft tissue treatment such as massage and stretching. The
sports medicine professional will also be able to assess and determine why you developed ulnar nerve
compression and address this during your recovery to prevent a re-occurrence when you return to full
activity. This may require the wearing of elbow pads to prevent reinjury to the nerve.
BRUKNER AND KHAN, CLINICAL SPORTS MEDICINE 3E, MCGRAW-HILL PROFESSIONAL
Olecranon bursitis
What is it?
Also known as ‘student’s elbow’, olecranon bursitis refers to inflammation and swelling of the bursa located
between the point of the elbow (olecranon) and overlying skin. A bursa is a fluid-filled sac which allows
adjacent tissues to slide over one another without friction.
How does it happen?
Olecranon bursitis occurs when the olecranon bursa is damaged or irritated. This can occur following either a single injury
or a series of injuries to the bursa. Injury may result from a direct blow to the point of the elbow such as falling on a hard
surface with your elbow being used to stop the fall. This can damage blood vessels within the olecranon bursa, causing
bleeding. The blood in the bursa causes an inflammatory response resulting in swelling of the bursa and subsequent
bursitis. Another cause of olecranon bursitis is repeated minor trauma. This can occur when you repeatedly rest on your
elbows on a hard surface for long periods of time such as when working or studying. Thus, the term ‘student’s elbow’. This
increases wear and tear on the bursa causing microtrauma which, over time, can result in bursal thickening, inflammation
and bursitis.
How does it feel?
Olecranon bursitis causes pain and swelling over the point of the elbow. You may feel the pain most when you lean on
your elbows or when you bend and straighten your arm. The swelling may be substantial, resulting in distension of the
bursa and a large bulge over the point of the elbow. There may also be small lumps that can be felt underneath the skin
over the point of the elbow. These lumps result from the thickening of the bursal sac and may give you pain and the
feeling that something is floating around under the skin.
What should you do?
To limit the severity of olecranon bursitis, it is advised that you stop your activity immediately and start initial
treatment. The most important time in the treatment of any injury is the first 24–48 hours. Swelling is a
necessary step in the healing process, however too much swelling can delay healing and cause further
tissue damage. To control the amount of swelling and limit the degree of damage to the elbow, the RICE
regime should be commenced (Rest, Ice, Compression, Elevation). This will help to reduce blood flow to the
injured area, thereby reducing the extent of swelling and tissue damage.
If your bursitis develops from repeated minor trauma to the olecranon bursa, the inflammatory process taking
place may have become chronic. Therefore, it may not respond as well to the RICE regime. However, it is
still advised you follow this regime. This will help control the inflammation and swelling, and help reduce
your pain. In addition, it is advised you avoid the activities you think may have caused your bursitis, such as
leaning on your elbows on a hard surface. If this is not possible, you should take regular breaks and cushion
the point of your elbow to reduce pressure and friction on the olecranon bursa. Following this, you should
consult your nearest sports medicine professional, as bursitis of this type often requires active treatment in
the form of anti-inflammatory drugs or an injection to resolve it.
What shouldn’t you do?
In the first few days following an injury to the olecranon bursa, you shouldn’t undertake activities which
increase blood flow to the elbow. These include hot showers, heat rubs, massage, the consumption of
alcohol and excessive activity. These can prolong bleeding in the bursa resulting in further swelling and an
extended recovery. In olecranon bursitis caused by repeated minor trauma you should also avoid these
activities until you consult your nearest sports medicine professional, as they can make your swelling worse.
In addition, you shouldn’t undertake any activity which involves resting on your elbows. This could further
irritate the olecranon bursa, making the pain and swelling worse.
Management
The assistance of a sports medicine professional is important in the treatment of olecranon bursitis. In
bursitis caused by an injury, they will able to assist in determining the extent of damage to the bursa and
whether any surrounding tissues have been injured. From this, an estimation of how long your injury is
expected to take to heal can be provided. The sports medicine professional can also use a number of
treatment techniques to assist in reducing the pain and swelling, and enhance the healing of the injured
structures. This will facilitate your return to activity.
In olecranon bursitis caused by repeated minor trauma, the sports medicine professional will be able to
assist in identifying the cause and how best to stimulate healing, thereby reducing your pain and swelling. In
some situations, this may involve draining the swelling in the bursa, taking anti-inflammatory medications or
injecting a small quantity of anti-inflammatory directly into the bursa to stimulate healing. Following healing,
the sports medicine professional will be able to advise on how to prevent this injury from re-occurring.
BRUKNER AND KHAN, CLINICAL SPORTS MEDICINE 3E, MCGRAW-HILL PROFESSIONAL
Posterior dislocation of the elbow joint
What is it?
A posterior dislocation of the elbow joint refers to when the bones that join to make the elbow joint shift on
one another such that the joint surfaces are no longer in contact.
How does it happen?
When forces acting on the elbow joint are too great for the supporting muscles and ligaments to resist, the
elbow joint may be caused to dislocate. This usually requires considerable force and can occur following a
direct impact to the arm such as occurs in contact sports or following a fall from a height.
How does it feel?
The first sensation felt when the elbow is dislocated is immediate and intense pain felt in and around the
elbow. It is usually so intense that you cradle your arm against your body with your other arm. At the time of
injury, you may have also sensed something ‘popping out’. This ‘popping out’ or dislocation of the joint is
often visible when you compare the appearance and contours of the injured elbow to the opposite side.
What should you do?
A posterior dislocation of the elbow is a serious injury which requires immediate medical attention. When
you dislocate your elbow, occasionally the artery which supplies blood to the forearm, wrist and hand may be
injured. Damage to this blood vessel can have dire consequences if it is not treated immediately. If you
have or suspect you have dislocated your elbow you should go directly to your nearest emergency
department. To support your arm whilst travelling, you should wear an arm sling or, if one is not available,
fold up the bottom half of your jumper or shirt to support and cradle your arm. To help with your pain, you
can apply ice to the elbow. Ideally, this should be in the form of crushed ice wrapped in a moist towel or
cloth applied for up to 20 minutes.
What shouldn’t you do?
If you have or suspect that you have dislocated your elbow, the main thing you shouldn’t do is try to ‘reduce’
or relocate the bones back into their normal position. This requires the assistance of a doctor. If not done
properly, serious damage may be done to other structures (arteries, nerves, bones, ligaments, cartilage),
resulting in irreparable damage and/or a longer recovery time. In addition, you shouldn’t undertake any
activities which increase blood flow to the injured site. These include hot showers, heat rubs, the
consumption of alcohol and massage. These will cause further swelling in the damaged tissues, resulting in
a prolonged recovery.
Could there be any long-term effects?
Due to the seriousness of an elbow dislocation there are potential long-term effects. When the elbow joint is
dislocated it is not uncommon to injure surrounding structures. The most significant of these is the artery
supplying blood to the forearm, wrist and hand. Injury to this artery may lead to damage to tissues in these
regions reducing the function of your arm. In addition to damage to blood vessels, when the elbow is
dislocated, it is not uncommon to overstretch ligaments, compress nerves, break bones and damage the
cartilage lining the joint surfaces of the elbow joint. Injury to these structures may prolong your recovery and
result in ongoing elbow problems.
Management
The assistance of a sports medicine professional is important in the treatment of a dislocated elbow. Initially,
they can confirm that the elbow is actually dislocated. If it is, they can assist in relocating or ‘reducing’ the
bones back into their normal position and assess whether the artery to forearm, wrist and hand has been
damaged. Following this, they can assess whether any other tissues have been damaged and the extent of
this damage. An X-ray may be ordered to determine whether any of the bones are damaged. From this,
they can provide you with an estimation of how long the injury is expected to take to heal. During your
recovery, the sport medicine professional will be able to assist in reducing your pain and promoting your
recovery. This may involve wearing a sling for the first few weeks, followed by a progression of exercises
designed to return you back to full function and reduce the risk of ongoing elbow problems.
BRUKNER AND KHAN, CLINICAL SPORTS MEDICINE 3E, MCGRAW-HILL PROFESSIONAL
Fracture of the radius and ulna
What is it?
A fracture of the radius and ulna refers to a break in the two bones within the forearm.
How does it happen?
A fracture of the radius and ulna are typically caused by a fall where you land on an outstretched hand or
forearm. These bones may also be broken by hitting your forearm on a stationary object or being struck by
an object travelling at high speed.
How does it feel?
The first sensation felt when the radius and ulna are broken is immediate and intense pain felt in the forearm.
This pain is often so intense that you cradle your injured arm against your body with your other arm. When
you look at the forearm there may be an obvious deformity. This results from movement or displacement of
the bone pieces when the bones are broken.
What should you do?
A fracture of the distal radius and ulna is a serious injury which requires immediate medical attention. If you
suspect a fracture, it is advised you cease your activity or sport, begin initial treatment and seek immediate
medical attention. Initial treatment involves immobilising the arm as soon as possible using splints and
bandages. You may alternatively place the arm in a sling if a splint is not available.
What shouldn’t you do?
If you have or suspect that you have fractured your radius and ulna, you shouldn’t perform any activities
which may cause the broken ends of the bone to move on one another. To achieve this, you shouldn’t use
or bend the injured arm until it has been assessed by a sports medicine professional. In addition, you should
avoid any activities which may increase the blood flow to the injured area. These include hot showers, heat
rubs, massage and the consumption of alcohol. These may increase bleeding and swelling around the
broken ends of bone and potentially prolong your recovery.
Could there be any long-term effects?
Most fractures of the radius and ulna heal without complication, in a matter of weeks. However, a proportion
of injuries can result in longer-term effects, depending on the severity of the injury and extent of damage.
When the radius and ulna are broken a number of nearby structures may also be injured. These include
nerves, blood vessels, ligaments, muscles and tendons. Injury to these structures may delay your recovery.
Management
The assistance of a sports medicine professional is important in the treatment of a fractured radius and ulna.
Initially, they can assist in diagnosing the injury and the extent of the damage. An X-ray may be used to
confirm the diagnosis. From this, they can provide you with an estimation of how long the injury is expected
to take to heal and determine the appropriate treatment. Treatment may involve applying an arm cast and
wearing a sling or, in some cases, surgery to put the bones back in their original position and to hold them
there. If a cast is required, a sports medicine professional will be able to assist you when the bones have
healed and the cast is removed. When a cast is applied, the joints within the cast become stiff and the
muscles lose strength. Although range of movement and strength will gradually return as you use your
forearm, the return is slow and often not complete, predisposing you to other injuries. A sports medicine
professional can facilitate the return of your joint range of movement and muscle strength, and ensure that
upon return to activity and sport you are at minimal risk of further injury.
BRUKNER AND KHAN, CLINICAL SPORTS MEDICINE 3E, MCGRAW-HILL PROFESSIONAL
Fracture of the distal radius and ulna
What is it?
Often referred to a ‘Colles’ fracture’, a fracture of the distal radius and ulna refers to a break in the forearm
bones just above the wrist joint.
How does it happen?
A fracture of the distal radius and ulna are most frequently caused by a fall where you land on an
outstretched hand.
How does it feel?
The first sensation felt when the distal radius and ulna are fractured is immediate and intense pain felt just
above the wrist joint. This pain is often so intense that you cradle your injured arm against your body with
your other arm. When you look at the back of the wrist there may be an obvious bump or deformity. This
results from displacement of the bone pieces when the bones are broken.
What should you do?
A fracture of the distal radius and ulna is a serious injury which requires immediate medical attention. If you
have or suspect you have this injury, you should cease participating and go directly to your nearest sports
medicine professional. To support your arm whilst travelling you should wear an arm sling or, if one is not
available, fold up the bottom half of your jumper or shirt to support and cradle your arm. To help with your
pain and reduce and control any swelling, you should apply ice to the wrist. Ideally, this should be in the
form of crushed ice wrapped in a moist towel or cloth applied for up to 20 minutes. You should also apply
compression. Compression involves the application of a firm elastic bandage around the injured site. It
should be firm but not tight enough to cause you increased pain.
What shouldn’t you do?
If you have or suspect you have fractured your distal radius and ulna, you shouldn’t perform any activities
which may cause the broken ends of the bone to move on one another. To do achieve this, you shouldn’t
use the injured arm until it has been assessed by a sports medicine professional. In addition, you should
avoid any activities which may increase the blood flow to the injured area. These include hot showers, heat
rubs, massage and the consumption of alcohol. These may increase bleeding and swelling around the
broken ends of bone and potentially prolong your recovery.
Could there be any long-term effects?
Most fractures of the distal radius and ulna heal without complication in a matter of weeks. However, a
proportion of injuries can result in longer-term effects, depending on the severity of the injury and extent of
damage. When the distal radius and ulna are broken, a number of nearby structures may also be injured.
These include the cartilage lining the surfaces of the wrist joint, nerves, blood vessels, ligaments and
tendons. Injury to these structures may delay your recovery. In addition, injury to the cartilage can increase
your chance of developing arthritis within the wrist later in life.
Management
The assistance of a sports medicine professional is important in the treatment of a fractured distal radius and
ulna. Initially, they can assist in diagnosing the injury and the extent of the damage. This may require the
use of an X-ray to view the bones. From this, they can provide you with a determination of how long the
injury is expected to take to heal and determine the appropriate treatment. This may involve applying an arm
cast and wearing a sling or, in some cases, surgery to put the bones back in their original position and hold
them there. If a cast is required, a sports medicine professional will be able to assist you when the bones
have healed and the cast is removed. When a cast is applied, the joints within the cast become stiff and the
muscles lose strength. Although range of movement and strength will gradually return as you use your wrist,
the return is slow and often not complete, predisposing you to other injuries. A sports medicine professional
can facilitate the return of your joint range of movement and muscle strength, and ensure that upon return to
participation you are at minimal risk of further injury.