Evaluation of Forearm Pain

Differential Diagnosis

Most Common

1. Fracture of the Radius or Ulna

2. Stress Fractures

Less Common

1. Forearm Compartment Syndrome

History

• Location and character of pain

• Onset: acute or insidious

• Aggravating and Alleviating Factors

• Paresthsias or neck pain.

• Change in training patterns

• Treatment

• Aleviation by rest

Examination

Always remember to examine the joint above (Shoulder) and below (Wrist).

Inspection

1. Scars or stretch marks

2. Wasting of muscles

3. Carrying angle (normal is 5-10 degrees for males and 10-15 degrees for females)

4. Swelling at olecranon

Palpation

1. Radius / Ulna

2. Olecranon

3. Muscles of Forearm

Motion

Note that range of movement is measured determined actively first, if there is a deficiency, move on to passive range of motion. Any deficits should be measured with a goniometer. Note should be made of discrepence between active and passive movement.

Motion of ligamentous instability should be assessed at 15 -30 degrees short of full extension. In particular, valgus stress should be applied (looking for disruption of the Medial Collateral Ligment)

Watch for a fixed flexion deformity, which may represent posterior impingement.

Muscles

Measurement of muscle strength using the Oxford (MRC) Scale.

1. Flexion

2. Extension

3. Pronation

4. Supination

NeuroVascular

1. Check and Grade reflexes (biceps (C5), brachioradialis (C6), and triceps (C7))

2. Check Pulses: Particularly important for Compartment Syndromes

3. Sensation in radial / ulnar / median nerve

4. Strength in radial / ulnar / median nerve

5. Two point discrimination in Ulnar Nerve distribution if Ulnar Nerve Entrapment suspected

Investigationsn

1. Plain Films: May reveal fractures. In minimally displaced fractures of the radial head, sometimes the only radiographic clue is the Anterior Sail Sign

Appendix

Elbow Joint Mechanics

+++ Prime Mover +Secondary Movers

Index

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