Forearm Fracture: Overview

The forearm consists of two bones:

• radius – the larger of the two bones that runs along the thumb side of your arm
• ulna – the smaller of the two bones that runs along the little finger side of your arm

A forearm fracture is caused by trauma to the bone. Trauma includes:

• falling on an outstretched arm
• falling directly on the forearm
• direct blow to the forearm
• twisting the arm beyond the elbow's normal range of motion

Risk factors that increase your chances of fracturing your forearm include:

• advanced age
• postmenopause
• decreased muscle mass
• osteoporosis
• poor nutrition
• certain congenital bone conditions
• participating in contact sports
• violence

Diagnosis

Symptoms include:

• pain, often severe
• tenderness, swelling, and bruising around the injury
• decreased range of motion
• a lump or visible deformity over the fracture site

The doctor will ask about your symptoms, physical activity, and how the injury occurred, then examine the injured area. Tests may include:

• x-rays
  This is a test that uses radiation to take a picture of structures inside the body, especially bones. It is used to look for a break in the forearm area.
• computed tomography (CT) scan
  This is a type of x-ray that uses computers to make pictures of structures inside the arm. It is used to look at the cartilage and tendons around the forearm. In complex fractures of both bones, it may be used to help reconstruct the bones.

Treatment Options

Treatment will depend on the severity of the injury. Treatment involves:

• putting the pieces of the bone back in place, which may require anaesthesia and/or surgery
• keeping the pieces together while the bone heals itself

Devices that may be used to hold the bone in place while it heals include:

• a cast or splint (may be used with or without surgery)
• a metal plate with screws (requires surgery)
• screws alone (requires surgery)

The doctor may prescribe pain medication depending on the level of pain. Your doctor will order more x-rays while the bone heals to ensure that the bones have not shifted position. It takes about eight to 10 weeks for a fractured forearm to heal.

When your doctor decides you are ready, start range-of-motion and strengthening exercises. You may be referred to a physical therapist to assist you with these exercises. Do not return to sports until your arm is fully healed.

To help prevent forearm fractures:

• Do not put yourself at risk for trauma to the arms.
• Eat a diet rich in calcium (pdf file) and vitamin D.
• Do weight-bearing exercises to build strong bones.
• Build strong muscles to prevent falls and protect the forearm.
• Wear proper padding and safety equipment when participating in sports or activities.

How can I prevent a forearm fracture?

Since forearm fractures are nearly always results of falls or other accidents, there is not much that can be done to prevent them. However, there are steps you can take to aid in the prevention of fractures:

• Eat a diet rich in calcium and vitamin D.
• Build strong muscles to prevent falls and stay agile.
• Wear proper padding and safety equipment when participating in sports or activities.

Improving Sports Performance

The key to improving sports performance after recovering from a forearm fracture is a proper a rehabilitation program, and adhering to some of those same principles after the injury is gone.

The single most important aspect of improving performance is stretching before and after you step onto the field, court, ice or golf course.

Benefits derived from stretching include:

• increased physical efficiency and performance
• decreased risk of injury
• increased blood supply and nutrients to joint structures
• increased coordination
• improved muscular balance and postural awareness
• decreased risk of lower-back pain
• reduced stress
• enhanced enjoyment

Rehabilitation for a forearm fracture

As an athlete, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important.

When your doctor decides you are ready, start range-of-motion and strengthening exercises. You may be referred to a physical therapist to assist you with these exercises.

Remember: Do not return to sports until your forearm is fully healed. The major objectives of rehabilitation from a forearm fracture are to improve the elasticity of the arm and gradually increase pain-free range of motion.

The exercises below stretch the muscles of the forearm and upper arm. These exercises should be performed once or twice daily.

• Wrist flexor stretch
  Extend affected arm forward with palm up and elbow straight. Place fingers and palm of opposite hand across palm and fingers of the extended hand and draw back with it until stretch is felt in the forearm. Hold this position for 3 to 5 seconds then relax for 3 to 5 seconds. Perform this exercise 10 times.
• Wrist extensor stretch
  Extend affected arm forward with palm down, elbow straight, and fingers slightly curled. Grasp the affected side hand with other hand and draw affected side hand down until stretch is felt in the forearm. Hold this position from 3 to 5 seconds then relax for 3 to 5 seconds. Perform this exercise 10 times.
• Pronation/Suppination stretch
  Extend affected arm forward in a hand-shaking position with palm facing up. Slowly rotate the hand from a palm-up position to a palm-down position. Hold for 3 to 5 seconds and then rotate back. Perform this exercise 10 times. When you work your way up to strength training, you may use a small weight while rotating the hand and wrist.
• Tricep stretch
  Stand erect with feet at about shoulder width. Raise injured arm at the shoulder with elbow bent and place the forearm behind the head. Grasp the injured elbow with opposite hand and draw it toward the center of the body until stretch is felt. Hold this position for 3 to 5 seconds, then relax for 3 to 5 seconds. Perform this exercise 10 times.
• Bicep stretch
  Stand erect with arms raised to shoulder height and palms up. Press arms backward until stretch is felt. Hold this position for 3 to 5 seconds, then relax for 3 to 5 seconds. Perform this exercise 10 times. The bicep is stretched by this exercise as well as the muscles of the shoulder and upper chest.

Strengthening exercises

The following exercises develop strength of the muscles of the forearm and upper arm. To maintain symmetry of the arms in terms of strength and appearance, perform these strength exercises with the uninjured arm as well as the injured arm.

• Wrist extension
  Sit in a chair with forearm resting on the end of a table, palm down. Grasp a light weight dumbbell and raise the weight up as high as possible while maintaining contact with the table top. Hold this position for 3 to 5 seconds. Relax for 3 to 5 seconds. Repeat this exercise 5 to 10 times. Substitute a heavier dumbbell as strength increases.
• Arm curls
  Either standing or sitting, grasp a two- to four-pound dumbbell in one hand. With palm up, flex elbow and draw the dumbbell up to the same side shoulder while maintaining erect posture. Do not bend at the waist or swing the dumbbell. Lower dumbbell slowly and with control to the starting position. Repeat this exercise 10 times. Use a heavier dumbbell as strength increases.

The following exercises may aid in restoring strength and range of motion to the hand, especially in cases where immobilization of the fingers and/or thumb is required.

• Ball squeeze
  Place a tennis ball or equivalent in the palm of the injured arm and squeeze as forcefully as pain permits for five seconds. Slowly relax the hand. Rest for five seconds. Repeat 10 times at least three times a day. Generally, the more often the sequence can be repeated in a day, the better. From day to day, pain should subside until the point where the exercise can be done without pain.
• Finger extension
  Place hand, palm forward, on a wall or other flat surface. Press the palm toward the flat surface as fully as pain permits and hold for five seconds. Return to starting position and rest for five seconds. Repeat this sequence 10 times at least three times a day. Generally, the more often the sequence can be repeated in a day, the better. From day to day, pain should subside until the point where the exercise can be done without pain.
• Thumb extension
  While seated, place the elbow of the injured-side arm on the same-side thigh with the elbow at a right angle and fingers extended. Grasp the injured arm's thumb with the forefinger of the opposite hand. Gently draw back on the thumb, stopping at the point of pain. Hold the thumb in this position for 10 seconds, then release and rest for 10 seconds. Do this sequence five times, three times per day. You should be able to draw the injured thumb back a bit further with each day.
• Thumb flexion
  While seated, place the elbow of the injured-side arm on the same-side thigh with the elbow at a right angle and fingers extended. Move the injured thumb inward so that the end of the thumb is brought as closely as first pain permits to the base of the small finger of the same hand. Hold this position for 10 seconds, then relax the injured thumb for five seconds. Perform this sequence 10 times, three times a day. From day to day it should be possible to press the injured thumb closer to the base of the same-side small finger. If not, see your doctor for advice.

Alternative exercises

During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:

• brisk walking
• stationary bicycle

Rehabilitation after surgery

Keep in mind that if your forearm fracture requires surgery, the soft tissue needs time to heal before exercise can begin.

A physical therapy program usually begins with range-of-motion and resistive exercises, then incorporates power, aerobic and muscular endurance, flexibility, and coordination drills.

Finally, patients develop speed and agility through sport-specific exercise routines.

The ultimate goal of surgery for a forearm fracture is to put the pieces of bone together so that they heal themselves. This will help provide dynamic stability while maintaining full range of motion, so that athletes can return to competitive or recreational sports. Progress is assessed by the patient's perception of how stable the wrist feels and by comparing the strength and stability of the injured and uninjured arms.

How long will the effects of my injury last?

It usually takes 8 to 10 weeks for a forearm fracture to heal. You may safely return to your sport or activity when the bones are healed and you have full strength and range of motion in the injured arm compared to the uninjured arm.

When can I return to my sport or activity?

Some may be ready for full participation in eight weeks, others not for four months or more. Of course, time for return to activity is much longer if surgery is necessary.

Remember: The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your forearm fracture recovers, not by how many days or weeks it has been since your injury occurred.