6 Signs of Spinal Stenosis

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Article feature on Spine-Health

Does your back, arm, or leg pain seem to come and go, depending on what you’re doing at the moment? This sign may indicate spinal stenosis.

Spinal stenosis happens when the bony openings for your spinal nerves (foramen) and/or the spinal cord (central canal) become narrow. This narrowing may compress your spinal cord and/or spinal nerves and can develop at various points along your spine. Spinal stenosis is a condition that’s more likely to occur in people over 60 years of age and tends to worsen as the years add up.

Here are 6 typical signs and symptoms to watch out for if you suspect your pain is from spinal stenosis. Depending on the type and location of the stenosis, one or more symptoms may be experienced:

1. Neurogenic claudication

When the nerves in your lower back get compressed, you may experience neurogenic claudication in your legs. Neurogenic claudication usually has the following characteristics:

  • Constant pain and/or numbness in your legs while standing
  • Increased pain and/or numbness in your legs while walking variable distances and/or while bending the spine backward
  • Difficulty in performing upright exercises or activities
  • Improvement or resolution of pain and/or numbness with rest

Neurogenic claudication pain is typically relieved when you bend your spine forward (such as while leaning on a shopping cart/walker, squatting, or sitting and leaning forward).

Your doctor will likely need to differentiate this pain from vascular claudication, which can mimic neurogenic claudication.

2. Sciatica

Compression of the nerve roots in your lower back may lead to lumbar radiculopathy or sciatica (depending on the nerve roots affected). Sciatica is experienced as nerve pain and weakness typically felt in one leg at a time.

Depending on the nerve root(s) affected, pain may occur in your lower back, buttock, thigh, calf, leg, and/or foot. A pins-and-needles sensation, tingling, weakness, and/or numbness may also occur in the areas affected by pain.

3. Foot drop

Compression of the L4 and L5 nerve roots in the lower spine may cause motor weakness in your foot, resulting in foot drop. This condition typically causes a feeling of weakness while attempting to lift the foot and/or toes upward. As a result, the individual may involuntarily drag their foot or tend to trip while attempting to walk.

The compression of the S1 nerve root may cause weakness while walking on tip-toes.

4. Gait problems

Spinal stenosis can affect walking in different ways depending on its location within the spine, for example:

  • Lumbar spinal stenosis (in the lower back) may cause gait problems due to foot drop. The condition may also cause weakness in thigh and leg muscles, such as the quadriceps and the calves.
  • Cervical spinal stenosis (in the neck) with spinal cord compression may cause difficulty in maintaining balance while walking, especially in the dark. However, cervical spine stenosis with a pinched nerve does not cause gait imbalance.

Changes in gait may be too subtle to notice at first. Over time, the condition may present with progressively increasing falls.

5. Radiating arm pain

Cervical spinal stenosis may cause mild to moderate burning or shock-like pain in the neck, shoulder, and/or arms. Abnormal sensations, such as tingling, crawling, and/or numbness may be felt in both hands. The arms and hands may feel weak.

6. Loss of fine motor skills

Spinal stenosis in the cervical spine may cause difficulty in doing tasks that involve fine motor skills of the hand, such as buttoning a shirt. In the advanced stages, there may be difficulty with writing, eventually making holding a pen impossible. 6

If these symptoms sound familiar, check with your doctor, since spinal stenosis may get worse without treatment.

Red-flag signs and symptoms of spinal stenosis

Rarely, severe spinal stenosis may cause red-flag symptoms, such as bowel and/or bladder incontinence, numbness in the inner thighs and genital area, and/or severe weakness in both legs.

These symptoms indicate a serious medical condition, such as cauda equina syndrome, which must be treated urgently to prevent permanent loss of function in the legs.

An accurate diagnosis by a medical professional is necessary to determine the underlying cause of spinal stenosis. Depending on the cause and severity, your doctor may suggest nonsurgical treatments, such as physical therapy, pain-relieving medications, and/or activity modification. Sometimes, minimally invasive procedures, such as epidural steroid injections may be advised. Surgery is rarely advocated as the first-line treatment unless there are severe symptoms or neurologic deficits.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

What are Hand, Wrist or Elbow Dislocations?

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Article featured on Mercy Health

What are hand, wrist or elbow dislocations?

Hand dislocations occur when one of the eight carpal bones (bones located at the base of the hand) fall out of the joint to cause a hand dislocation. The capitate (largest bone in the hand) or lunate bones are the bones that most frequently dislocate.

Wrist dislocations occur when one of the eight bones of the wrist fall out of socket due to a fall.

Elbow dislocations occur when the joints of the elbows somehow separate. In a partial elbow dislocation, the joint surfaces are not completely separated (also known as subluxation), while in a complete dislocation, the joint surfaces are completely dislocated.

Causes of hand, wrist or elbow dislocations

  • Hand dislocations typically occur when direct, intense force is applied to the wrist and the hand is bent backward.
  • High impact sports such as basketball and football are common causes of hand, wrist or elbow dislocations – football and basketball players can dislocate finger joints when striking the ball, the ground or another player.
  • A hard blow to the joint, for example in a car accident, could cause a hand, wrist or elbow dislocation.

Risk factors of hand, wrist or elbow dislocations

Risk factors of hand, wrist or elbow dislocations are:

  • Participating in high impact, extreme sporting activities, such as football and hockey can put people at higher risk for a hand, wrist or elbow dislocation
  • Sports where falls are common, such as volleyball, gymnastics and downhill skiing put people at a higher risk of hand, wrist or elbow dislocations
  • Some people are born with ligaments and joints that are more prone to injury
  • Patients who are more susceptible to falls (such as the elderly) are at a higher risk for hand, wrist or elbow dislocations

Symptoms of hand, wrist or elbow dislocations

Symptoms of hand, wrist or elbow dislocations include:

  • Visible deformities in the hand, wrist or elbow after trauma
  • Inability to move your hand, wrist or elbow
  • Severe pain in the affected area
  • Swelling in the hands, wrists or elbow
  • Misshaped appearance of the hand, wrist or elbow
  • Numbness

Diagnosis of a hand, wrist or elbow dislocation

If you suspect you have a hand, wrist or elbow dislocation, visit the ER right away. It is crucial to treat a hand, wrist or elbow dislocation right away to avoid developing arthritis or death of bone tissue. When possible, ice the joint and keep it immobile while waiting to see the physician.

Hand, wrist or elbow dislocations are diagnosed in a physical exam and with an x-ray, MRI or CT scan to evaluate the extent of the injury and determine the best course of treatment.

Treatments for hand, wrist or elbow dislocations

Wrist dislocations typically require surgery by a hand or wrist orthopedic surgeon.

The hand surgeon will place the bones back into the correct location as well as repair the ligaments and soft tissue surrounding the injury during the procedure.

After the procedure, the wrist will be immobilized in a cast for eight weeks to ensure proper healing.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

How to Tell if You Fractured Your Forearm

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Article featured on Raleigh Orthopaedic

The forearm is made up of two bones in your lower arm, the radius and ulna. A fracture in the forearm can occur near the wrist, in the middle of the forearm or near the elbow. The forearm motion allows us to rotate our palms up or down. A broken forearm can affect your ability to rotate your arm and even bend or straighten the wrist and elbow.

A bone may be completely fractured or partially fractured in any number of ways (crosswise, lengthwise, in multiple pieces). If the bone breaks in such a way that bone fragments stick out through the skin, or a wound penetrates down to the broken bone, the fracture is called an “open” fracture and requires immediate attention. Call 911 or go to your nearest emergency room.

Cause of a fractured forearm

  • A direct blow to the forearm
  • Fall on an outstretched arm

What are the symptoms of a broken forearm?

  • Immediate pain in the lower arm
  • Obvious deformity
  • Swelling
  • Bruising
  • Inability to rotate the arm

To determine whether you have broken forearm, your physician will ask you for a complete medical history and conduct a physical examination. An X-ray can confirm the diagnosis.

How do you treat a fractured forearm?

In an emergency room or urgent care, forearm fracture treatment begins with stabilizing the bones and temporarily realigning them with a cast or splint.

Nonsurgical treatment for a broken forearm

If the broken bone is in a good position or can be put back into good alignment, a cast can be used to keep the forearm steady until it heals. An orthopedic physician will monitor the healing of the fracture with frequent clinic visits and X-rays.

Broken forearm surgery

If the broken bone is out of place and the alignment cannot be corrected, surgery may be required. Surgery is also necessary for open fractures where the bones have broken through the skin. This type of forearm surgery depends on where the break in the bones occurred and the severity of the break. Your surgeon will determine the best surgery for your injury.

Rehabilitation

Recovery for a broken forearm depends on the severity of the injury. Forearm bones typically take three to six months to fully heal. The more severe your injury, the longer the recovery may be.

Rehabilitation usually begins are a few weeks of healing. Sometimes you may still use a cast or brace during the beginning stages of physical therapy. Physical therapy will focus on strength and range of motion exercises.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Causes and Treatment of a Bicep Tear or Strain

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Article featured on MercyHealth

What is a bicep tear or strain?

A bicep tear is a strain or tear in the bicep muscle that can occur in the shoulder or elbow. The tear can be complete (the tendon has torn completely away from the bone) or partial.

Bicep tears or strains are classified as grades 1 – 3 depending upon severity of the injury.

Types of bicep tears or strains

  • Grade 1 — minor injury that involves overstretching the biceps muscle or tendon, typically without a loss of strength or mobility.
  • Grade 2 — causes moderate tearing in the biceps or tendon with some loss of mobility or strength.
  • Grade 3 — a complete rupture of the biceps muscle or tendon, may require surgery to repair.

Causes of a bicep tear or strain

There are a variety of causes for a bicep tear or strain including:

  • Constant overuse — sports that require repetitive movement on the bicep in the shoulder or elbow can cause a bicep tear or strain.
  • Acute injury — moving or twisting your elbow in an unfamiliar way can cause a bicep tear or strain, for example, falling on an outstretched arm.

Risk factors for a bicep tear or strain

Individuals at risk for a bicep tear or strain include:

  • People who participate in sports that require throwing, such as baseball or softball
  • People with poor circulation
  • People with previous shoulder or other upper-arm injuries
  • People who don’t warm up for sporting activities as much as they should

Symptoms of bicep tear or strain

The most common symptom of a bicep tear or strain is a sudden burst of pain in the upper arm near the shoulder. You could also hear a “popping” sound as the tendon tears. Other signs that you may have torn a bicep tendon can include:

  • Weakness in the shoulder
  • Bruising on the upper arm
  • Inability to move or rotate your arm
  • Change in the look of the bicep in the upper arm (it may look popped out)
  • Muscle spasms

Diagnosis of bicep tear or strain

Your doctor can diagnose a bicep tear or strain in a full physical exam. Your doctor will ascertain your symptoms and medical history before performing physical tests. In a complete tear, diagnosis is obvious due to the appearance of a bump on the upper arm.

Other shoulder conditions, such as rotator cuff injuries, shoulder impingement and shoulder tendinitis, often accompany a bicep tear.

Your doctor may order diagnostic tests, like an x-ray or MRI, to evaluate the severity of the injury and if you have any other conditions.

Treatment of bicep tear or strain

In most cases, nonsurgical treatments will relieve the symptoms associated with a torn or strained bicep. Nonsurgical treatment options include rest, ice and anti-inflammatory medications.

Other nonsurgical treatments may include:

  • Physical therapy and rehabilitation — exercises to help improve shoulder flexibility and build shoulder strength, your physical therapist will develop a treatment plan that is customized for you.
  • Platelet rich plasma (PRP) therapy — helps speed up the recovery process up by injecting concentrated growth factor platelets from your blood back into the affected shoulder. PRP therapy is a newer treatment option for soft tissue injuries.

It is rare for a patient to need surgical treatment for a bicep tear. Candidates for surgery include:

  • People who experience chronic cramping or muscle pain in the bicep near the shoulder
  • Athletes who need to have complete range of motion restored
  • People who have occupations that demand full range of motion in the shoulder

There are several surgeries your surgeon could recommend to repair bicep tear including:

  • Bicep tenodesis — bicep tenodesis surgery will anchor the ruptured end of the biceps tendon to the bone with a screw.
  • Acromioplasty and direct tenodesis — this is a procedure that is more commonly performed on younger patients who have a history of prior shoulder injuries.

Recovery from bicep tear or strain

The time needed to recover from a bicep tear or strain will depend on many factors, including age and health of patient, as well as severity of the injury. Mild injuries take ten weeks or more, while more severe injuries that require surgery can take months to fully recover function.

Your physical therapist and orthopedic surgeon will require you to wear a sling for four weeks following surgery and gradually build up your strengthening exercises as you get stronger. Physical therapy will be crucial to strengthening the muscles to allow you to return to your day-to-day activities.

During the recovery process, avoid participating in activities that cause pain (other than physical therapy).

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

What You Need to Know About Torn Bicep Tendon Injuries

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Your bicep is the muscle in the front of your upper arm. It helps you bend your elbow and twist your forearm.

Three tendons attach your bicep to bone:

  • The long head tendon attaches your bicep to the top of your shoulder socket.
  • The short head tendon attaches your bicep to a bump on your shoulder blade called the coracoid process.
  • A third tendon attaches your bicep to your radius, which is one of the bones in your forearms.

When you have a torn bicep, one of these tendons is damaged or detaches from the bone. Any of these three bicep tendons can tear.

Types of bicep tendon tear injuries

There are three types of bicep tendon tear injuries, categorized by their location and severity. Tears can also be partial (in which a tendon is damaged) or complete (in which the tendon completely detaches from the bone).

The three types of bicep tendon tear injuries are:

Proximal biceps tendon tear at shoulder

This injury occurs when one of the tendons that attaches the bicep to the shoulder tears. The long head tendon is more likely to tear than the short head tendon. This type of tear often starts as normal tendon fraying, but can also tear if you get injured.

It’s likely that only one part of the tendon will tear in this injury. This means that you can usually continue to use your arm. However, a bicep tendon tear at the shoulder may damage other parts of the shoulder at the same time.

Distal biceps tendonitis and tear at the elbow

A bicep tendon tear at the elbow usually happens when the elbow is pushed straight against a heavy weight. This stress can tear the tendon from the bone, and usually causes a complete tear.

When you tear your bicep tendon at the elbow, your other arm muscles will compensate, so you’ll still have full range of motion. However, your arm will most likely lose strength if the tendon is not repaired. Bicep tendon tears at the elbow are not common. They happen to approximately 3 to 5 people per 100,000 per year. They’re also less common in women. Distal biceps tendonitis is inflammation in the biceps tendon near the elbow. It’s usually caused by normal wear and tear but repetitive motion can make it worse.

Tendonitis (microtears from use)

Tendonitis is the inflammation or irritation of the long head of the bicep tendon. This can cause microtears. As with distal biceps tendonitis, tendonitis of the long head of the biceps tendon is usually due to normal wear and tear, but can also be made worse by repetitive motion. It often happens with other shoulder problems, such as arthritis, shoulder impingement, and chronic shoulder dislocation.

Torn bicep tendon symptoms

Symptoms of a torn bicep tendon include:

  • a “pop” or tearing sensation when the injury happens
  • warmth around the injury
  • swelling
  • bruising
  • pain or ache at the injury site, and throughout your arm (usually severe at first, and may get better over a few weeks)
  • arm weakness
  • difficulty turning your palm
  • fatigue or increased pain in your arm when you do repetitive activity
  • bulge in your upper arm, because the bicep is no longer being held in place (you might also see a gap or indentation in front of your elbow)

Causes of a torn bicep tendon

The two main causes of a torn bicep tendon are injury and overuse. Injuries might be caused by lifting something heavy or falling on your arm. Most tears of the elbow bicep tendon happen because of an injury.

Overuse can cause the tendons to wear down or fray over time. This happens naturally as you age. It may also be made worse by repetitive motion, and is common in people who participate in sports such as weightlifting, tennis, or swimming.

Diagnosing a torn bicep tendon

To diagnose a torn bicep tendon, a doctor will first take a medical history. They’ll ask about your symptoms, whether you had any recent injuries, and when the pain began.

Then they’ll do a physical exam to test your range of motion and strength. During these tests, they’ll see if you have pain or difficulty with certain movements, especially rotations. They’ll also look at your arm for swelling, bruising, or bulging.

A history and physical exam are often enough to diagnose a bicep tendon tear. However, your doctor might also do an X-ray to help rule out any bone injuries, or an MRI to see if the tear is partial or complete.

Torn bicep treatment

Treatment for a torn bicep will mostly depend on how severe the tear is, as well as your overall bicep function and whether you damaged any other body part, such as your rotator cuff. Potential treatments include:

Rest

Taking time off from exercising, lifting, or holding anything heavy — and using your arm as little as possible — can help you recover, especially from overuse injuries. Be sure to avoid any activity that causes pain, even if it doesn’t seem strenuous.

NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are over-the-counter medications that help reduce inflammation. They can help reduce the inflammation (the hallmark of tendonitis), as well as help reduce swelling from bicep tears. They can also help reduce the pain you might have from any bicep tendon injuries.

Physical therapy

Physical therapy can help you regain strength and range of motion after a bicep tendon injury. A physical therapist will take you through a series of motions designed to help heal your injury and relieve pain.

A physical therapist or your doctor might also give you exercises to do at home when you’re healed enough to do so. These might include exercises to flex and extend your arm, arm rotations, and strength-building exercises like bicep curls.

Torn bicep surgery

If none of the measures above help your bicep injury heal, or if more than half the tendon is torn, your doctor might recommend surgery to repair the bicep tendon.

Many doctors will recommend surgery as a first-line treatment for bicep tendon tears at the elbow, although surgery can also be done later if other treatments don’t restore range of motion and strength.

Surgery is used to reattach the tendon to the bone. Complications of surgery are rare, but may include arm numbness or weakness. In some people, the tendon can tear again.

Torn bicep tendon recovery time

Recovery time depends on the severity of the bicep tendon tear, as well as type of treatment. Even mild injuries can take at least two months to heal. It often takes four to five months before you can start returning to normal activities.

After surgery, you’ll probably need to wear a sling or otherwise immobilize your arm such as in a splint or cast for four to six weeks. You’ll then have to do physical therapy and exercises to help strengthen your arm and improve range of motion.

Complete recovery from surgery can take up to a year, although most people recover much of their range of motion and strength in four to six months.

Takeaway

Bicep tendon tears can be serious, but many respond to nonsurgical treatment, such as rest and physical therapy. If you think you might have injured your bicep tendon, see a doctor as soon as possible. Getting a diagnosis and treatment early can help you recover more fully.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Adult Forearm Fractures

Adult Forearm Fractures

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Article Featured on AAOS

Your forearm is made up of two bones, the radius and ulna. In most cases of adult forearm fractures, both bones are broken.

Fractures of the forearm can occur near the wrist at the farthest (distal) end of the bone, in the middle of the forearm, or near the elbow at the top (proximal) end of the bone. This article focuses on fractures that occur in the middle segments of the radius and ulna. Fractures that involve the wrist or the elbow are discussed in separate articles.

Anatomy

If you hold your arms at your side with your palms facing up, the ulna is the bone closest to your body and the radius is closest to your thumb. The ulna is larger at the elbow — it forms the “point” of your elbow — and the radius is larger at the wrist.

The primary motion of the forearm is rotation: the ability to turn our palms up or down. The ulna stays still while the radius rotates around it. This is the motion used to turn a screwdriver or twist in a light bulb. Forearm fractures can affect your ability to rotate your arm, as well as bend and straighten the wrist and elbow.

Description

Forearm bones can break in several ways. The bone can crack just slightly, or can break into many pieces. The broken pieces of bone may line up straight or may be far out of place.

Fractures of both the radius and ulna.

Fractures of both the radius and ulna.

In some cases, the bone will break in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone. This is called an open fracture and requires immediate medical attention because of the risk for infection.

Because of the strong force required to break the radius or ulna in the middle of the bone, it is more common for adults to break both bones during a forearm injury. When only one bone in the forearm is broken, it is typically the ulna — usually as a result of a direct blow to the outside of your arm when you have it raised in self defense.

Related Articles

DISEASES & CONDITIONS

Fractures (Broken Bones)

TREATMENT

Internal Fixation for Fractures

RECOVERY

Care of Casts and Splints

DISEASES & CONDITIONS

Distal Radius Fractures (Broken Wrist)

Cause

The most common causes of forearm fractures include:

  • Direct blow
  • Fall on an outstretched arm, often during sports or from a height
  • Automobile/motorcycle accidents

Symptoms

A broken forearm usually causes immediate pain. Because both bones are usually involved, forearm fractures often cause an obvious deformity — your forearm may appear bent and shorter than your other arm. You will most likely need to support your injured arm with your other hand.

Additional symptoms include:

  • Swelling
  • Bruising (not as common as in other broken bones)
  • Inability to rotate arm
  • Numbness or weakness in the fingers or wrist (rare)

Doctor Examination

Most people with forearm fractures will go to an urgent care center or emergency room for initial treatment.

Physical Examination and Medical History

It is important that your doctor knows the circumstances of your injury. For example, if you fell from a ladder, how far did you fall? It is just as important for your doctor to know if you sustained any other injuries and if you have any other medical problems, such as diabetes. Your doctor also needs to know if you take any medications.

After discussing your symptoms and medical history, your doctor will do a careful examination. Your doctor will:

  • Examine your skin to see if there are any cuts from the injury. Bone fragments can break through the skin and create lacerations. This leads to an increased risk for infection.
  • Palpate (feel) all around your arm to determine if there are any other areas of tenderness. This can indicate other broken bones or injuries.
  • Check your pulse at the wrist to be sure that good blood flow is getting through your forearm to your hand.
  • Check to see if you can move your fingers and wrist, and can feel things with your fingers. Sometimes, nerves may be injured at the same time that the bone is broken, which can result in hand and wrist weakness and numbness.
  • The doctor may examine your shoulder, upper arm, elbow, wrist, and hand, even if you only complain of arm pain.

X-rays

X-rays are the most common and widely available diagnostic imaging technique. X-rays can show if the bone is broken and whether there is displacement (the gap between broken bones). They can also show how many pieces of broken bone there are.

Treatment

Treatment of broken bones follows one basic rule: the broken pieces must be put back into position and prevented from moving out of place until they are healed. Because the radius and ulna rely on each other for support, it is important that they are properly stabilized. If the bones are not accurately aligned during healing, it may result in future problems with wrist and elbow movement.

Most cases of adult forearm fractures require surgery to make sure the bones are stabilized and lined up for successful healing.

Immediate Treatment

While you are in the emergency room, the doctor may try to temporarily realign the bones, depending upon how far out of place the pieces are. “Reduction” is the technical term for this process in which the doctor moves the pieces into place. This is not a surgical procedure. Your pain will be controlled with medication. Afterward, your doctor will apply a splint (like a cast) to your forearm and provide a sling to keep your arm in position. Unlike a full cast, a splint can be tightened or loosened, and allows swelling to occur safely.

forearm fracture splint application

The emergency room doctor may apply a splint to protect your arm.

Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

It is very important to control the movement of a broken bone. Moving a broken bone can cause additional damage to the bone, nearby blood vessels, and nerves or other tissues surrounding the bone.

Additional immediate treatment will include applying ice to help reduce swelling, and providing you with pain medicine.

Nonsurgical Treatment

If only one bone is broken and it is not out of place, it may be possible to treat it with a cast or brace. Your doctor will closely monitor the healing of the fracture, and have you return to the clinic for x-rays frequently. If the fracture shifts in position, you may require surgery to put the bones back together.

Surgical Treatment

When both forearm bones are broken, or if the bones have punctured the skin (open fracture), surgery is usually required.

Because of the increased risk for infection, open fractures are usually scheduled for surgery immediately. Patients are typically given antibiotics by vein (intravenous) in the emergency room, and may receive a tetanus shot. During surgery, the cuts from the injury will be thoroughly cleaned out. The broken bones are typically fixed during the same surgery.

If the skin around your fracture has not been broken, your doctor may recommend waiting until swelling has gone down before having surgery. Keeping your arm immobilized and elevated for several days will decrease swelling. It also gives skin that has been stretched a chance to recover.

Open reduction and internal fixation with plates and screws. This is the most common type of surgical repair for forearm fractures. During this type of procedure, the bone fragments are first repositioned (reduced) into their normal alignment. They are held together with special screws and metal plates attached to the outer surface of the bone.

forearm fracture fixation with plates and screws

The broken bones of the forearm are held in position by plates and screws while they heal.

Open reduction and internal fixation with rods. During this procedure, a specially designed metal rod is inserted through the marrow space in the center of the bone.

External fixation. If the skin and bone are severely damaged, using plates and screws and large incisions may injure the skin further. This may result in infection. In this case, you may be treated with an external fixator. In this type of operation, metal pins or screws are placed into the bone above and below the fracture site. The pins and screws are attached to a bar outside the skin. This device is a stabilizing frame that holds the bones in the proper position so they can heal.

Complications

Complications from Forearm Fractures

Forearm fractures can cause further injury and complications.

  • The ends of broken bones are often sharp and can cut or tear surrounding blood vessels or nerves.
  • Excessive bleeding and swelling right after the injury may lead to acute compartment syndrome, a condition in which the swelling cuts off blood supply to the hand and forearm. It typically occurs within 24 to 48 hours of the injury and causes severe pain when moving the fingers. Compartment syndrome can result in loss of sensation and function, and requires emergency surgery once it is diagnosed. In such cases, the skin and muscle coverings are opened and left open to relieve pressure and allow blood to return.
  • Open fractures expose the bone to the outside environment. Even with good surgical cleaning of the bone and muscle, the bone can become infected. Bone infection is difficult to treat and often requires multiple surgeries and long-term antibiotics.

Complications from Surgery

There are risks associated with all surgery. If your doctor recommends surgery, he or she thinks that the possible benefits of surgery outweigh the risks.

  • Infection. There is a risk of infection with any surgery, whether it is for a forearm fracture or another purpose.
  • Damage to nerves and blood vessels. There is a minor risk of injury to nerves and blood vessels around the forearm. Although some temporary numbness is common right after your injury, if you experience persistent numbness or tingling in your fingers, contact your doctor.
  • Synostosis. Another rare complication is healing between the two bones of the forearm with a bridge of bone known as synostosis. This can decrease the rotation of the bones and prevent full movement.
  • Nonunion. Surgery does not guarantee healing of the fracture. A fracture may pull apart, or the screws, plates, or rods may shift or break. This can occur for a variety of reasons, including:
    • The patient does not follow directions after surgery.
    • The patient has other health issues that slow healing. Some diseases, like diabetes, slow healing. Smoking or using other tobacco products also slow healing.
    • If the fracture was associated with a cut in the skin (an open fracture), healing is often slower.
    • Infections can also slow or prevent healing.

If the fracture fails to heal, further surgery may be needed.

Recovery

Bones have a remarkable capacity to heal. Forearm bones typically take 3 to 6 months to fully heal. The more severe your injury, however, the longer your recovery may be.

Pain Management

Pain after an injury or surgery is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover faster.

Medications are often prescribed for short-term pain relief after surgery or an injury. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

Be aware that although opioids help relieve pain after surgery or an injury, they are a narcotic and can be addictive.  It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your treatment.

Rehabilitation

Nonsurgical treatment. Rehabilitation typically begins after a few weeks of keeping the arm still by using a cast or brace. In many cases, a physical therapist will help with rehabilitation, beginning with gentle exercises to increase range of motion, and gradually adding exercises to strengthen the arm.

Surgical treatment. Depending on the complexity of the fracture and the stability of the repair, a cast or brace may be necessary for 2 to 6 weeks after surgery. Motion exercises for the forearm, elbow, and wrist usually begin shortly after surgery. This early motion is important to prevent stiffness. Your doctor may also prescribe visits to a physical or occupational therapist, depending on how long your arm was immobilized.

Outcome

Some stiffness after healing is common, but this does not usually affect the overall function of your arm.

Your doctor will advise you on when you may return to work and sports activities. This varies depending on the fracture pattern and the type and stability of the repair.

If you have had surgery, the plates and screws are usually left in place forever. If you consider removal, this second surgery is typically not scheduled until your bones have fully solidified (1 to 2 years after initial surgery)