Forearm Fracture

with Rehab

ExitCare ImageA break (fracture) of the thumb side forearm bone (radius) and/or little finger side forearm bone (ulna) is a common injury for athletes. This document does not discuss fracture of these bones that extends into either the elbow or wrist joint.

SYMPTOMS

  • Severe pain in the forearm at the time of injury.

  • Tenderness, swelling, and later bruising (contusion) of the forearm, and possibly the hand.

  • Visible deformity, if the bone fragments are out of alignment (displaced fracture).

  • Numbness, coldness, or paralysis below the fracture site, from pressure on or stretching of blood vessels or nerves (uncommon).

CAUSES

Fractures occur when a force is placed on the bone that is greater than it can withstand. Common causes of injury for forearm fracture include:

  • Direct hit (trauma) to the forearm.

  • Indirect trauma, due to falling on an outstretched hand, twisting injury, or violent muscle contraction.

RISK INCREASES WITH:

  • Contact sports (football, rugby, soccer, martial arts, hockey).

  • History of bone or joint disease (osteoporosis, bone tumor).

  • Previous restraint of the forearm.

  • Poor strength and flexibility.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Wear properly fitted and padded protective equipment.

PROGNOSIS

If treated properly, forearm fractures can usually be cured within 6 to 8 weeks in adults, and 4 to 6 weeks in children.

RELATED COMPLICATIONS

  • Bone fails to heal (nonunion).

  • Bone heals in a poor position (malunion).

  • Chronic pain, stiffness, loss of motion, or swelling of the elbow or wrist.

  • Excessive bleeding in the forearm, causing pressure and injury to nerves and blood vessels.

  • Calcium deposits in the soft tissues (heterotopic ossification).

  • Injury to the nerves of the hand or wrist, due to stretching from the injury, causing numbness, weakness, or paralysis.

  • Shortening of the arm.

  • Loss of motion of the elbow or wrist.

TREATMENT

If the bones are not aligned, treatment first involves realigning the bones (reduction). After reduction, or if the fracture is properly aligned, ice and medicine should be used to reduce pain and inflammation. The wrist, forearm, and elbow should then be restrained, to allow for healing. If the fracture is severe and/or the bones protrude through the skin, surgery may be necessary. After restraint (with or without surgery), stretching and strengthening exercises should be performed to help regain strength and a full range of motion. Rehabilitation exercises are usually completed with the assistance of a therapist.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are needed. Use only as directed and only as much as you need.

COLD THERAPY

Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Pain, tenderness, or swelling gets worse, despite treatment.

  • You experience pain, numbness, or coldness in the hand.

  • Blue, gray, or dark color appears in the fingernails.

  • Any of the following occur after surgery: fever, increased pain, swelling, redness, drainage, or bleeding in the affected area.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Forearm Fracture

These exercises may help you when beginning to recover from your injury. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image RANGE OF MOTION – Wrist Flexion, Active-Assisted

  • Extend your right / left elbow, with your palm turned toward you and your fingers pointing down.*

  • Gently pull the back of your hand towards you until you feel a gentle stretch on the top of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If directed by your physician, physical therapist or athletic trainer, complete this stretch with your elbow bent, rather than extended.

ExitCare Image RANGE OF MOTION – Wrist Extension, Active-Assisted

  • Extend your right / left elbow and turn your palm upwards.*

  • Gently pull your palm/fingertips back so your wrist extends and your fingers point more toward the ground.

  • You should feel a gentle stretch on the inside of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If directed by your physician, physical therapist or athletic trainer, complete this stretch with your elbow bent, rather than extended.

ExitCare Image STRETCH - Wrist Flexion

  • Place the back of your right / left hand on a tabletop, leaving your elbow slightly bent. Your fingers should point away from your body.

  • Gently press the back of your hand down onto the table, by straightening your elbow. You should feel a stretch on the top of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH – Wrist Extension

  • Place your right / left fingertips on a tabletop, leaving your elbow slightly bent. Your fingers should point backwards.

  • Gently press your fingers and palm down onto the table by straightening your elbow. You should feel a stretch on the inside of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image RANGE OF MOTION – Supination, Active

  • Stand or sit with your elbows at your side. Bend your right / left elbow to 90 degrees.

  • Turn your palm upward, until you feel a gentle stretch on the inside of your forearm.

  • Hold this position for __________ seconds. Slowly release and return to the starting position.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image RANGE OF MOTION – Pronation, Active

  • Stand or sit with your elbows at your side. Bend your right / left elbow to 90 degrees.

  • Turn your palm downward, until you feel a gentle stretch on the top of your forearm.

  • Hold this position for __________ seconds. Slowly release and return to the starting position.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Forearm Fracture

These exercises may help you when beginning to recover from your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does get worse, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

ExitCare Image STRENGTH – Wrist Flexors

  • Sit with your right / left forearm palm-up, and fully supported on a table. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.

  • Loosely holding a __________ weight, or holding a rubber exercise band or tubing in both hands, slowly curl your hand up toward your forearm.

  • Hold this position for __________ seconds. Slowly lower the wrist back to the starting position, in a controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Wrist Extensors

  • Sit with your right / left forearm palm-down and fully supported on a table. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.

  • Loosely holding a __________ weight, or holding a rubber exercise band or tubing in both hands, slowly curl your hand up toward your forearm.

  • Hold this position for __________ seconds. Slowly lower the wrist back to the starting position, in a controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Ulnar Deviators

  • Stand with a ____________________ weight in your right / left hand, or sit while holding onto a rubber exercise band or tubing in both hands, with your healthy arm supported on a table, and your injured arm below the table.

  • Move only your right / left wrist, so that your pinkie travels toward your forearm and your thumb moves away from your forearm.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day

ExitCare Image STRENGTH - Radial Deviators

  • Stand with a ____________________ weight in your right / left hand, or sit while holding onto a rubber exercise band or tubing in both hands, with your right / left arm supported on a table, and your healthy arm below the table.

  • Raise your right / left hand upward in front of you, so that your thumb moves toward your forearm.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Forearm Supinators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm down.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward, to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Forearm Pronators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm up.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward, to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Grip

  • Hold a tennis ball, dense sponge, or large, rolled sock in your hand.

  • Squeeze as hard as you can, without increasing any pain.

  • Hold this position for __________ seconds. Release your grip slowly.

Repeat __________ times. Complete this exercise __________ times per day.