From the Guidelines
The main tendons in the forearm include the flexor tendons (flexor carpi radialis, flexor carpi ulnaris, palmaris longus, and flexor digitorum superficialis and profundus) which bend the wrist and fingers, and the extensor tendons (extensor carpi radialis longus and brevis, extensor carpi ulnaris, and extensor digitorum) which straighten the wrist and fingers. Injuries to these tendons are typically managed based on severity. For minor strains, the RICE protocol (Rest, Ice, Compression, Elevation) is recommended for 24-48 hours, followed by NSAIDs like ibuprofen (400-600mg three times daily) for pain and inflammation, as suggested by 1. Complete tendon ruptures or lacerations require surgical repair, ideally within 7-10 days of injury, with post-surgery rehabilitation programs lasting 8-12 weeks, beginning with protected immobilization for 3-4 weeks, followed by passive motion exercises, and gradually progressing to active motion and strengthening, as noted in 1. For tendinitis (tendon inflammation), treatment includes rest, NSAIDs, physical therapy with eccentric strengthening exercises, and possibly corticosteroid injections for persistent cases, as discussed in 1. Imaging studies such as radiography, US, or MRI without IV contrast may be used to assess suspected tendon, ligament, or muscle injury, as recommended in 1. These tendons are crucial for hand function, and proper management is essential to prevent long-term disability, as they have relatively poor blood supply which can slow healing and increase the risk of adhesions that limit movement.
Some key points to consider in managing forearm tendon injuries include:
- Relative rest to reduce activity and decrease repetitive loading of the damaged tendon, as encouraged by 1
- The use of analgesics such as NSAIDs to relieve pain and inflammation
- The potential benefits of surgical intervention for carefully selected patients with persistent pain despite conservative treatment, as mentioned in 1
- The importance of a structured rehabilitation program to promote healing and prevent long-term disability.
Overall, the management of forearm tendon injuries requires a comprehensive approach that takes into account the severity of the injury, the patient's overall health, and the potential risks and benefits of different treatment options, with the goal of optimizing outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Main Tendons in the Forearm
The main tendons in the forearm include the flexor and extensor tendons.
- Flexor tendons: responsible for wrist and finger flexion, including the flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, and flexor digitorum profundus 2, 3.
- Extensor tendons: responsible for wrist and finger extension, including the extensor carpi radialis brevis, extensor carpi radialis longus, extensor carpi ulnaris, and extensor digitorum communis 2.
Injuries to Forearm Tendons
Injuries to the forearm tendons can occur due to various reasons, including trauma, overuse, or repetitive strain.
- Treatment of injuries: the general principles of treatment of injuries of the flexor and extensor tendons in the hand and distal forearm are mentioned in 2.
- Management of tendon disorders: treatment strategies for tendon complaints vary considerably, and the given treatment is frequently based on empirical evidence only 4, 5.
Management of Tendon Injuries
Management of tendon injuries typically involves a combination of conservative and surgical treatments.
- Conservative treatment: includes rest, ice, compression, and elevation (RICE), as well as physical therapy and pain management 5.
- Surgical treatment: may be necessary for more severe injuries, such as tendon ruptures or chronic tendonitis 3, 5.
- Corticosteroid injections: may be used to reduce inflammation and relieve pain, but their use is controversial and should be carefully considered 4, 5.