What are the treatment options for upper arm posterior and forearm boggy swelling after bowling for 2 hours?

Treatment of Upper Arm and Forearm Boggy Swelling After Bowling

Immediately stop bowling, apply ice for 20-30 minutes (3-4 times daily using ice and water in a damp cloth), rest the arm completely, and seek medical evaluation to exclude fracture or serious soft tissue injury. 1

Immediate First Aid Management

The 2024 American Heart Association/American Red Cross guidelines provide clear direction for acute extremity injuries:

• Stop all activity immediately – any painful extremity injury that limits use requires cessation of the aggravating activity and medical attention 1
• Apply cold therapy properly – use a bag filled with ice and water surrounded by a damp cloth (most effective cooling method), applied for 20-30 minutes per session, 3-4 times daily 1
• Never place ice directly on skin – this prevents cold injury while still providing therapeutic benefit 1
• Avoid activities that cause pain – rest is the mainstay of treatment for strains and sprains 1

Important caveat: Cold application decreases pain and swelling acutely but has not been demonstrated to improve function or speed recovery time. 1

When to Seek Urgent Medical Evaluation

You should obtain medical evaluation because:

• "Boggy swelling" suggests significant soft tissue injury that could represent muscle strain, tendon injury, or occult fracture 2
• Plain radiographs are the mandatory first imaging study to exclude fracture, even with seemingly minor trauma 1, 2, 3
• Swelling that persists beyond 7 days warrants investigation – physiological post-traumatic swelling should resolve within the first week 4

Red flags requiring immediate emergency evaluation:

• Inability to move the arm 1
• Visible deformity 1
• Severe pain disproportionate to the injury 1
• Numbness or tingling (suggesting nerve involvement) 1
• Fever, spreading redness, or warmth (suggesting infection) 2

Diagnostic Approach

The American College of Radiology provides a clear imaging algorithm:

• Start with plain radiographs of the upper arm and forearm – this is the appropriate first-line study to exclude fracture 1, 2, 3
• If radiographs are normal but symptoms persist, consider ultrasound or MRI without contrast to evaluate for tendon, ligament, or muscle injury 1, 3
• Ultrasound can identify hematomas, muscle tears, and tendon injuries 4

Expected Recovery Timeline

Normal healing follows a predictable pattern:

• Swelling should resolve within 7 days in uncomplicated cases 4
• If swelling persists at 2 weeks, obtain repeat radiographs to assess for occult fractures or other pathology 4
• Evaluation should occur no later than 6 weeks after injury to detect complications or healing delays 4

Compression Wrapping Considerations

The evidence on compression is mixed:

• Compression wraps may provide comfort in the acute phase but must not compromise circulation 1
• However, systematic reviews show compression does not reduce swelling, pain, or improve recovery time in sprains and strains 1
• If you choose to use compression, apply it loosely and monitor for signs of circulatory compromise 1

Common Pitfalls to Avoid

• Do not dismiss persistent swelling as "normal healing" – swelling beyond 7 days requires investigation 4
• Do not return to bowling until completely asymptomatic – premature return risks worsening the injury 3
• Do not rely on pain medications alone without addressing the underlying injury 3
• Do not assume "no fracture" without radiographs – occult fractures may present initially as only soft tissue swelling 2, 4

Rehabilitation After Acute Phase

Once inflammation is controlled (typically after 7 days):

• Begin gentle range of motion exercises when pain-free 3
• Progress to strengthening exercises of forearm and upper arm muscles 3
• Gradually return to bowling only after completing a progressive program without symptoms 3
• Address biomechanics – repetitive bowling motion may have contributed to the injury 5