Treatment of Forearm Pain in Young Athletes

Diagnostic Approach

Radiography is the appropriate first imaging study for acute forearm pain to rule out fractures, as recommended by the American College of Radiology 1
If radiographs are normal or indeterminate but symptoms persist, ultrasound or MRI without IV contrast may be appropriate to assess for suspected tendon, ligament, or muscle injury, according to the American College of Radiology 1
In pediatric athletes, pain is often related to overuse injuries rather than acute trauma, as noted by the American College of Radiology 2

The American College of Radiology recommends complete rest from throwing or aggravating activities until the athlete is asymptomatic 3
For overuse injuries, activity modification is crucial to prevent worsening of symptoms, as recommended by the American Academy of Physical Medicine and Rehabilitation 4
Pitch count and rest restrictions should be implemented for young athletes, with a maximum of 75 pitches per game and appropriate rest days between sessions for 11-12 year olds, as recommended by the American Academy of Physical Medicine and Rehabilitation 5

The American Academy of Physical Medicine and Rehabilitation recommends a progressive rehabilitation program, including rest from aggravating activities, ice application, and gentle range of motion exercises during the acute phase 3
Progressive strengthening of forearm muscles, scapular stabilizer strengthening, and re-establishing proper mechanics of the arm and spine are recommended during the strengthening phase, according to the American Academy of Physical Medicine and Rehabilitation 3
A progressive throwing program emphasizing proper mechanics, gradual return to sport-specific activities, and return to competition only after completing a functional, progressive, and individualized program without symptoms are recommended during the return to sport phase, as recommended by the American Academy of Physical Medicine and Rehabilitation 3

Pediatric athletes are particularly susceptible to overuse injuries due to developing musculoskeletal systems, as noted by the American College of Radiology 2
Pain in young athletes may indicate developing overuse injury and should not be ignored, according to the American Academy of Physical Medicine and Rehabilitation 3
Biomechanical assessment should be coordinated with coaches to identify abnormal motions, as recommended by the American Academy of Physical Medicine and Rehabilitation 3

Returning to activity too soon before complete resolution of symptoms should be avoided, as recommended by the American Academy of Physical Medicine and Rehabilitation 3
Failing to address the entire kinetic chain (shoulder, elbow, wrist) in rehabilitation should be avoided, according to the American Academy of Physical Medicine and Rehabilitation 3
Ignoring pitch count and rest guidelines for young throwers should be avoided, as recommended by the American Academy of Physical Medicine and Rehabilitation 5
Relying solely on pain medications without addressing underlying mechanical issues should be avoided, according to the American Academy of Physical Medicine and Rehabilitation 4

Education about proper technique and biomechanics is recommended, as recommended by the American Academy of Physical Medicine and Rehabilitation 3
Implementation of appropriate rest periods between activities is recommended, according to the American Academy of Physical Medicine and Rehabilitation 5
Regular monitoring for recurrence of symptoms is recommended, as recommended by the American Academy of Physical Medicine and Rehabilitation 4
Gradual progression of training intensity and volume is recommended, according to the American Academy of Physical Medicine and Rehabilitation 3