Treatment of Upper Arm and Forearm Injuries

Immediate First Aid Management

The American Heart Association recommends stopping all activity immediately in case of a painful extremity injury that limits use, and seeking medical attention 1, 2
The American Heart Association suggests applying cold therapy properly, using a bag filled with ice and water surrounded by a damp cloth, applied for 20-30 minutes per session, 3-4 times daily 1, 2
The American Heart Association advises against placing ice directly on skin to prevent cold injury while still providing therapeutic benefit 1, 2
Rest is the mainstay of treatment for strains and sprains, according to the American Heart Association, and activities that cause pain should be avoided 1, 2

The American College of Radiology recommends obtaining medical evaluation because "boggy swelling" suggests significant soft tissue injury that could represent muscle strain, tendon injury, or occult fracture 3
Plain radiographs are the mandatory first imaging study to exclude fracture, even with seemingly minor trauma, as recommended by the American College of Radiology 4, 3, 5
Swelling that persists beyond 7 days warrants investigation, as physiological post-traumatic swelling should resolve within the first week, according to the American College of Radiology 6

The American College of Radiology provides a clear imaging algorithm, starting with plain radiographs of the upper arm and forearm to exclude fracture 4, 3, 5
If radiographs are normal but symptoms persist, the American College of Radiology suggests considering ultrasound or MRI without contrast to evaluate for tendon, ligament, or muscle injury 4, 5
Ultrasound can identify hematomas, muscle tears, and tendon injuries, according to the American College of Radiology 6

Swelling should resolve within 7 days in uncomplicated cases, according to the American College of Radiology 6
If swelling persists at 2 weeks, repeat radiographs should be obtained to assess for occult fractures or other pathology, as recommended by the American College of Radiology 6
Evaluation should occur no later than 6 weeks after injury to detect complications or healing delays, according to the American College of Radiology 6

Compression wraps may provide comfort in the acute phase but must not compromise circulation, as suggested by the American Heart Association 1, 2
However, systematic reviews show compression does not reduce swelling, pain, or improve recovery time in sprains and strains, according to the American Heart Association 1, 2

The American College of Radiology advises against dismissing persistent swelling as "normal healing" – swelling beyond 7 days requires investigation 6
The American College of Radiology recommends not returning to bowling until completely asymptomatic – premature return risks worsening the injury 5
The American College of Radiology suggests not relying on pain medications alone without addressing the underlying injury 5
The American College of Radiology advises against assuming "no fracture" without radiographs – occult fractures may present initially as only soft tissue swelling 3, 6

Once inflammation is controlled, gentle range of motion exercises should be begun when pain-free, as recommended by the American College of Radiology 5
Strengthening exercises of forearm and upper arm muscles should be progressed, according to the American College of Radiology 5
Gradual return to bowling should only occur after completing a progressive program without symptoms, as suggested by the American College of Radiology 5