Our forearm comprises the lower half of the arm. It extends from the elbow joint right to the hand and is made up of the ulna and radius bones. These two long bones form a rotational joint, allowing the forearm to turn so that the palm of the hand faces up or down. The flexor carpi radialis (FCR) muscle is a thin muscle located on the anterior part of our forearm.
It arises in the humerus epicondyle, near the wrist area. It is a superficial muscle that becomes visible as the wrist comes into flexion. The muscle travels on the outside of another muscle known as the flexor digitorium superficialis. The innervation of the flexor carpi radialis is provided by the median nerve as it receives its blood supply through the radial artery.
It performs the function of providing flexion of the wrist and assists in abduction of the hand and wrist. If this muscle suddenly becomes weakened, it can be strengthened with the help of movements that provide resistance against its flexion.
Any type of injury or damage to the flexor carpi radialis may result in decreased ability to flex or abduct the wrist or the hand. Another known condition that involves pain in the flexor carpi radialis muscle is tendonitis. Similar to the tendons involved in DeQuervain’s syndrome, the flexor carpi radialis tendon runs in a sheath.
Therefore, overuse can lead to swelling within the sheath, leading to compression / pinching of the FCR tendon. This leads to pain and tenderness, typically located about an inch above the wrist. This pain is often increased by gripping and by lifting with the palm up, both of which stress the tendon.
Causes & Symptoms of Flexor Carpi Radialis
There are several ways that can injure and cause pain in your flexor carpi radialis, including the following:
- Wrist injuries – If there is a direct blow or injury to the wrist or the palm region, this may cause the flexor carpi radialis muscle to get damaged.
- Certain activities – Activities requiring repetitive twisting movements along with having a tight grip can cause damage to the flexor carpi radialis muscle.
- Sports activities – Sporting events such as tennis or golf can place you at risk of injuries to the flexor carpi radialis. This is due to having a tight grip on either the tennis racket or golf club while performing a twisting movement to hit the tennis / golf ball.
Furthermore, any damage to the flexor carpi radialis can lead to a numerous amount of other medical conditions, such as:
Golfer’s elbow
Also known as medial epicondylitis, golfer’s elbow is a condition that occurs whenever the tendons on the inside of the forearm have become irritated, inflamed, and painful because of the repetitive use of the hand, wrist, and forearm.
Carpal tunnel syndrome
This condition is when the median nerve is squeezed (compressed) as it passes through the carpal tunnel. The carpal tunnel is an opening in your wrist that is formed by the carpal bones on the bottom of the wrist and the transverse carpal ligament across the top of the wrist. As for the median nerve, it provides sensory and motor functions to the thumb and 3 middle fingers.
Cubital tunnel syndrome
This is caused by compression of the ulnar nerve when it passes under a bony bump (the medial epicondyle) on the inside portion of the elbow. In this area, the nerve is relatively unprotected and can be trapped between the bone and the skin is in the cubital tunnel.
Dupuytren contracture
Dupuytrens contracture is characterized by a deformity of the hand in which the joints of one or more fingers cannot be fully straightened. The condition is a disorder of connective tissue, which supports the body’s muscles, joints, organs, and skin and produces strength and flexibility to structures throughout the body.
In particular, Dupuytrens contracture results from the shortening and thickening of connective tissues in the hand, including fat and bands of fibrous tissue called fascia; the skin is also involved.
Certain symptoms linked to injuries of the flexor carpi radialis include:
- Pain with gripping items like a bottle cap.
- Pain in the wrist while twisting a doorknob.
- Wrist pain radiating up towards the forearm.
- Any pain with bending or keeping the wrist straight.
- Pain is felt at the center of the wrist and radiates towards the thumb.
Who gets Flexor Carpi Radialis?
Certain risk factors that can lead to an injury of the FCR muscle/tendon involve sporting activities, occupational laboring, and others:
- Occupational laborers – Repairmen who frequently loosen or tighten screws can experience the pain of the FCR muscle. Also, people involved in construction or assembling work where they have to tighten a lot of screws on an everyday basis can also cause damage to the flexor carpi radialis muscle.
- Sports – As mentioned earlier, athletes involved in sports like tennis, golf, or baseball are prone to injuries to the flexor carpi radialis due to the requirement of repetitive twisting movements.
- Rheumatoid arthritis – Chronic illnesses such as rheumatoid arthritis where muscles are weakened are more likely to cause a tear in the flexor carpi radialis tendon.
How Does Flexor Carpi Radialis Affect You? How Serious is it?
In most severe cases of injuries to the FCR tendon, a surgical repair known as extensor carpi radialis tendon repair is required. Also known as tennis elbow repair, this is a surgical procedure that will be performed using one of the two methods, which are open or arthroscopic.
Both treatment methods are usually done in an outpatient setting, which means that the surgery does not require an overnight stay in the hospital. Open surgery involves the use of a small incision over the elbow to complete the repair, while arthroscopic surgery involves the use of small instruments and small incisions in the elbow.
All surgical operations will come with a risk. The rare complications for an extensor carpi radialis tendon repair may include:
- Persistent forearm / wrist pain – Some patients tend to continue to have persistent pain after surgery.
- Long-term forearm stiffness – Long-term stiffness is usually caused by excessive scar tissue. Oftentimes, lack of use or exercise can cause scar tissue to build up in the soft tissue around the joint.
- Infection – There is a chance of infection but a low percentage of it happening. However, when infections do arise, they are considered serious.
Recommended Treatment & Rehabilitation for Flexor Carpi Radialis
Injuries and other conditions involving the flexor carpi radialis are often diagnosed by primary care physicians, hand surgeons, and sports medicine physicians. When either a regular FCR injury or FCR tendonitis is suspected, your doctor will begin by taking a complete medical history and conducting a physical examination. Medical imaging testing may be ordered in certain cases:
- Physical examination – Your doctor will check for any signs of tenderness, limited range of motion, and / or swelling located on the anterior side of your forearm. He or she will check the rest of your arm for any other signs of injury.
- Medical history – Your doctor will ask you a number of questions about your pain. Some include the onset of pain, what type and duration of pain, trauma or injury to the forearm, and any decreased strength in the injured area.
Two imaging tests are used to observe and agree with the condition you are currently experiencing, which are ultrasound and magnetic resonance imaging (MRI). An ultrasound can be performed at different angles of the forearm.
This test provides great details of the affected tendons / muscles. An MRI of the forearm is typically ordered if your doctor wants to evaluate the FCR tendons as well as their surrounding structures, such as bones and cartilage.
If any of the mentioned above have failed to determine what condition you’re experiencing, your doctor will perform a wrist flexion test which will check for pain in the flexor carpi radialis tendon. This test involves the following steps:
- Your forearm is placed on a table in the palm-up position.
- The wrist is then bent upward.
- You will then be asked to hold the wrist up while your doctor applies resistance. If wrist pain is felt when resistance is applied it indicates a tendon is inflamed.
After a diagnosis has been done, physiotherapy may be further advised. A physiotherapist will work with you by designing a special treatment program specific to your condition and goals. Therefore, some of these treatments will likely include:
Pain management
Your physiotherapist will help you identify and avoid painful movements and show you how to correct abnormal postures to reduce stress on the injured forearm. He or she will recommend resting the arm short-term and applying ice to the area to help alleviate the pain. Your therapist may also apply a forearm brace, allowing the tendons / muscle to heal with greater stability.
Manual therapy
Your physiotherapist may use hands-on techniques, such as gentle joint movements, soft tissue massage, and additional stretches to get your forearm moving properly.
Range-of-motion exercises
You will learn a set of exercises and stretches to reduce stiffness and help your wrist, hand, and forearm begin to move properly.
Strengthening exercises
Your physiotherapist will determine which strengthening exercises are perfect for you, depending on your specific areas of weakness.
Patient education
Depending on the activities you plan on continuing, your physiotherapist will teach you different ways to perform actions, while protecting your forearm.
Below are some examples of exercises for you to try. The exercises may be recommended to reduce symptoms linked to flexor carpi radialis injuries:
Wrist flexion and extension
Place your forearm on a table, with your hand and affected wrist extended beyond the table, palm down. Next, bend your wrist to move your hand upward and allow your hand to close into a fist, then lower your hand and allow your fingers to relax. Hold each position for 6 seconds, then repeat 8-12 times a day.
Forearm extensor stretch
Place your injured elbow down at your side, bent at a 90-degree angle. Then, make a fist with your palm facing down. Keeping your wrist bent, slowly straighten your elbow so your arm is down at your side. Next, twist your fist out so your palm is facing out to the side and you feel a good stretch. Hold for 15-30 seconds, then repeat 2-4 times a day.
Wrist curls
Place your forearm on a table with your hand hanging over the edge of the table, palm up. Next, place a 0.5 to 1kg of weight in your hand (This can be a dumbbell or a filled water bottle). Slowly raise and lower the weight while keeping your forearm on the table and your palm facing up. Repeat this 8-12 times a day.
Alternative & Homeopathic Treatment for Flexor Carpi Radialis
If you experience mild FCR pain symptoms (with an average recovery estimation of up to 2-3 weeks), you may be able to ease your symptoms with lifestyle changes and medication. Here are a few homeopathic treatments for flexor carpi radialis pain:
Take breaks from repetitive activities
Whether you are typing, playing guitar, or using a hand drill, try setting a timer beforehand for 15 minutes. When it goes off, stop what you’re doing and wiggle your fingers. Stretch your arms and move your wrists to help improve blood flow to these areas.
Rest
If you ever find yourself straining or forcing tasks such as writing, typing, or using a cash register, relax your grip or reduce the force you are using. Try using a soft-grip pen or tapping keys more lightly.
Stay warm
Keeping your forearm and wrist warm can help with pain and stiffness. Consider showering with warm water or using a heat pack to keep your forearm warm while increasing blood circulation.
Massage
Performing a self-massage or from a massage therapist may help increase blood flow to your injured forearm and boost your recovery speed. Adding an essential oil can help alleviate the pain more rapidly due to the anti-inflammatory properties it carries.