Anatomy: The muscles on the back of the upper arm (brachium) comprise the 3-headed arm stretcher (M triceps brachii). The muscle primarily stretches the elbow joint (and shoulder joint). The muscles on the front of the upper arm comprise 3 muscles. The function of two of the muscles, amongst other functions, is to bend the elbow joint (M biceps brachii, M brachialis), while the third muscle (M coracobrachialis) brings the arm towards the body (adduction).

Symptoms: Pain and swelling in the muscle. In some cases a hard, tender accumulation (accumulated bleeding in the muscle) can be felt. In other cases a bluish discolouration of the subcutis (the bleeding has penetrated the muscle membrane and spread into the subcutis) occurs after a few days. The pain is aggravated upon activation and stretching of the muscle.

Acute treatment: Click here.

Examination: In light cases with only minimal tenderness and no discomfort when walking normally, medical examination is not necessarily required. Although the extent of the pain is not always a measure of the extent of the injury. In cases of more pronounced pain or difficulty using the arm, medical examination is required to ensure the correct diagnosis and treatment. Ultrasound is the most suited examination to ensure the diagnosis (Ultrasonic image). The larger the bleeding, as revealed in the ultrasound scan, the longer the healing process.

Treatment: The treatment involves relief and rehabilitation as with a rupture of a muscle on the front of the upper arm or rupture of a muscle on the back of the upper arm, depending on whether the bleeding is located on the front or the back of the upper arm. In large bleedings the accumulated blood can be drained under ultrasound guidance. Some recommend treatment with rheumatic medicine (NSAID) and advise caution with regard to massage to reduce the risk of calcification in the muscle (myositis ossificans) .

Rehabilitation: The rehabilitation follows the principles with muscle ruptures. See therefore “rupture of muscle on the front of the upper arm” or “rupture of muscle on the back of the upper arm” depending on whether the bleeding is on the front or back of the upper arm.

Complications: If progress is not smooth, you should be (re)examined and consider if the diagnosis is correct or whether complications to the muscle bleeding have added.

Anatomy: The muscles on the back of the upper arm (brachium) comprise the 3-headed arm stretcher (M triceps brachii). The muscle primarily stretches the elbow joint (and the shoulder joint). The triceps muscle has 3 muscle heads around the shoulder joint which join and fasten on the back of the bone of the forearm by the elbow (olecranon).

Symptoms: In light cases a local tenderness is felt after the load (“strained muscle”, “imminent pulled muscle”). In severe cases sudden shooting pains are felt in the muscle (“partial muscle rupture”, “pulled muscle”) and in the worst case a violent snap is felt, after which bending of the elbow against resistance has been severely reduced (“total muscle rupture”). With muscle injuries the following three symptoms are characteristic: pain upon applying pressure, stretching (stretching the elbow) and activation against resistance (bending the elbow).

Acute treatment: Click here.

Examination: In light cases with only minimal tenderness, medical examination is not necessarily required. In cases of more pronounced pain or difficulty using the arm (stretching the elbow), a medical examination should be carried out to ensure a correct diagnosis and treatment. It can be necessary to supplement the normal clinical examination with an ultrasound scan (article) or an MRI scan.

Treatment: Most partial ruptures are treated with relief and rehabilitation. Only in cases with total or near-total ruptures, particularly in young people, is surgery advised (article).

Complications: If smooth progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. Amongst others the following should be considered: complication for muscular bleeding.

Anatomy: The muscles on the front of the upper arm comprise three muscles. Two of the muscles bend the elbow joint (M biceps brachii, M brachialis), while the third muscle (M coracobrachialis) brings the arm towards the body (adduction). The biceps muscle also rotates the hand (suppination).

Symptoms: In light cases a local tenderness is felt after the load (“strained muscle”, “imminent pulled muscle”). In severe cases sudden shooting pains are felt in the muscle (“partial muscle rupture”, “pulled muscle”) and in the worst case a violent snap is felt, after which bending the elbow against resistance is severely reduced (“total muscle rupture”). With muscle injuries the following three symptoms are characteristic: pain upon applying pressure, stretching (stretch the elbow) and activation against resistance (bending the elbow). With many elderly the rupture has not produced symptoms.

Acute treatment: Click here.

Examination: In light cases with only minimal tenderness medical examination is not necessarily required. In cases of more pronounced pain or difficulty using the arm (bending the elbow and rotate the hand (suppination)) a medical examination should be carried out to ensure the correct diagnosis and treatment. It can be necessary to supplement the normal clinical examination with an ultrasound scan (article 1) or an MRI scan (article 2).

Treatment: Most partial ruptures are treated with relief and rehabilitation. Only in cases with total or near-total ruptures, especially in young people, is surgery advised (article 1) (article 2) (article 3).

Complications: If progress is not smooth, you should be (re)examined and consider whether the diagnosis is correct or whether complications have arisen. Ruptures of the long biceps head can be combined with other injuries in the shoulder, for instance inflammation of the biceps muscle and complications for muscular bleeding.

Anatomy: On the upper arm there are numerous bursas, reducing the pressure on muscles and tendons, where these lie close to the bone.

Symptoms: Pain upon applying pressure on the bursa, which sometimes (but far from always) may feel swollen. Aggravated upon activation of the muscle located immediately above the bursa.

Acute treatment: Click here.

Examination: In light cases with only minimal tenderness, medical examination is not necessarily required. In cases of more pronounced pain or lack of progress, a medical examination should be carried out to ensure a correct diagnosis and treatment. A normal medical examination is usually sufficient in order to make the diagnosis, however, if there is any doubt concerning the diagnosis an ultrasound scan can be performed.

Treatment: The treatment primarily consists of relief. Removal of the provoking cause, if such is known. The treatment can be supplemented with rheumatic medicine (NSAID) or the injection of corticosteroid in the bursa preceded by draining of the bursa, which can advantageously be done under ultrasound guidance.

Rehabilitation: The treatment is completely dependant on which bursa is inflamed, but sports activity can usually be cautiously resumed once pain has decreased, particularly if it has been possible to remove the provoking cause.

Complications: If smooth progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. In rare cases the bursa can become infected with bacteria. This is a serious condition where the bursa becomes red, warm and increasingly swollen and tender. This condition requires immediate medical examination and treatment. 
If there is no progress with relief, medical treatment rheumatic medicine (NSAID) and the ultrasound guided injection of corticosteroid, surgical removal of the bursa may be attempted.

Anatomy: The upper arm (humerus) consists of the head (caput), the neck (collum), the long tubular bone (corpus) and the epicondyle.

Symptoms: Sudden pain and pain induced constriction of movement of the arm and shoulder after a fall.

Acute treatment: Click here.

Examination: Sudden, powerful pains in the arm with constriction of movement after a fall, should always lead to acute medical examination. The fracture is usually visible on x-rays, and on the basis of the type of fracture, the correct treatment can be determined.

Treatment: Depending on the type of fracture, rest and possible use of bandaging until pain decreases and the fracture is fixed (which usually takes approx. 6 weeks). Most fractures are treated non-operatively (article). In certain types of fractures, an operative fixation is an option.

Rehabilitation: When pain has decreased (after 2-3 weeks) physical training in the form of cycling may be started along with retraining as specified under rehabilitation, general. After approximately 4-6 weeks running can be commenced, and subsequently careful training of the upper arm and shoulder muscles. Participation in contact sports will be possible after approx. three months have elapsed.

Bandage: Special plastic bandages can be made for use when contact sports are resumed.

Complications: In the vast majority of cases the fracture heals without complications, although in some cases a delayed healing occurs, possibly with the development of a false joint (pseudoartrosis) requiring (renewed) surgery. In some cases, the fracture can affect the nerve supply to the arm (N radialis), which can cause sensory disturbances in the hand (and is usually treated with (renewed) surgery).