Injury to the Arm

First aid for an arm injury

1. Stop any bleeding with firm pressure from a clean cloth.
2. Support the arm in the position you found it. A sling made from a scarf or folded towel, or a rolled magazine as a splint, limits movement. Do not try to straighten a deformed limb or push a bone back.
3. Remove rings, watches and bracelets right away, before swelling makes them impossible to take off.
4. Apply ice wrapped in a cloth for 15 to 20 minutes at a time.
5. Raise the arm above heart level to reduce swelling.
6. Take pain relief such as acetaminophen (paracetamol) or ibuprofen at the label dose. Do not give aspirin to children or teenagers. Avoid eating or drinking if surgery might be needed.

Types of arm injury

Bruises, sprains and strains

A bruise (contusion) is bleeding in the muscle after a direct blow. A sprain stretches or tears a ligament around a joint, often the wrist or elbow. A strain is a stretched or torn muscle or tendon. All cause pain, swelling and bruising, but movement is usually possible. See sprains and strains.

Fractures

• Wrist (distal radius): the most common arm fracture, usually from a fall on an outstretched hand. Older women with osteoporosis are at high risk. See wrist fracture.
• Scaphoid: a small wrist bone near the thumb. Pain in the hollow at the base of the thumb after a fall needs a splint and X-rays even if the first film looks normal, because this fracture can be missed and heal poorly.
• Forearm (radius and ulna): common in children, often as "buckle" fractures that heal quickly.
• Elbow: supracondylar fractures in children after falls from monkey bars or trampolines can damage nerves and blood vessels.
• Upper arm (humerus): fractures near the shoulder are common in older adults after falls. See humerus fracture.
• Collarbone: from falls onto the shoulder. See clavicle fracture.

The broken arm page covers casting and healing in detail.

Dislocations

• Shoulder: the most commonly dislocated large joint. The shoulder looks squared off and the arm is held away from the body. See shoulder dislocation.
• Elbow: usually from a fall on an outstretched arm. See elbow dislocation.
• Nursemaid's elbow: in children aged 1 to 4, a sudden pull on the hand slips a ligament out of place. The child holds the arm still and refuses to use it. A clinician can usually correct it within seconds.

Tendon and muscle tears

• Rotator cuff tear: shoulder weakness and night pain after a fall or heavy lift, more common after 40. See rotator cuff tear.
• Biceps tendon rupture: a pop, then a "Popeye" bulge in the upper arm (tear near the shoulder) or a dent at the front of the elbow (tear at the elbow). Tears at the elbow often need repair within 2 to 3 weeks.

Nerve and blood vessel injuries

Numbness, tingling or weakness in the hand after an arm injury suggests a nerve has been stretched or trapped, for example the radial nerve with upper arm fractures (wrist drop). Any change in sensation or circulation needs urgent assessment.

Compartment syndrome

Swelling inside a tight muscle compartment can cut off blood flow. It usually follows a forearm fracture or crush injury and causes pain far beyond what you would expect, especially when the fingers are stretched. It is a surgical emergency. See compartment syndrome.

Is my arm broken or sprained?

Only an X-ray can tell for sure, but some clues help:

How doctors assess an arm injury

The doctor asks how the injury happened, checks the skin, pulses, sensation and movement in the hand, and presses along the bones. X-rays in two views are standard. CT is used for complex joint fractures, and ultrasound or MRI for tendon and ligament tears. Children's growth plates can hide fractures, so comparison views or follow-up X-rays are sometimes needed.

Treatment

• Minor injuries: RICE (rest, ice, compression, elevation) for 48 to 72 hours, then gentle movement. A sling for a few days at most, because long immobilization causes stiffness, especially in the shoulder and elbow.
• Fractures: a splint or cast for stable fractures, typically 4 to 6 weeks in adults and less in children. Displaced fractures are realigned under anesthesia (reduction) and may need plates, screws or wires.
• Dislocations: put back in place (reduced) as soon as possible, then a brief period in a sling followed by physical therapy.
• Tendon tears: physical therapy, or surgical repair for complete tears in active people.

Healing times

Frequently asked questions

How do I know if my arm injury is serious?

Get urgent care for deformity, bone through the skin, numb or cold fingers, severe or rapidly increasing swelling, inability to move the arm, or pain at one point on a bone. These suggest a fracture, dislocation, or nerve or blood vessel damage.

Can you move your arm if it is broken?

Sometimes. With small or buckle fractures, especially in the wrist or forearm, people can still move the arm and fingers, though it hurts. Being able to move it does not rule out a fracture. Pain when pressing on one spot of bone is a better reason to get an X-ray.

Should I use ice or heat on an arm injury?

Use ice for the first 48 to 72 hours to limit swelling and pain, for 15 to 20 minutes at a time with a cloth between the ice and skin. Heat can help stiffness later, once swelling has settled.

How long does arm pain last after a fall?

Bruising and mild sprains usually improve within 1 to 3 weeks. Fractures need about 6 to 8 weeks to heal, and stiffness can last longer. Pain that is not improving after 1 to 2 weeks needs a check, because a small fracture such as a scaphoid fracture may have been missed.