Forearm neuritis is a common problem in pitchers at all levels, from high school to the MLB. Recently the Atlanta Braves pitcher, Max Fried, was diagnosed with forearm neuritis and placed on a 15-day injury list. The sports medicine staff reported that he felt discomfort in the forearm but was able to finish the inning. He had an MRI that was normal. Max Fried’s forearm pain is a frequent injury that is treated at The Fascia Institute and Treatment Center. Many of these cases are the result of fascial inflammation.

Causes of Forearm Neuritis

The most common cause of forearm neuritis is ulnar nerve entrapment at the elbow. The ulnar nerve is the main nerve that controls the muscles in the inner forearm and in the hand. Ulnar nerve entrapment can cause pain in the inner forearm; in addition to, a significant loss in pitch control and velocity. Forearm neuritis after a ulnar collateral ligament tear can also occur and is commonly related to ulnar nerve entrapment. In cases of a severe ulnar neuropathy, the ulnar nerve is surgically moved out of the area of compression, which tends to help reduce symptoms.

Fascial inflammation in the muscles in the forearm can also lead to a fascial neuritis. While ligaments and nerves in the inner forearm are well understood causes of forearm pain, fascial inflammation is not well recognized. Stress from pitching also places excessive forces on the muscles and fascia in the inner forearm. Fascial abnormalities and inflammation of forearm neuritis can only be seen with ultrasound imaging, which can be challenging.

How to Diagnose Forearm Neuritis

Ultrasound imaging is used to diagnose forearm neuritis. A sports medicine physician with extensive fascial evaluation experience is needed to make an accurate diagnosis. After localizing the area of pain with the physical exam, the ultrasound is used to “look under the skin” to determine areas of fascial thickness, tearing, inflammation or loss of fascial shear movement. In addition, the ultrasound can be used to look at the deep fascia in the inner forearm muscles for similar injury. In some cases, a fascial adhesion may attached to the ulnar nerve causing a traction-type of injury on the nerve. Most cases involve injury to the fascial structures of the forearm that are too small to be seen with an MRI.

How to Treat Forearm Neuritis

Forearm neuritis can be treated with rest and anti-inflammatory medications to start. However, in-season pitchers do not have time to wait for inflammation to reduce. In cases of chronic forearm pain or when in-season, a fascial hydrodissection for forearm neuritis can return a pitcher back in three to four days. The hydrodissection treatment can be directed specifically to the area of injury with the use of ultrasound imaging. Ultrasound use ensures the accuracy and safety of the hydrodissection. If ulnar nerve entrapment is identified, a hydrodissection may be used to free the nerve. In most cases, the pitcher feels immediate relief and rehab can be initiated immediately following the injection.

Summary

Forearm neuritis is a complex injury that is unique to pitchers. Fortunately, a modern sports medicine evaluation with ultrasound can be used to identify a subtle injury that will keep a pitcher sidelined. The Fascia Institute and Treatment Center has evaluated, treated and published on cases of pain in pitchers. Once the cause of forearm pain is identified, the proper type of treatment can be initiated to help the pitcher return to play quickly. While a fascial hydrodissection may be the best option, other injection treatments may be recommended depending on the type and extent of injury.

Schedule an evaluation to see if a fascia treatment will help your case of forearm neuritis.