New York State Medical Treatment Guidelines for Elbow Sprains in workers compensation patients

The guidelines from the New York State Workers Compensation Board have been created to aid physicians, podiatrists, and other healthcare professionals in offering suitable treatment for Elbow Sprains. These guidelines aim to support healthcare professionals in deciding the appropriate level of care for patients with elbow sprains

It’s essential to note that these guidelines are not a replacement for clinical judgment or professional expertise. The final decision regarding care should be a collaborative one, made by the patient in consultation with their healthcare provider.


Elbow Sprains

A rare occurrence, an isolated elbow sprain results from a significant, high-force impact that tears the ligaments encircling the elbow, often caused by a fall. Such sprains are infrequent and may coincide with other complications like fractures, dislocations, or contusions.

To assess potential issues, it is imperative to thoroughly examine the motor, sensory, and circulatory systems, aiming to rule out any associated injuries.

When treating a dislocated elbow, obtaining an x-ray is essential to verify the absence of fractures. Similarly, for the medical management of a sprained elbow, an x-ray is typically recommended to confirm the absence of fractures, particularly in cases of minor sprains.


Diagnostic Studies of Elbow Sprains

Sprains are identified by the convergence of a typical triggering event (often a fall or forceful impact), accompanied by the characteristic elbow pain and localized tenderness around the ligament(s). Unlike dislocations and fractures, sprains typically allow for a normal range of motion, albeit a painful one.

Special Studies and Diagnostic and Treatment Considerations X-rays for Elbow Sprain are recommended, with two to three views necessary to rule out fractures.

Repeat x-rays are also suggested if the condition fails to improve as clinically anticipated within approximately a week.

Monitoring Progress To track progress, patients should undergo a reevaluation seven to ten days after the initial assessment. If no improvement is observed, an x-ray and reevaluation are warranted.


Medications of Elbow Sprains


Ibuprofen, naproxen, or other NSAIDs from an earlier generation are recommended as the initial treatment for most patients. If NSAIDs are not suitable, acetaminophen (or paracetamol) might be a viable alternative, although research suggests it is slightly less effective than NSAIDs.

Evidence indicates that NSAIDs are safer and equally effective in managing pain compared to opioids like tramadol.

Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Elbow Sprains are suggested. Over-the-counter medications should be tried first to assess their effectiveness.

Frequency/Duration – Many patients may use them as needed.

Indications for Discontinuation – Discontinuation criteria include relief of elbow pain, lack of effectiveness, or the emergence of adverse effects.

NSAIDs for Patients at High Risk of Gastrointestinal Bleeding are recommended, especially for those with a history of gastrointestinal bleeding, the elderly, diabetics, and smokers. Cytoprotective drugs like misoprostol, sucralfate, H2 blockers, and proton pump inhibitors can be used together.

Frequency/Dose/Duration – Follow the manufacturer’s dosage recommendations. There are generally no significant differences in effectiveness for preventing gastrointestinal bleeding.

Indications for Discontinuation – Discontinuation criteria include intolerance, the emergence of unfavorable effects, or cessation of NSAID use.

NSAIDs for Patients at Risk for Cardiovascular Adverse Effects are recommended, especially for patients with a history of cardiovascular disease or multiple cardiovascular risk factors. Non-selective NSAIDs are preferable to COX-2-specific medications when using low-dose aspirin for cardiovascular disease prevention.

Dose/Frequency – NSAIDs should be given at least 30 minutes after or eight hours before aspirin. Follow the manufacturer’s dosage recommendations.

Acetaminophen for Treatment of Elbow Pain is recommended, especially for patients with NSAID contraindications.

Dose/Frequency – Follow the manufacturer’s recommendations; can be used as required. Evidence of liver toxicity exists over four gm/day.

Opioids for Select Patients with Elbow Sprains are recommended for individuals with significant pain from severe elbow sprains that are not adequately controlled by alternative treatments.

Frequency/Dose – Administer the bare minimum number of doses since elbow sprains typically have a brief recovery time.

Indications for Discontinuation – Discontinuation criteria include undesirable effects, non-compliance with prescription guidelines, and adequate pain relief to avoid the need for opioids.

Rationale for Recommendation – Opioids are generally unnecessary for the majority of patients, and their use should be limited to select cases with severe sprains for a short duration (no longer than one week).


Treatments of Elbow Sprains

Rehabilitation/Devices Slings for Elbow Sprains are advised as part of the treatment for sprained elbows.

Duration – Generally, the use of slings should be gradually reduced to fewer than 7 to 10 days. While wearing a sling, it is recommended to perform range-of-motion exercises for the elbow and shoulder multiple times per day to prevent complications arising from restricted ranges of motion.

Activity Modification and Exercise – Patients are typically instructed to engage in gentle range-of-motion exercises several times a day to maintain normal range of motion. Additionally, interventions are provided to address modifications in the performance of Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).


What our office can do if you have workers compensation injuries

We have the expertise to assist you with your workers’ compensation injuries. We empathize with the challenges you’re facing and are committed to addressing your medical needs while adhering to the guidelines established by the New York State Workers Compensation Board.

Recognizing the significance of your workers’ compensation cases, we are here to guide you through the complexities of interactions with the workers’ compensation insurance company and your employer.

We understand the stress you and your family are experiencing during this challenging time. If you wish to schedule an appointment, please reach out to us. We are dedicated to making the process as smooth and stress-free for you as possible.

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