What is the management and workup for an elbow sprain?

Elbow Sprain Workup and Management

For elbow sprains, first aid providers should apply cold therapy (ice and water in a damp cloth) for 20-30 minutes per application to reduce pain and swelling, and the patient should avoid activities that cause pain while seeking medical attention. 1

Initial Assessment and Diagnosis

• Radiographs are the appropriate initial imaging for chronic elbow pain to exclude fractures, intra-articular bodies, heterotopic ossification, osteochondral lesions, soft tissue calcification, or osteoarthritis 1
• The Ottawa Ankle and Foot Rules provide clinical guidelines for excluding fractures in extremity injuries, and similar principles can be applied to elbow injuries to determine if radiography is indicated 1
• Comparison with the asymptomatic side is often useful in radiographic assessment 1
• MRI may be considered if radiographs are normal or nonspecific and there is suspicion of associated tendon or ligament pathology 2
• Stress radiographs may be useful to detect joint line opening and evaluate joint stability, particularly in cases of suspected ligament injury 1

Treatment Approach

Acute Phase (0-4 weeks)

• PRICE protocol (Protection, Rest, Ice, Compression, and Elevation) is a well-established protocol for the treatment of acute sprains 1
• Apply cold therapy (ice and water surrounded by a damp cloth) for 20-30 minutes, 3-4 times daily to decrease pain and swelling 1
• Avoid direct ice contact with skin to prevent cold injury 1
• Consider compression wrap for comfort, ensuring it doesn't compromise circulation 1
• Avoid activities that cause pain to prevent worsening the injury 1
• NSAIDs may be used for pain management and to improve healing 1

Rehabilitation Phase (4-12 weeks)

• Functional rehabilitation (motion restoration and strengthening exercises) is preferred over immobilization 1
• Continue conservative measures including relative rest and activity modification 2
• Use of semirigid supports is superior to elastic bandages for protection 1
• For persistent symptoms, consider the following:
  • Continue functional rehabilitation with progressive strengthening 1
  • Local corticosteroid injections may be considered for persistent pain but should be used with caution due to potential complications including skin atrophy, infection, and tendon weakening 3

For Refractory Cases (>6-12 months)

• Surgical consultation may be considered for cases that fail to respond to appropriate conservative management 2
• Surgical intervention should be directed to the correction of specific pathologic tissue changes without harm to adjacent normal tissue 4

Special Considerations

• Lateral collateral ligament (LCL) injuries may present with posterolateral rotatory instability (PLRI) and may require ligament reconstruction if conservative treatment fails 5
• Ulnar collateral ligament (UCL) injuries are common in throwing athletes and may benefit from functional bracing to restore medial stability 6, 7
• Prolonged immobilization should be avoided as it may lead to complications including muscle atrophy and joint stiffness 8
• Support devices provide some protection against future sprains, particularly in persons with a history of recurrent sprains 1

Prevention of Recurrence

• Functional support (bracing or taping) is effective in preventing recurrent sprains 1
• Exercise therapy has shown a significant preventive effect for recurrent sprains 1
• Proprioceptive neuromuscular facilitation exercise regimens may be helpful in preventing recurrence 1