What is the recommended treatment for a young wrestler with an elbow sprain?

Treatment of Elbow Sprain in a Young Wrestler

For a young wrestler with an elbow sprain, begin immediate functional treatment with a hinged elbow brace for 4-6 weeks combined with early active range-of-motion exercises starting within 48-72 hours, while using NSAIDs or acetaminophen for pain control and avoiding prolonged immobilization beyond 10 days. 1, 2

Immediate Management (First 48-72 Hours)

Pain and Swelling Control

• Apply ice for 20-30 minutes per application using ice and water in a bag surrounded by a damp cloth, avoiding direct skin contact to prevent cold injury 1, 3
• Use NSAIDs (ibuprofen, naproxen, or diclofenac) for pain and swelling control, as they are equally effective as opioids but with significantly fewer side effects 1, 3
• Acetaminophen is equally effective as NSAIDs for pain, swelling, and range of motion if NSAIDs are contraindicated 4, 1
• Never prescribe opioids for elbow sprains, as they provide no superior pain relief but cause significantly more adverse effects 1, 3

Functional Support

• Apply a hinged elbow brace within the first 48 hours and continue for 4-6 weeks, as functional support is superior to immobilization 1, 5, 2
• The brace can restore medial stability to the elbow joint by 35-49% in athletes with ulnar collateral ligament injuries 5
• Avoid rigid immobilization beyond 10 days, as prolonged immobilization leads to worse functional outcomes including decreased range of motion, chronic pain, and joint instability 4, 1, 6

Rehabilitation Protocol (Starting 48-72 Hours Post-Injury)

Early Active Range of Motion

• Begin active range-of-motion exercises within 48-72 hours, starting with gentle flexion and extension exercises multiple times daily to maintain joint mobility 1, 7
• Supervised exercise therapy has Level 1 evidence for effectiveness and is superior to non-supervised home exercises 3, 6

Progressive Strengthening

• Progress to strengthening exercises focusing on grip strength and individual finger/forearm strength once pain allows 1, 7
• Include proprioceptive training to restore coordination and prevent recurrent injury 1, 6
• For wrestlers with ulnar collateral ligament sprains specifically, rehabilitation of dysfunctional shoulder and forearm musculature is critical 7, 2

Criterion-Based Progression

The rehabilitation should follow a three-staged criterion-based protocol with progression determined by:

• Pain levels during activity 7
• Elbow range of motion restoration 7
• Arm strength recovery (particularly elbow flexion and forearm musculature) 7
• Functional outcome measures 7

Return to Wrestling Timeline

For Mild Elbow Sprains

• Return to mostly sitting activities at 2 weeks 3
• Full return to wrestling at 3-4 weeks depending on strength restoration and functional testing 3, 7

For Moderate to Severe Sprains (Including UCL Injuries)

• Return to light activities at 3-4 weeks 3
• Full return to competitive wrestling at 6-8 weeks with successful completion of return-to-sport testing 3, 7, 2
• In younger throwing athletes with medial-sided elbow pain, hinged elbow bracing and rehabilitation often lead to successful recovery within 1-2 months 2

Return-to-Sport Criteria

• Pain-free active range of motion 1, 7
• Grip strength and forearm strength restored to near-baseline 1, 7
• Joint stability without support during functional testing 1, 7
• No medial elbow instability during valgus stress testing 7, 8

Critical Pitfalls to Avoid

Immobilization Errors

• Do not immobilize beyond 10 days unless there is a specific surgical indication, as this causes worse outcomes including muscular atrophy, deconditioning, and joint contractures 4, 1
• Complete immobilization should be avoided to prevent muscular atrophy and deconditioning 4

Medication Misuse

• Limit NSAID use to less than 14 days when possible, as NSAIDs may delay natural healing since inflammation is necessary for tissue recovery 4, 6
• Never use opioid analgesics, as they cause significantly more side effects without superior pain relief 4, 1, 3

Rehabilitation Errors

• Do not allow return to wrestling without completing return-to-sport testing, as inadequate treatment leads to chronic problems including decreased range of motion, pain, and joint instability 3, 6, 7
• Supervised exercises are superior to non-supervised training—wrestlers should work with an athletic trainer or physical therapist rather than performing home exercises alone 3, 6

Prevention of Recurrent Injury

• Continue wearing the hinged elbow brace during wrestling practice and competition for the full 4-6 weeks, even after symptoms resolve 1, 6, 2
• Incorporate ongoing elbow strengthening and proprioception exercises into regular training activities to prevent recurrence 1, 6
• For wrestlers with a history of elbow sprains, continue protective bracing during high-risk activities even after full recovery 6