Elbow Sprain Management

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, according to the American College of Radiology 2
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, as suggested by the American Academy of Family Physicians 3
Comparison with the asymptomatic side is often useful in radiographic assessment, as recommended by the American College of Radiology 2
MRI may be considered if radiographs are normal or nonspecific and there is suspicion of associated tendon or ligament pathology 4
Stress radiographs may be useful to detect joint line opening and evaluate joint stability, particularly in cases of suspected ligament injury, according to the American College of Radiology 2

The American Heart Association recommends applying 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, as advised by the American Heart Association 1
Consider compression wrap for comfort, ensuring it doesn't compromise circulation, as suggested by the American Heart Association 1
Avoid activities that cause pain to prevent worsening the injury, according to the American Heart Association 1
NSAIDs may be used for pain management and to improve healing, as recommended by the American Academy of Family Physicians 3

Functional rehabilitation (motion restoration and strengthening exercises) is preferred over immobilization, according to the American Academy of Family Physicians 3
Continue conservative measures including relative rest and activity modification 4
Use of semirigid supports is superior to elastic bandages for protection, as suggested by the American Academy of Family Physicians 3
For persistent symptoms, consider continuing functional rehabilitation with progressive strengthening, as recommended by the British Journal of Sports Medicine 5
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 6

Surgical consultation may be considered for cases that fail to respond to appropriate conservative management 4

Support devices provide some protection against future sprains, particularly in persons with a history of recurrent sprains, as suggested by the American Academy of Family Physicians 3

Functional support (bracing or taping) is effective in preventing recurrent sprains, according to the British Journal of Sports Medicine 5
Exercise therapy has shown a significant preventive effect for recurrent sprains, as recommended by the British Journal of Sports Medicine 5
Proprioceptive neuromuscular facilitation exercise regimens may be helpful in preventing recurrence, as suggested by the American Academy of Family Physicians 3