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Early management of elbow sprains and strains

Minor injuries to the elbow such as a mild sprain or strain should settle with time. They can often be managed very well at home.

A soft tissue injury to the elbow may result in the following:

  • Pain
  • Swelling
  • Bruising
  • Stiffness and loss of function

The pain can be particularly strong in the first three weeks as this is the inflammatory phase of your body healing itself. Typically, these injuries last 4 to 6 weeks depending on the severity.

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Go to an urgent treatment centre or emergency department if your arm:

  • has been injured and you heard a snapping noise or your arm has changed shape
  • is swollen and you have a very high temperature or feel hot and shivery
  • is extremely painful and difficult to move
  • tingles or feels numb

These could be signs of something more serious.

You can also call 111 for advice or go 111.nhs.uk.

Speak to a GP or physiotherapist if:

  • the pain is severe or stopping you doing normal activities
  • the pain is getting worse and/or keeps coming back
  • the pain has not improved in any capacity after following the simple advice below
  • Click here to self-refer to a physiotherapist.

How to manage a sprain or a strain

Day 1 – Early Management

Protect by minimising use of the affected arm and initially avoiding stretching the area which could cause further injury. 

Rest can be beneficial in the very early stages of the injury (days 1-4). Complete rest, however, is not advisable. In the early stages, gentle active movements and specific exercises can help decrease pain and swelling, they also promote good tissue healing with less unwanted scar tissue and joint stiffness. It is important to move the shoulder and wrist gently so that these joints do not stiffen. 

Ice pack/frozen peas wrapped in a damp cloth, placed on the swollen area for up to 20 minutes at a time, 3 times a day. So long as there is swelling you will need to continue ice therapy, often beyond the third week.   

  • Please note only use ice if you have normal skin sensation  
  • Check the skin regularly  
  • Stop if there is excessive pain, numbness or tingling  
  • Do not put ice directly on to the skin as this may cause a burn. 

Compression of the elbow can be achieved by using a tubigrip or crepe bandage. It should compress firmly but not restrict blood flow and create a tourniquet.  Remove if there are signs of poor circulation, or if you start to experience pins and needles or numbness. 

Elevation. This is difficult for the elbow. If you have swelling in your arm sit on a chair and place your arm on cushions so it is supported. 

WEEK 1 – Early Mobilisation

After 72 hours is important to start using your elbow normally again. Start to do normally everyday activities. You should also try doing these exercises 3 – 4 times a day. Repeat each one 10 times..

1. 

Sitting or standing – Slowly bend your elbow and then straighten it.  

You may need to assist your arm with the other hand in the early days after an injury.

2.

Start with your elbows bent. Clasp your hands together. Turn your palm towards the floor and then back towards the ceiling. You can use the other hand to assist.

3.

Rest your forearm on a table with your hand over the edge. Using your wrist only, move your hand down towards the floor, and then back up towards the ceiling in a patting motion.

You can use the other hand to assist if needed.

4.

Support your elbow on a table make a fist bend your fingers into your palm as tightly as you can and feel them stretching. Now stretch your fingers as wide as you can and feel them stretching.

WEEK 2 – Strengthening Exercises

1. Sitting or standing – hold on to a small weight, such as a can of beans or bottle of water. Bend and straighten your elbow. 

2. Sit or Stand with one elbow bent and palm turned up. Hold on to a small weight such as a can of beans or bottle of water. Turn your palm down by rotating your forearm.

As you start to do these exercises you may feel there is some discomfort, however, this is normal and you should continue. If you have discomfort and pain for more than 2 hours after these exercises, then you should reduce the number and gradually build up again. 

Recovery time and returning to activity 

It usually takes 6 weeks to heal from simple soft tissue injuries to the elbow.  However, everyone recovers from injuries at different rates. Some may be back in 2 weeks however for some it can take up to 3 months.    

Returning to work – Gradually build up your strength and function, practice doing similar tasks that you would do at work before returning. Start doing this little and often ensuring there is minimal pain or swelling. 

Returning to hobbies/sport – it is advised not to return to these activities until you have full strength and range of movement without pain or swelling. Try to practice the specific movements of your hobby / sport in a controlled manner and build up the time and intensity that you do the movements before returning to your activity fully.

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