General Guideline Principles for Epicondylitis

(Epicondylalgia) for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Epicondylitis (Epicondylalgia).

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Lateral Epicondylitis Diagnostic Criteria

Pain or discomfort on the outer (lateral) side of the upper arm close to the elbow is a symptom of lateral epicondylitis, also known as tennis elbow. The diagnosis of lateral epicondylitis is made on the basis of lateral elbow pain along with palpable soreness over the lateral epicondyle or tenderness a few cm distal to the epicondyle.

Most patients don’t need any more tests as long as there are no warning signs. Additional testing could be necessary for patients whose symptoms have not subsided after receiving treatment for at least four weeks.

Other potential explanatory illnesses like elbow arthrosis, fibromyalgia, or cervical radiculopathy (particularly C-6) shouldn’t exist in patients. Although this is not necessary to obtain a diagnosis, some individuals will experience onset following a stressful event, typically a relatively minor mishap like hitting the elbow on a hard surface.

Medial Epicondylitis Diagnostic Criteria

The medial or inner aspect of the elbow is far less frequently affected by medial epicondylitis. Sometimes it’s hypothesized that ulnar neuropathy in the elbow occurs together with medial epicondylalgia. Similar to lateral epicondylitis, medial epicondylitis can be treated.

Special Studies and Diagnostic and Treatment Considerations of Epicondylitis

Most patients don’t need any more tests as long as there are no warning signs. Additional testing could be necessary for patients whose symptoms have not subsided after receiving treatment for at least four weeks.

For certain patients, testing is necessary to rule out potential alternative diagnoses including arthrosis or C-6 cervical radiculopathy (usually via MRI) (x-ray of the elbow).

Cervical radiculopathy may be treated using electromyography (EMG), although it is advised to wait at least six weeks following the onset of symptoms so that the EMG changes can become apparent (need at least three weeks).

Medications of Epicondylitis

For the majority of individuals, older NSAIDs like ibuprofen, naproxen, or endorsed as first-choice treatments. Acetaminophen or an equivalent For patients who are not candidates for NSAIDs, paracetamol (acetaminophen) may be a viable alternative to NSAIDs, despite the fact that the majority of research indicates that it is just marginally less effective.

There is proof that NSAIDs are less dangerous and just as good in relieving pain as opioids, such as tramadol.

  1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) NSAIDs for Treatment of Acute, Subacute, Chronic, or Postoperative Epicondylalgia

    Non-Steroidal Anti-inflammatory Drugs (NSAIDs) NSAIDs for Treatment of Acute, Subacute, Chronic, or Postoperative Epicondylalgia are recommended for the treatment of postoperative, chronic, or acute epicondylalgia

    Indications – NSAIDs are advised as a treatment for acute, subacute, chronic, or post-operative epicondylalgia. First, try over-the-counter (OTC) medications to see whether they work.

    Frequency/Duration –- For many patients, as required, use may be suitable.

    Indications for Discontinuation – The easing of elbow pain, a lack of effectiveness, or the appearance of side effects that require stopping the treatment.

     

  2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

    NSAIDs for Patients at High Risk of Gastrointestinal Bleeding are recommended Misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors are commonly used together by individuals who are at high risk of gastrointestinal bleeding.

    Indications – For patients who additionally have a high-risk factor profile, the use of NSAIDs and cytoprotective drugs should be taken into account, especially if longer-term treatment is being discussed. At-risk Patients having a background of previous gastrointestinal bleeding, older people, people with diabetes, and smokers.

    Frequency/Dose/Duration – H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are advised. dosage recommendations from the manufacturer. It is generally accepted that there are no significant differences in effectiveness for preventing gastrointestinal bleeding.

    Indications for Discontinuation – Intolerance, the emergence of negative effects, or the stopping of NSAIDs.

     

  3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

    NSAIDs for Patients at Risk for Cardiovascular Adverse Effects are recommended Acetaminophen or aspirin tend to be the safest medications for cardiovascular side effects when used as first-line therapy.If necessary, non-selective NSAIDs are preferred to COX-2-specific medications.

    To reduce the chance that an NSAID will negate the protective effects of low-dose aspirin in individuals receiving it for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or eight hours before the daily aspirin.

     

  4. Acetaminophen for Treatment of Elbow Pain

    Acetaminophen for Treatment of Elbow Pain is recommended for treatment of elbow discomfort, particularly in patients \with contraindications for NSAIDs.

    Indications – All patients, including those with acute, subacute, chronic, and post-operative elbow pain.

    Dose/Frequency – As per the manufacturer’s recommendations; can be used as required. When more than four gm/day is consumed, there is evidence of liver toxicity.

    Indications for Discontinuation –- The disappearance of discomfort, side effects, or intolerance.

     

  5. Topical NSAIDs of Epicondylitis (Epicondylalgia)

    Topical NSAIDs for Treatment of Acute, Subacute, Chronic, or Post-Operative Epicondylalgia

    Topical NSAIDs for Treatment of Acute, Subacute, Chronic, or Post-Operative Epicondylalgia are recommended for lateral epicondylalgia that is acute, subacute, chronic, or post-operative

    indications – Oral drugs are advised for the majority of individuals. Topical NSAIDs, however, might be a good substitute for people who cannot take oral NSAIDs or who are intolerant to them.

    Frequency/Dose/Duration – as per the advice of the manufacturer.

    Indications for Discontinuation – The easing of elbow pain, a lack of effectiveness, or the appearance of side effects that require stopping the treatment.

    There is Support for Topical NSAIDs and Other Agents in the Treatment of Lateral Epicondylalgia

     

  6. Opioids of Epicondylitis (Epicondylalgia)

    Patients with epicondylalgia are hardly ever treated with opioids. They are more typically utilised for limited periods right after surgery.

     

    • Opioids for Select Patients with Post-Operative Epicondylalgia

      Opioids for Select Patients with Post-Operative Epicondylalgia are recommended for the selective management of post-operative epicondylalgia patients.

      Indications – A brief opioid regimen of a few days to no more than one week is advised for the treatment of post-operative epicondylalgia. Following surgery, a small nocturnal dose of opioids may be beneficial. Opioids are not advised for people with various forms of epicondylalgia.

      Prior to using opioids, the majority of patients should try NSAIDs and acetaminophen for pain relief. It is advised to stop using opioids as soon as possible.

      Frequency/Dose/Duration – For most epicondylar surgeries, patients typically need no more than a few days to a week of opioid treatment.

      Indications for Discontinuation – Elimination of elbow pain, adequate control with additional drugs, ineffectiveness, or emergence of side effects that need discontinuation.

       

    • Opioids for Acute, Subacute, or Chronic Epicondylalgia

      Opioids for Acute, Subacute, or Chronic Epicondylalgia are not recommended for chronic epicondylalgia or acute, subacute, or both. Rationale for Recommendations Opioids have not been adequately studied when used to treat epicondylalgia.Opioids have serious side effects, including poor tolerance, constipation, sleepiness, impaired judgement, memory loss, and the potential for overuse or dependency, which has been observed in up to 35% of patients.

      Patients should be warned against using machinery or motor vehicles and aware of these possible side effects prior to receiving an opioid prescription. The majority of musculoskeletal complaints can be treated with safer analgesics, and opioids should only be taken in extreme cases of pain or for a brief period of time (no longer than one week) after surgery.

      Patients with epicondylalgia are not advised to take opioids, unless it is a brief postoperative course. There is Support for Opioid Use in Lateral Epicondylalgia.

Rehabilitation: Devices / Therapy of Epicondylitis

In the event that rehabilitation is necessary as a result of a job-related injury, the main goal should be to help the patient regain the functional ability needed to carry out daily tasks and return to work, with the goal of returning them as closely as possible to their pre-injury condition.

Active therapy calls for the patient to put in an internal effort to finish a particular activity or assignment. This type of therapy necessitates therapist supervision, such as verbal, visual, and/or tactile guidance (s).

The majority of the energy needed to perform the job is executed by the patient, while the therapist may occasionally assist in stabilizing the patient or directing the movement pattern. In order to maintain improvement levels, the patient should be advised to continue active therapy at home as an extension of the treatment process.

Over passive interventions, active initiatives should be prioritized. Passive interventions are those that rely on modalities administered by a therapist rather than requiring the patient to expend any effort.

Passive therapies are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains.

To facilitate functional gains, assistive devices may be used as an adjuvant measure in the rehabilitation strategy.

  1. Tennis Elbow Bands, Straps, and Braces for Acute, Subacute, and Chronic Epicondylalgia

    Tennis Elbow Bands, Straps, and Braces for Acute, Subacute, and Chronic Epicondylalgia are recommended to handle acute, subacute, or long-term epicondylalgia.

    Devices are typically worn everyday, but not at night or just when more strenuous activity is required (discontinue for less strenuous tasks during daily routine).

    The dorsum of the hand may become numb or there may be pain radiating down the dorsum of the forearm into the hand as a result of treatment that has not resolved elbow pain, intolerance, or lack of effectiveness.

     

  2. Cock-up Wrist Braces for Acute, Subacute, or Chronic Epicondylalgia

    Cock-up Wrist Braces for Acute, Subacute, or Chronic Epicondylalgia are recommended to manage acute, subacute, or chronic epicondylalgia.

    Indications – Devices are typically worn every day (but not at night) or only when necessary for more strenuous activities. They are discontinued for less strenuous activities performed as part of daily routine.

    Frequency/Dose/Duration – Devices are typically worn throughout the day (but not at night) or only when more strenuous activity is required (discarding for less strenuous activities during daily routine).

    Indications for Discontinuation – – The disappearance of elbow discomfort, intolerance, or ineffectiveness.

Therapy (Active and Passive) of Epicondylitis (Epicondylalgia)

Rehab (supervised formal therapy) needed after a work-related injury should be concentrated on regaining the functional ability needed to meet the patient’s daily and work obligations and enable them to return to work, with the goal of returning the injured worker to their pre-injury status to the extent that is practical.

Active therapy calls for the patient to put in an internal effort to finish a particular activity or assignment. The procedures known as passive therapy rely on modalities that are administered by a therapist rather than the patient exerting any effort on their side.

Passive therapies are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains. Interventions that are active should be prioritized over those that are passive.

To sustain improvement levels, the patient should be advised to continue both active and passive therapies at home as an extension of the therapeutic process.

To facilitate functional gains, assistive devices may be used as an adjuvant measure in the rehabilitation strategy.

Active Therapy of Epicondylitis (Epicondylalgia)

Physical / Occupational Therapy Physical or Occupational Therapy for Acute, Subacute, Chronic, or Post-operative Epicondylalgia

Physical / Occupational Therapy Physical or Occupational Therapy for Acute, Subacute, Chronic, or Post-operative Epicondylalgia are recommended for the management of postoperative, chronic, or acute epicondylalgia.

Frequency/Dose/Duration – Patients with moderate functional deficits may require as few as two to three visits overall; patients with more severe deficits may require 12 to 15 appointments with documentation of continued objective functional improvement.

If there is evidence of functional improvement toward particular objective functional goals (e.g., enhanced grip strength, key pinch strength, range of motion, or improving capacity to execute work activities), more than 12 to 15 visits may be necessary to address persistent functional impairments.

A home exercise regimen should be created as part of the rehabilitation strategy and carried out alongside the therapy.

Indications for Discontinuation – Resolution of elbow discomfort, intolerance, lack of effectiveness, or non-compliance, including failure to perform the recommended at-home exercises.

Passive Therapy of Epicondylitis (Epicondylalgia)

  1. Heat or Cold Packs

    Heat or Cold Packs are recommended for the management of postoperative or chronic or subacute acute epicondylalgia

    Frequency/Dose/Duration – Three to five times each day, self-applications of heat or ice may be reasonable therapies.

    Indications for Discontinuation – Elimination of elbow discomfort, intolerance, or ineffectiveness.

     

  2. Iontophoresis

    Iontophoresis is recommended Iontophoresis for the treatment of acute, subacute, or chronic epicondylalgia in combination with glucocorticoids or NSAIDs

    Indications – For patients with acute, subacute, or chronic epicondylalgia; people who are unable to take oral NSAIDs or who don’t respond to alternative treatments (such as inadequate pain alleviation from elbow straps and exercise may make for the best candidates. In most cases, mild Patients who are badly harmed are viewed as better candidates.

    Frequency/Dose/Duration – A variety of drugs were employed in the quality studies. Dexamethasone, naproxen, and ketorolac are a few of these.

    Indications for Discontinuation – Pain, intolerance, lack of effectiveness, or non-compliance are all resolved.

     

  3. Ultrasound of Epicondylitis (Epicondylalgia)

    Ultrasound of Epicondylitis (Epicondylalgia) is recommended to manage acute, subacute, or chronic epicondylalgia.

    Indications – Ideal candidates may include people with acute, subacute, or chronic epicondylalgia, those who cannot tolerate oral NSAIDs and exercise, as well as those who have not responded to conventional treatments (such as inadequate pain alleviation with elbow straps and activity adjustment).

    Patients who are moderately to severely impaired are typically considered to be better candidates. Ultrasound’s overall impact seems small, therefore additional interventions particularly exercise are advised before it.

    Frequency/Dose/Duration – The quality studies have made use of a variety of regimens. Ten to twelve treatments spread over four to six weeks were used in the two trials demonstrating the greatest benefit

    Indications for Discontinuation – Pain, intolerance, lack of effectiveness, or non-compliance are all resolved.

Other Therapies of Epicondylitis (Epicondylalgia)

  1. Manipulation and Mobilization Soft Tissue Mobilization for Acute, Subacute, or Chronic Epicondylalgia

    Manipulation and Mobilization Soft Tissue Mobilization for Acute, Subacute, or Chronic Epicondylalgia are not recommended to manage acute, subacute, or chronic epicondylalgia.

     

  2. Manipulation and Mobilization for Acute, Subacute, or Chronic Epicondylalgia

    Manipulation and Mobilization for Acute, Subacute, or Chronic Epicondylalgia are not recommended – for the treatment of acute, subacute, or chronic epicondylalgia.

     

  3. Massage, Including Friction Massage, for Acute, Subacute, or Chronic Epicondylalgia

    Massage, Including Friction Massage, for Acute, Subacute, or Chronic Epicondylalgia not recommended: Massage techniques such as friction massage

     

  4. Magnets and Pulsed Electromagnetic Field for Acute, Subacute, or Chronic Epicondylalgia

    Magnets and Pulsed Electromagnetic Field for Acute, Subacute, or Chronic Epicondylalgia are not recommended: to handle acute, subacute, or long-term epicondylalgia.

     

  5. Extracorporeal Shockwave Therapy for Acute, Subacute, or Chronic Epicondylalgia

    Extracorporeal Shockwave Therapy for Acute, Subacute, or Chronic Epicondylalgia not recommended: to handle acute, subacute, or long-term epicondylalgia.

     

  6. Phonophoresis for Acute, Subacute, or Chronic Epicondylalgia

    Phonophoresis for Acute, Subacute, or Chronic Epicondylalgia are not recommended: to handle acute, subacute, or long-term epicondylalgia.

     

  7. Low-Level Laser Therapy for Acute, Subacute, or Chronic Epicondylalgia

    Low-Level Laser Therapy for Acute, Subacute, or Chronic Epicondylalgia are not recommended: to handle acute, subacute, or long-term epicondylalgia.

     

  8. Acupuncture of Epicondylitis (Epicondylalgia)

    Acupuncture for Select Chronic Epicondylalgia are recommended to treat a select number of patients with long-lasting epicondylalgia

    Indications – Patients with chronic epicondylalgia; those not sufficiently responding to oral NSAID treatment and/or topical), activity, or individuals who don’t respond to treatments therapies (such as inadequate pain alleviation with elbow restraints and activity adjustment) can be the best options.

    Injections of glucocorticosteroids are also acceptable. Other interventions to try before acupuncture. Generally, moderately to severely impacted people are thought to be superior applicants. Acupuncture appears to have moderate overall advantages and seems to lose its effectiveness quickly. a few weeks afterwards.

    Frequency/Dose/Duration – Two to three treatments per week for eight to ten sessions per regimen. Patients must show improvement after four to five appointments; otherwise, the technique needs to be changed or acupuncture should be stopped.

    Indications for Discontinuation – Getting rid of pain, intolerance, ineffectiveness, or non-compliance.

     

  9. Acupuncture for Acute, Subacute, or Post-Operative Epicondylalgia

    Acupuncture for Acute, Subacute, or Post-Operative Epicondylalgia are not recommended for the treatment of post-operative or acute, subacute, or acute epicondylalgia.

    Biofeedback, Electrical Nerve Stimulation, and Diathermy for Acute, Subacute, or Chronic Epicondylalgia

    Biofeedback, Electrical Nerve Stimulation, and Diathermy for Acute, Subacute, or Chronic Epicondylalgia are not recommended in order to treat acute, subacute, or persistent epicondylalgia.

Injections of Epicondylitis

  1. Glucocorticosteroid Injections

     

    • Glucocorticosteroid Injections for Subacute or Chronic Epicondylalgia

      Glucocorticosteroid Injections for Subacute or Chronic Epicondylalgia are recommended for the management of very specific chronic or subacute epicondylalgia.

      Indications – patients with persistent or subacute epicondylalgia. Patients should not have responded well enough to several NSAIDs (oral and/or topical), exercise, elbow straps, and activity adjustment during NYS WCB MTG – Elbow Injuries 38 treatment.

      Patients should be informed that following an injection, symptoms frequently return. Patients who are moderately to severely affected are regarded to be better candidates, especially those who are thought to be surgical candidates but are delaying treatment in the hopes that the pain will go away.

      Frequency/Dose/Duration – All high-quality trials have only administered one injection and have checked the outcomes for a successful outcome before administering more.

      Indications for Discontinuation – Pain, intolerance, lack of effectiveness, or non-compliance are all resolved. The diagnosis should be reevaluated if there is no response.

       

    • Glucocorticosteroid Injections for Acute Epicondylalgia

      Glucocorticosteroid Injections for Acute Epicondylalgia are not recommended to alleviate acute epicondylalgia.

       

    • Glucocorticosteroid Injections Using Bupivacaine for Subacute

      Glucocorticosteroid Injections Using Bupivacaine for Subacute or Chronic Epicondylalgia are not recommended – as a supplement to the treatment of chronic or subacute epicondylalgia.

       

  2. Botulinum Injections for Acute, Subacute, or Chronic Lateral Epicondylalgia

    Botulinum Injections for Acute, Subacute, or Chronic Lateral Epicondylalgia are not recommended for the treatment of lateral epicondylalgia that is acute, subacute, or persistent.

     

  3. Platelet Rich Plasma Injections

    Platelet Rich Plasma Injections are recommended pertaining to Chronic Lateral Epicondylalgia

    Indications – Unresponsive to various therapies such as NSAIDs, straps, stretching and strengthening exercises, and at least one glucocorticosteroid injection. Lateral epicondylalgia persisting at least 6 months.

    Dose/Duration – Approximately 3mL of platelet-rich plasma, buffered with NS, 8.4% sodium bicarbonate, 0.5% bupivacaine, and epinephrine, were administered in one injection (1:200,000).

     

  4. Autologous Blood Injections

    Autologous Blood Injections are recommended pertaining to Chronic Lateral Epicondylalgia

    Indications – Unresponsive to various therapies such as NSAIDs, straps, stretching and strengthening exercises, and at least one glucocorticosteroid injection. Lateral epicondylalgia persisting at least 6 months.

    Dose/Frequency – 2 millilitres of autologous blood are drawn from a peripheral vein, then are injected into the area that is most sensitive (s).

     

  5. Platelet-rich Plasma or Autologous Blood Injections for Acute or Subacute Epicondylalgia

    Platelet-rich Plasma or Autologous Blood Injections for Acute or Subacute Epicondylalgia are not recommended as a remedy for subacute or acute epicondylalgia.

     

  6. Polidocanol Injections for Acute, Subacute, or Chronic Epicondylalgia

    Polidocanol Injections for Acute, Subacute, or Chronic Epicondylalgia are not recommended to treat acute, subacute, or chronic conditions epicondylalgia.

     

  7. Periarticular Viscosupplementation (Hyaluronate and Glycosaminoglycan) Injections for Chronic Epicondylalgia

    Periarticular Viscosupplementation (Hyaluronate and Glycosaminoglycan) Injections for Chronic Epicondylalgia are not Recommended in order to manage chronic epicondylalgia.

     

  8. Other Injections of Epicondylitis (Epicondylalgia)

     

    • Prolotherapy or Sonographically Guided Percutaneous Tenotomy Injections for Acute, Subacute, or Chronic Epicondylalgia

      Prolotherapy or Sonographically Guided Percutaneous Tenotomy Injections for Acute, Subacute, or Chronic Epicondylalgia are not recommended to handle acute, subacute, or long-term epicondylalgia.

       

    • Dry Needling or Multi Puncture Technique (‘peppering”) May Be Effective for Treatment of Subacute or Chronic Epicondylalgia

      Dry Needling or Multi Puncture Technique (‘peppering”) May Be Effective for Treatment of Subacute or Chronic Epicondylalgia are recommended to treat subacute or persistent epicondylalgia

      Rationale for Recommendations – There is some preliminary evidence that the numerous puncture approach (sometimes known as “peppering”) or dry needling may be useful.

Surgical Considerations of Epicondylitis

When lateral epicondylalgia does not improve with nonsurgical methods, adequate nonoperative care trials. The three primary surgical methods for arthroscopic, percutaneous, and open lateral epicondylalgia.

A review discovered no proof that one method was superior to another and came to the conclusion that The surgeon should be free to make their own decision.

  1. Lateral Epicondylar Release for Chronic Lateral Epicondylalgia

    Lateral Epicondylar Release for Chronic Lateral Epicondylalgia are recommended for the treatment of lateral epicondylalgia that is persistent.

    Indications – Surgery should be scheduled according to the degree of functional impairment, as well as the progression and seriousness of objective findings.

    Contrary to severe entrapment neuropathies, lateral epicondylalgia typically does not result in unmistakably objective proof of impairment or severe dysfunction; for this reason, it is especially necessary to document adequate non-operative management trials notwithstanding adherence to therapy.

    Although there are a few rare exceptions, most patients should experience pain for at least 6 months before considering surgery. In some cases, however, only 3 months of non-operative treatment may be required.

    In order to increase the range of motion and strength of the musculature around the elbow, there should typically be considerable restrictions, failure to improve with NSAIDs, elbow bands or straps, activity adjustment, and exercise programmes.

    Ideally, patients should have verified short-term alleviation from injection after failing glucocorticosteroid injection(s) (s). Any of the three primary surgical techniques is suitable.

     

  2. Radiofrequency Microtenotomy for Chronic Lateral Epicondylalgia

    Radiofrequency Microtenotomy for Chronic Lateral Epicondylalgia are recommended to treat lateral epicondylalgia that is persistent.

    Indications – the same as before.

What our office can do if you have Epicondylitis (Epicondylalgia)

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.

Call Us Now!

5.0
Based on 107 reviews
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
Dave
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
Eclectic54
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
Sam
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
js_loader

Disclaimer

Complete Orthopedics is a medical office and we are physicians . We are not attorneys. The information on this website is for general informational purposes only.

Nothing on this site should be taken as legal advice for any individual case or situation. The information posted is not intended to create, and receipt or viewing does not constitute, an attorney-client relationship or a doctor-patient relationship nor shall the information be used to form an legal or medical opinions.

You should not rely on any of the information contained on this website. You should seek the advice of a lawyer or physician immediately for more accurate information surrounding any legal or medical issues.

This information has been posted for informational and/or advertisement purposes only. You consent to these terms and conditions by using our website

I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

You can see my full CV at my profile page.