General Guideline Principles for Hip and Groin Disorders

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 Hip and Groin Disorders.

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.

Scaphoid Fracture of Hand, Wrist and Forearm Injuries

Among the most frequent fractures of the carpal bones are scaphoid fractures, also referred to as wrist navicular fractures. While most are not occupational, some are unquestionably related to the workplace.

A fall onto an extended hand or from an axial force is the main reason for the scaphoid injury. In an auto accident, loading with a closed fist might involve holding the steering wheel.

Scaphoid fractures, especially those involving the proximal third of the navicular and especially if displaced, are prone to non-union and avascular necrosis. The fracture plane’s disruption of the limited blood supply, which contributes to healing issues in the proximal third, has been identified as the cause.

Confirming a fracture, determining which patients have fractures that respond best to surgery, and providing apropriate splinting to those who have a high clinical suspicion of fracture are the three main initial tasks. Patients frequently complain of scaphoid-area tenderness and persistent swelling near the base of the thumb.|

  1. Diagnostic Studies of Scaphoid Fracture X-Rays

    Diagnostic Studies of Scaphoid Fracture X-Rays is recommended for diagnostic purposes, with at least three to four views, one of which is a “scaphoid view.”


  2. X-Rays

    X-Rays – Follow-up in two weeks is recommended for the assessment of possible scaphoid fractures,) especially in patients who have a strong clinical suspicion of fracture despite having negative initial x-rays.


  3. MRI

    MRI is recommended when clinical suspicion is high despite negative x-rays for the diagnosis of occult scaphoid fractures in a small subset of patients.Indications – X-rays are negative despite clinical suspicion of a scaphoid fracture.

    Rationale for Recommendation -The majority of scaphoid fractures do not require MRI, but it may be recommended for patients who have a clinical suspicion of a scaphoid fracture despite having negative x-ray results.


  4. CT Imaging

    CT Imaging is recommended to identify hidden scaphoid fractures when MRI is not recommended and clinical suspicion of fracture persists despite negative x-ray results.


  5. Bone Scan

    Bone Scan is recommended for a select group of patients to detect occult scaphoid fractures when clinical suspicion is high and x-ray results are negative.Indications – At least 48 hours after the accident, as long as the clinic is still suspecting a scaphoid fracture.

    Motives for the Recommendation

    For the majority of patients with scaphoid fractures, bone scans are not necessary for evaluation; however, in patients who have a clinical suspicion of scaphoid fracture but negative x-rays, bone scans may help in securing an earlier diagnosis, obviating prolonged splinting in those without a fracture. Therefore, bone scans are advised for these particular patients.

Medications of Hand, Wrist and Forearm Injuries

Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients. For patients who are not candidates for NSAIDs, acetaminophen (or the analogue paracetamol) may be a viable alternative, even though the majority of research indicates it is only marginally less effective than NSAIDs.

There is proof that NSAIDs are less dangerous and just as effective at treating pain as opioids, such as tramadol.

  1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic Scaphoid Fractures Pain

    Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic Scaphoid Fractures Pain is recommended for the treatment of pain from scaphoid fractures that is acute, subacute, or chronic.Indications – NSAIDs are advised as a treatment for the acute, subacute, or chronic pain associated with Scaphoid fractures.First, try over-the-counter (OTC) medications to see if they work.

    Frequency/Duration: Many patients might find it reasonable to use as needed. warning signs ofDiscontinuation: discontinuation is necessary due to symptom resolution, ineffectiveness, or the emergence of side effects.


  2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

    NSAIDs for Patients at High Risk of Gastrointestinal Bleeding is recommended for patients at high risk of gastrointestinal bleeding to take misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors concurrently.Indications: Cytoprotective drugs should be taken into consideration for patients with a high-risk factor profile who also have indications for NSAIDs, especially if a longer course of treatment is planned.

    Patients who have a history of gastrointestinal bleeding in the past, the elderly, diabetics, and smokers are at risk. 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.

    Signals of Discontinuation Intolerance, the emergence of negative effects, or the stopping of NSAIDs.


  3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

    Patients with known cardiovascular disease or multiple risk factors for cardiovascular disease should have the risks and benefits of NSAID therapy for pain discussed.


  4. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects


    • NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

      NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended as far as adverse cardiovascular effects go, acetaminophen or aspirin as first-line therapy seem to be the safest options.


    • NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

      NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended 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 patients 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.


  5. Acetaminophen for Treatment of Scaphoid Fractures Pain

    Acetaminophen for Treatment of Scaphoid Fractures Pain is recommended for the treatment of scaphoid fracture pain, especially in patients who have NSAID contraindications.Indications: Patients with acute, subacute, chronic, and post-operative scaphoid fracture pain.

    Dose/Frequency: As per the manufacturer’s recommendations; can be used as required.Over four gm/day, there is evidence of hepatic toxicity.Indications for Discontinuation: pain, side effects, or intolerance are gone.

Opioids of Scaphoid Fracture

Opioids are Limited Use of Opioids for Acute and Post-operative Pain Management

Opioids are Limited Use of Opioids for Acute and Post-operative Pain Management is recommended for brief (less than seven-day) use as an adjunctive therapy to more powerful treatments for the management of acute and post-operative pain.

Indications: In addition to more effective treatments (especially NSAIDs, acetaminophen, elevation, and splinting), a brief opioid prescription is frequently needed for acute injury and post-operative pain management, especially at night.

Frequency/Duration: As needed during the day, only at night later, and finally completely discontinued.

Rationale for Recommendation: When NSAIDs are ineffective in relieving a patient’s pain, opioids should be used sparingly, especially at night. Opioids are advised for brief, selective use in postoperative patients, with nighttime use being the main recommendation for achieving postoperative sleep.

Treatments of Scaphoid Fracture

  1. Wrist Splinting

    Wrist Splinting is recommended for the treatment of fractures of the scaphoid tubercle. Reasons forRecommendation – Splinting may be sufficient because these fractures heal quickly because of the good blood flow.


  2. Cast Immobilization

    Cast Immobilization is recommended to treat scaphoid fractures that are stable and not displaced.Frequency/Duration – Casting should be applied for 6 to 8 weeks, followed by cast removal, clinical reevaluation, and a repeat x-ray to see if more casting is necessary.


  3. Thumb Immobilization with Spica Casting

    Thumb Immobilization with Spica Casting is recommended In order to treat scaphoid fractures, the thumb and wrist are both immobilised simultaneously.Frequency/Duration – Casting should be done for 6 to 8 weeks, after which the patient should be evaluated clinically and have a new x-ray to see if more casting is necessary.


  4. Spica Splints

    Spica Splints is recommended for patients whose x-rays are negative but who may have a scaphoid fracture.Duration: 2 weeks, with a follow-up clinical examination and follow-up x-ray. If the x-ray is negative, you might want to stop wearing the splint.

Rehabilitation of Scaphoid Fracture

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 forth an internal effort to finish a particular exercise or task. The interventions known as passive therapy rely on modalities that are administered by a therapist rather than the patient exerting any effort on their part.

Passive interventions are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains. Over passive interventions, active interventions should be prioritised.

To maintain 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 adjunctive measure in the rehabilitation plan.

Therapy: Active of Scaphoid Fracture

Therapeutic Exercise – for Post-operative Scaphoid Fractures

Therapeutic Exercise – for Post-operative Scaphoid Fractures is recommended for the treatment of post-operative scaphoid fractures

Frequency/Dose/Duration – With documentation of ongoing objective functional improvement, the total number of visits may be as low as two to three for patients with mild functional deficits or as high as 12 to 15 for those with more severe deficits.

If there is evidence of functional improvement toward specific objective functional goals, more than 12 to 15 visits may be necessary when there are persistent functional deficits (e.g., increased grip strength, key pinch strength, range of motion, advancing ability to perform work activities).

Part of A home exercise programme should be created as part of the rehabilitation plan and carried out alongside the therapy.

Surgery of Scaphoid Fracture

Surgical Fixation

Surgical Fixation is recommended in the case of displaced scaphoid fractures

Rationale for Recommendation It is thought that displaced fractures need surgical fixation for treatment.

Due to the increased risk of these fractures developing a nonunion, malunion, or degenerative joint disease, high-risk scaphoid fractures should be promptly referred to hand or orthopaedic surgical specialists for effective treatment.

Surgical Intervention of Non-Displaced or Minimally Displaced Scaphoid Fractures

  1. Surgical Intervention of Non-Displaced or Minimally Displaced Scaphoid Fractures

    Surgical Intervention of Non-Displaced or Minimally Displaced Scaphoid Fractures are recommended for some patients who need a faster return to function.


  2. Surgical Intervention of Non-Displaced or Minimally Displaced Scaphoid Fractures

    Surgical Intervention of Non-Displaced or Minimally Displaced Scaphoid Fractures is not Recommended cast immobilisation is typically the best course of treatment for non-displaced fractures.

    Rationale for Recommendation –Patients with non-displaced or minimally displaced scaphoid fractures who cannot or do not want to try non-operative treatment may benefit from surgical intervention.Athletes are included. Patients who are unable to work until the fracture heals may also be included.

    The orthopedist and patient must decide whether to operate on a non-displaced scaphoid fracture, and it is advised that they weigh the advantages of an earlier functional recovery against the long-term risks of osteoarthrosis.


  3. Hardware Removal Surgical Intervention of Non-Displaced or Minimally Displaced Scaphoid Fracture

    Hardware Removal Surgical Intervention of Non-Displaced or Minimally Displaced Scaphoid Fractures are recommended Hardware removal is advised after it has been implanted in some cases, depending on the doctor’s and the patient’s preferences

    Indications: in situations where there is 1) protruding hardware, 2) pain related to the hardware, 3) broken hardware on imaging, and/or 4) positive anaesthetic injection response, as per the doctor’s or patient’s preference.

What our office can do if you have workers compensation injury

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!

Based on 96 reviews
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.
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


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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.

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