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G56.0 Carpal tunnel syndrome

  • A

    Actual

    67.37 days

    Benchmarks againts the actual outcomes data

  • B

    Best Practice

    28 days

    Manage toward the best practice duration

Manage toward the best practice duration

Scenario Activity Level Duration in Days
Conservative treatment, modified work (limit repetitive use of hand/wist) Modified 0 Days
Conservative treatment, regular work (if not aggravating to disability/use of splint) Regular 0-5 Days
Endoscopic/mini-palm surgery, modified work Modified 3-5 Days
Open Surgery (median nerve neurolysis), modified work Modified 10-14 Days
Conservative treatment, regular work (if work related & electrodiagnostically confirmed) Regular 28 Days
Endoscopic/mini-palm surgery, regular work, non-dominant arm Regular 28 Days
Endoscopic/mini-palm surgery, regular/repetitive/heavy manual work, dominant arm Regular 42 Days
Open Surgery, regular work, non-dominant arm: Regular 42 Days

G56.0 Carpal tunnel syndrome

  • ICD-9 Codes: 7176.6, 732.7
  • ICD-10 Codes: M17
  • CPT Codes: 29871
  • HCPS Codes: 29991
  • NDC Codes: 20001
Other names:
Arthroscopic lavage and debridement
Body system:
Knee
Treatment type:
Surgery

Arthroscopic lavage and debridement in patients with osteoathritis of the knee is no better than placebo surgery, and arthroscopic surgery provides no additional benefit compared to optimized physical and medical therapy. Arthroscopic surgery in the presence of significant knee OA should only rarely be considered for major, definite and new mechanical locking/catching (i.e., large lose body) after failure of non-operative treatment.

ODG Criteria: Arthroscopic surgery for Osteoarthritis

  • Sample Bullet Point
  • Bullet 2
  • Bullet 3
  • Bullet 4

ODG Treatment Guidelines

Initial trial:
5-7 visits over 3-4 weeks
Overall treatment:
With evidence of improvemnet, a total of 10-12 visits over 12 weeks.

Risk vs. Benefit

This is some sample text because there wasn't any available for this section. But I must explain to you how all this mistaken idea of denouncing pleasure and praising pain was born and I will give you a complete account of the system, and expound the actual teachings of the great explorer of the truth, the master-builder of human happiness. No one rejects, dislikes, or avoids pelasure itself, because it is pleasure, because those who do not know how to pursue pleasure rationally ecounter consequences that are extremely painful. Nor again is there anyone who loves or pursues or desires to obtain pain of itself, because it is pain, but because occasionally circumstances occur in which toil and pain can procure him some great pleasure. To take a trivial example, which of us ever undertakes laborious physical exercise, except to obtain some advantage from it? But who has any right to find fault with a man who chooses to enjoy a pleasure that has no annoying consequences, or one who avoids a pain that produces no resultant pleaure?

Related Links

Loose body removal surgery (arthroscopy); Knee joint replacement; Osteotomy; Meniscectomy;

Description

Arthroscopic surgery

This is a sample text because this topic did not have this info. But I must explain to you how all this mistaken idea of denouncing pleasure and praising pain was born and I will give you a complete account to the system, and expound the actual teachings of the great explorer of the truth, the master-builder of human happiness.No one rejects, dislikes, or avoids pelasure itself, because it is pleasure, because those who do not know how to pursue pleasure rationally ecounter consequences that are extremely painful.

Osteoarthristis

More sample text. Nor again is there anyone who loves or pursues or desires to obtain pain of itself, because it is pain, but because occasionally circumstances occur in which toil and pain can procure him some great pleasure. To take a trivial example, which of us ever undertakes laborious physical exercise, except to obtain some advantage from it? But who has any right to find fault with a man who chooses to enjoy a pleasure that has no annoying consequences, or one who avoids a pain that produces no resultant pleaure?

Evidence Summary

In the Meniscal Tear in Osteoarthritis Research (METEOR) trial, there were similar outcomes from PT versus surgery (Katz, 2013) In this RCT, arthroscopic surgery was not superior to supervised exercise alone after non-traumatic degenerative medial meniscal tear in older patients. (Herrlin, 2007) Another systematic review concluded that arthroscopic surgery for degenerative meniscal tears and mild or no osteoarthristis provided no benefit when compared with nonoperative management. (Khan, 2014) The small inconsequantial benefit seen from interventions that include arthroscopy for the degenerative knee is limited in time and absent at one to two years after surgery. Knee arthroscopy is associated with harms. Token together, these findings do not support arthroscopic knee surgery involving partial meniscectomy, debridement, or both for middle aged or older patients with knee pain and degenerative knee disease, with or without signs of osteoarthritis. (Thorlund, 2015)

Other Guidelines

According to the National Institute for Clinical Excellence (NICE) guidelines, arthroscopic lavage and debridement should not be offered as part of treatment for OA, unless a patient suffers from knee OA with a clear history of mechanical locking associated with intraarticular loose bodies or meniscal tears, emphasizing the importance of proper patient selection. Contrarily, the most recent AAOS guidelines indicate that arthroscopic debridement or lavage is just not recommended for patients with primary diagnosis of symptomatic OA of the knee. Consequently, 27% of orthopedic surgeons still recommend arthroscopy for the treatment of OA, but this treatment was found to be significantly more populer outside of the United States. (Abu-Ghanem, 2015)

References

  • Lechner DE. Work hardening and work conditioning interventions: do they effect disability? Phys Ther. 1994:74:471-93. PMID: 8171109
  • Legorreta AP, Metz RD, Nelson CF, Ray S, Chernicoff HO, Dinubile NA. Comparative analysis of individuals with and without chiropractic coverage: patient characteristics, utilization, and costs. Arch Intern Med. 2004 Oct 11;164(18):1985-92. PMID: 15477431
  • Leininger B, Bronfort G, Evans R, Reiter T. Spinal manipulation or mobilization for radiculopathy: a systematic review. Phys Med Rehabil Clin N Am. 2011 Feb;22(1):105-25. Epub 2010 Dec 30. PMID: 21292148
  • Licciardone JC, Stoll ST, Fulda KG, Russo DP, Siu J, Winn W, Swift J Jr, Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial, Spine. 2003 Jul 1;28(13):1355-62. PMID: 12838090
  • Licciardone JC, Brimhall AK, King LN. Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials. BMC Muskuloskelet Disord. 2005 Aug 4;6(1):43. PMID: 16080794