Ankle Arthrodesis Physical Therapy Protocol
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Synovial Fluidfluid 11
LWBK461-c11_p253-262.qxd 11/18/09 6:04 PM Page 253 Aptara Inc CHAPTER SynovialSynovial FluidFluid 11 Key Terms ANTINUCLEAR ANTIBODY ARTHROCENTESIS BULGE TEST CRYSTAL-INDUCED ARTHRITIS GROUND PEPPER HYALURONATE MUCIN OCHRONOTIC SHARDS RHEUMATOID ARTHRITIS (RA) RHEUMATOID FACTOR (RF) RICE BODIES ROPE’S TEST SEPTIC ARTHRITIS Learning Objectives SYNOVIAL SYSTEMIC LUPUS ERYTHEMATOSUS 1. Define synovial. VISCOSITY 2. Describe the formation and function of synovial fluid. 3. Explain the collection and handling of synovial fluid. 4. Describe the appearance of normal and abnormal synovial fluids. 5. Correlate the appearance of synovial fluid with possible cause. 6. Interpret laboratory tests on synovial fluid. 7. Suggest further testing for synovial fluid, based on preliminary results. 8. List the four classes or categories of joint disease. 9. Correlate synovial fluid analyses with their representative disease classification. 253 LWBK461-c11_p253-262.qxd 11/18/09 6:04 PM Page 254 Aptara Inc 254 Graff’s Textbook of Routine Urinalysis and Body Fluids oint fluid is called synovial fluid because of its resem- blance to egg white. It is a viscous, mucinous substance Jthat lubricates most joints. Analysis of synovial fluid is important in the diagnosis of joint disease. Aspiration of joint fluid is indicated for any patient with a joint effusion or inflamed joints. Aspiration of asymptomatic joints is beneficial for patients with gout and pseudogout as these fluids may still contain crystals.1 Evaluation of physical, chemical, and microscopic characteristics of synovial fluid comprise routine analysis. This chapter includes an overview of the composition and function of synovial fluid, and laboratory procedures and their interpretations. -
ICD~10~PCS Complete Code Set Procedural Coding System Sample
ICD~10~PCS Complete Code Set Procedural Coding System Sample Table.of.Contents Preface....................................................................................00 Mouth and Throat ............................................................................. 00 Introducton...........................................................................00 Gastrointestinal System .................................................................. 00 Hepatobiliary System and Pancreas ........................................... 00 What is ICD-10-PCS? ........................................................................ 00 Endocrine System ............................................................................. 00 ICD-10-PCS Code Structure ........................................................... 00 Skin and Breast .................................................................................. 00 ICD-10-PCS Design ........................................................................... 00 Subcutaneous Tissue and Fascia ................................................. 00 ICD-10-PCS Additional Characteristics ...................................... 00 Muscles ................................................................................................. 00 ICD-10-PCS Applications ................................................................ 00 Tendons ................................................................................................ 00 Understandng.Root.Operatons..........................................00 -
CPT® Procedural Coding 110 L with Areportoftheprocedure
20610-20611 2017 Illustrated Coding and Billing Expert for Orthopedics Lower 20610-20611 ICD-9-CM Diagnostic Codes M16.7 Other unilateral secondary 711.05 Pyogenic arthritis involving pelvic osteoarthritis of hip 20610 Arthrocentesis, aspiration and/or region and thigh M17.0 Bilateral primary osteoarthritis of injection, major joint or bursa (eg, 711.06 Pyogenic arthritis involving lower leg knee shoulder, hip, knee, subacromial 713.5 Arthropathy associated with ⇄ M17.11 Unilateral primary osteoarthritis, right bursa); without ultrasound guidance neurological disorders knee 20611 Arthrocentesis, aspiration and/or 714.0 Rheumatoid arthritis ⇄ M17.12 Unilateral primary osteoarthritis, left knee injection, major joint or bursa (eg, 715.15 Osteoarthrosis, localized, primary, pelvic region and thigh M17.2 Bilateral post-traumatic osteoarthritis shoulder, hip, knee, subacromial 715.16 Osteoarthrosis, localized, primary, of knee bursa); with ultrasound guidance, with lower leg M17.5 Other unilateral secondary permanent recording and reporting 715.25 Osteoarthrosis, localized, secondary, osteoarthritis of knee (Do not report 20610, 20611 in pelvic region and thigh ⇄ M1A.051 Idiopathic chronic gout, right hip conjunction with 27370, 76942) 715.26 Osteoarthrosis, localized, secondary, ⇄ M1A.062 Idiopathic chronic gout, left knee (If fluoroscopic, CT, or MRI guidance is lower leg ⇄ M25.052 Hemarthrosis, left hip ⇄ M25.061 Hemarthrosis, right knee performed, see 77002, 77012, 77021) 715.35 Osteoarthrosis, localized, not specified whether primary -
Realignment Surgery As Alternative Treatment of Varus and Valgus Ankle Osteoarthritis
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 462, pp. 156–168 © 2007 Lippincott Williams & Wilkins Realignment Surgery as Alternative Treatment of Varus and Valgus Ankle Osteoarthritis Geert I. Pagenstert, MD*; Beat Hintermann, MD*; Alexej Barg, MD*; André Leumann, MD†; and Victor Valderrabano, MD, PhD† In patients with asymmetric (varus or valgus) ankle osteo- Level of Evidence: Level IV, therapeutic study. See the arthritis, realignment surgery is an alternative treatment to Guidelines for Authors for a complete description of levels of fusion or total ankle replacement in selected cases. To deter- evidence. mine whether realignment surgery in asymmetric ankle os- teoarthritis relieved pain and improved function, we clini- cally and radiographically followed 35 consecutive patients Surgical treatment for patients with symptomatic ankle with posttraumatic ankle osteoarthritis treated with lower osteoarthritis (OA) is controversial, particularly in me- leg and hindfoot realignment surgery. We further questioned if outcome correlated with achieved alignment. The average chanically induced, malaligned ankle OA in which joint patient age was 43 years (range, 26–68 years). We used a cartilage is partially preserved. These patients typically are standardized clinical and radiographic protocol. Besides dis- in their economically important, active middle ages be- tal tibial osteotomies, additional bony and soft tissue proce- cause early trauma is the predominant (70–80%) etiology dures were performed in 32 patients (91%). At mean fol- of their ankle OA.49,58 Currently, treatment recommenda- lowup of 5 years (range, 3–10.5 years), pain decreased by an tions after failed nonoperative therapy are polarized be- average of 4 points on a visual analog scale; range of ankle tween fusion2,11,33 and total ankle replacement motion increased by an average of 5°. -
Tibiocalcaneal Arthrodesis Using Screws in the Treatment of Equinovarus Deformity of the Foot in Adult: a Retrospective Study of 42 Cases L.Unyendje, M
14699 L.Unyendje et al./ Elixir Human Physio. 58 (2013) 14699-14702 Available online at www.elixirpublishers.com (Elixir International Journal) Human Physiology Elixir Human Physio. 58 (2013) 14699-14702 Tibiocalcaneal arthrodesis using screws in the treatment of equinovarus deformity of the foot in adult: a retrospective study of 42 cases L.Unyendje, M. Mahfoud, F.Ismael, A.Karkazan, MS. Berrada, M. EL Yaacoubi, A. El Bardouni, M. Kharmaz, MY.O.Lamrani, M.Ouadghiri and A. Lahlou Mohammed V University, Faculty of Medicine and Pharmacy, IBN SINA Hospital, Orthopedic Department Rabat-Morocco. ARTICLE INFO ABSTRACT Article history: The authors have retrospectively studied 42 cases of tibiocalcaneal arthrodesis using large Received: 6 March 2013; cannulated AO screws, staples and iliac crest graft mixed in treatment of fixed equinovarus Received in revised form: deformity of the foot in adult patients. There were 25 men and 17 women aged 22 to 70 17 April 2013; (mean, 45) years. All patients were reviewed with an average of 5 years. The operations Accepted: 3 May 2013; were performed between 2005 and 2012.Preoperatively, all patients had 50° of the mean calcaneal varus deformity and 75° (60-90°) of equinus deformity on Meary’s radiological. Keywords There were 24 idiopathic, 8 post traumatic,6 neurologic associated with IMC,4 polio. Tibiocalcaneal arthrodesis, Clinical and functional outcome was assessed with the kitaoka score, the x-rays included an Screw, AP and lateral view of the ankle and Meary view .Resultats were excellent in 73% , good in Equinovarus foot, 18 % , fair in 9%. X-rays showed 3 nonunions after 2 years and were reported. -
Radiation Synovectomy with 166Ho-Ferric Hydroxide: a First Experience
Radiation Synovectomy with 166Ho-Ferric Hydroxide: A First Experience Sedat Ofluoglu, MD1; Eva Schwameis, MD2; Harald Zehetgruber, MD2; Ernst Havlik, PhD3; Axel Wanivenhaus, MD2; Ingrid Schweeger, MD1; Konrad Weiss, MD4; Helmut Sinzinger, MD1; and Christian Pirich, MD1 1Department of Nuclear Medicine, University of Vienna, Vienna, Austria; 2Department of Orthopedics, University of Vienna, Vienna, Austria; 3Department of Biomedical Engineering and Physics and Ludwig Boltzmann Institute of Nuclear Medicine, Vienna, Austria; and 4Department of Nuclear Medicine, General Hospital of Wiener Neustadt, Wiener Neustadt, Austria lage, leading to the progressive loss of joint function and Radiation synovectomy (RS) is indicated when conventional significant disability. Treatment of chronic synovitis using pharmacologic treatment of chronic synovitis has not relieved radiation synovectomy (RS) aims to stop the inflammatory its symptoms. The use of radionuclides that are bound to ferric process causing pain, disability, and nonreversible structural hydroxide (FH) particles has been shown to be effective and damage to the joint (1–3). RS has been in clinical use for 166 safe for this procedure. Ho-FH macroaggregates offer prom- 50y(4) primarily as an alternative to surgical treatment (5). ising properties for RS but there is a lack of clinical data. We Safety is one of the most important aspects when radionu- investigated the efficacy and safety of 166Ho-FH in a prospective clinical trial in patients suffering from chronic synovitis. Meth- clides are applied therapeutically. The use of ferric hydrox- ods: Twenty-four intraarticular injections were performed in 22 ide (FH) particles as a carrier may offer some advantages patients receiving a mean activity of 1.11 GBq (range, 0.77–1.24 over other carriers with respect to the frequency and degree GBq) 166Ho-FH. -
Ankle and Pantalar Arthrodesis
ANKLE AND PANTALAR ARTHRODESIS George E. Quill, Jr., M.D. In: Foot and Ankle Disorders Edited by Mark S. Myerson, M.D. Since reports in the late 19th Century, arthrodesis has been a successful accepted treatment method for painful disorders of the ankle, subtalar, and transverse tarsal joints. While the title of this chapter involves arthrodesis - the intentional fusion of a joint - as a form of reconstruction, this chapter will address not only surgical technique, but nonoperative methods of care as well. We will address the pathophysiology leading to ankle and hindfoot disability, succinctly review the existing literature on the topic of hindfoot and ankle arthrodesis, highlight the pathomechanics involved, and spend considerable time on establishing the diagnosis, indications, and preoperative planning when surgery is indicated. We also will discuss the rehabilitation of the postoperative patient, as well as the management of complications that may arise after ankle and pantalar arthrodesis. There are more than thirty different viable techniques that have been described in order to achieve successful ankle and hindfoot arthrodesis. It is not the purpose of this chapter to serve as compendium of all the techniques ever described. The author will, rather, attempt to distill into a useful amount of clinically applicable material this vast body of information that the literature and clinical experience provide. Ankle arthrodesis is defined as surgical fusion of the tibia to the talus. Surgical fusion of the ankle (tibiotalar) and subtalar (talocalcaneal) joints at the same operative sitting is termed tibiotalocalcaneal arthrodesis. Fusion of the talus to all the bones articulating with it (distal tibia, calcaneus, navicular, and cuboid) is termed pantalar arthrodesis. -
DISSERTATION INVESTIGATION of CATIONIC CONTRAST-ENHANCED COMPUTED TOMOGRAPHY for the EVALUATION of EQUINE ARTICULAR CARTILAGE Su
DISSERTATION INVESTIGATION OF CATIONIC CONTRAST-ENHANCED COMPUTED TOMOGRAPHY FOR THE EVALUATION OF EQUINE ARTICULAR CARTILAGE Submitted by Bradley B. Nelson Department of Clinical Sciences In partial fulfillment of the requirements For the Degree of Doctor of Philosophy Colorado State University Fort Collins, Colorado Fall 2017 Doctoral Committee: Advisor: Christopher E. Kawcak Co-Advisor: Laurie R. Goodrich C. Wayne McIlwraith Mark W. Grinstaff Myra F. Barrett Copyright by Bradley Bernard Nelson 2017 All Rights Reserved ABSTRACT INVESTIGATION OF CATIONIC CONTRAST-ENHANCED COMPUTED TOMOGRAPHY FOR THE EVALUATION OF EQUINE ARTICULAR CARTILAGE Osteoarthritis and articular cartilage injury are substantial problems in horses causing joint pain, lameness and decreased athleticism resonant of the afflictions that occur in humans. This debilitating joint disease causes progressive articular cartilage degeneration and coupled with a poor capacity to heal necessitates that articular cartilage injury is detected early before irreparable damage ensues. The use of diagnostic imaging is critical to identify and characterize articular cartilage injury, though currently available methods are unable to identify these early degenerative changes. Cationic contrast-enhanced computed tomography (CECT) uses a cationic contrast media (CA4+) to detect the early molecular changes that occur in the extracellular matrix. Glycosaminoglycans (GAGs) within the extracellular matrix are important for the providing the compressive stiffness of articular cartilage and their degradation is an early event in the development of osteoarthritis. Cationic CECT imaging capitalizes on the electrostatic attraction between CA4+ and GAGs; exposing the proportional relationship between the amount of GAGs present within and the amount of CA4+ that diffuses into the tissue. The amount of CA4+ that resides in the tissue is then quantified through CECT imaging and estimates tissue integrity through nondestructive assessment. -
Ankle Fusion Protocol
Phone: 574.247.9441 ● Fax: 574.247.9442 ● www.sbortho.com ANKLE FUSION PROTOCOL This is the fusion of the tibia and the talus for ankle joint arthritis. Your ankle will lose the majority of its up and down motion, but typically retain some side to side motion. Occasionally the subtalar joint (between the talus and calcaneus) also needs to be fused, which further stiffens the ankle. Bone graft (typically allograft/cadaver bone or Augment, a synthetic graft) is used, and screws, staples, plates, and/or a metal rod are inserted to hold the bones together as they heal. Below is a general outline for these fusion procedures. MD recommendations and radiographic evidence of healing can always affect the timeline. **This is a guideline for recovery, and specific changes may be indicated on an individual basis** Preoperative Physical Therapy Pre surgical Gait Training, Balance Training, Crutch Training and Knee Scooter Training Phase I- Protection (Weeks 0 to 6) GOALS: - Cast or boot for 6 weeks - Elevation, ice, and medication to control pain and swelling - Non-weight bearing x 6 weeks - Hip and knee AROM, hip strengthening - Core and upper extremity strengthening WEEK 0-2: Nonweightbearing in splint - elevate the leg above the heart to minimize swelling 23 hours/day - ice behind the knee 30 min on/30 min off (Vascutherm or ice bag) - minimize activity and focus on rest 1ST POSTOP (5-7 DAYS): Dressing changed, cast applied - continue strict elevation, ice, NWB WEEKS 2-3: Sutures removed, cast changed WEEKS 4-5: Return for another cast change -
ARTICULAR BLEEDING (HEMARTHROSIS) in HEMOPHILIA an ORTHOPEDIST’S POINT of VIEW Second Edition
TREATMENT OF HEMOPHILIA April 2008 · No. 23 ARTICULAR BLEEDING (HEMARTHROSIS) IN HEMOPHILIA AN ORTHOPEDIST’S POINT OF VIEW Second edition E. C. Rodríguez-Merchán Consultant Orthopedic Surgeon La Paz University Hospital Madrid, Spain Associate Professor of Orthopedics University Autonoma Madrid, Spain Published by the World Federation of Hemophilia (WFH), 2000; revised 2008. © Copyright World Federation of Hemophilia, 2008 The WFH encourages redistribution of its publications for educational purposes by not-for-profit hemophilia organizations. In order to obtain permission to reprint, redistribute, or translate this publication, please contact the Programs and Education Department at the address below. This publication is accessible from the World Federation of Hemophilia’s eLearning Platform at eLearning.wfh.org Additional copies are also available from the WFH at: World Federation of Hemophilia 1425 René Lévesque Boulevard West, Suite 1010 Montréal, Québec H3G 1T7 CANADA Tel. : (514) 875-7944 Fax : (514) 875-8916 E-mail: [email protected] Internet: www.wfh.org The Treatment of Hemophilia series is intended to provide general information on the treatment and management of hemophilia. The World Federation of Hemophilia does not engage in the practice of medicine and under no circumstances recommends particular treatment for specific individuals. Dose schedules and other treatment regimes are continually revised and new side-effects recognized. WFH makes no representation, express or implied, that drug doses or other treatment recommendations in this publication are correct. For these reasons it is strongly recommended that individuals seek the advice of a medical adviser and/or to consult printed instructions provided by the pharmaceutical company before administering any of the drugs referred to in this monograph. -
Joint & Tendon Injection
Coding Corner JOINT & TENDON INJECTION Joint Aspiration/Injection Report only a single unit of a joint injection code (seen on table below) for each joint treated, regardless of how many aspirations and/or injections occur in a single joint. For example, if the physician administers two injections, one on either side of the right knee, you would report 20610 x 1. The Centers for Medicare & Medicaid Services (CMS) instructs that you should also “Indicate which knee was injected by using the RT (right) or LT (left) modifier on the injection procedure.” Code Description 20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (e.g., fingers, toes); without ultrasound guidance 20604 Arthrocentesis, aspiration and/or injection, small joint or bursa (e.g., fingers, toes); with ultrasound guidance, with permanent recording and reporting 20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance 20606 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); without ultrasound guidance 20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting You may report multiple units only if aspiration/injection is performed in more than one joint (e.g., both knees or left knee and left shoulder). If aspirations and/or injections occur on opposite, paired joints (e.g., both knees), you may report one unit with modifier 50 Bilateral procedure appended, per CMS instruction. -
Consensus of the 3 Round Table Barcelona June 2013
Consensus of the 3rd Round Table Barcelona June 2013 Mark Rogers FRCS (Tr & Orth) Derek Park FRCS (Tr & Orth) Dishan Singh FRCS (Orth) Aspects of Orthopaedic Foot & Ankle Surgery Preface The 1st Round Table meeting was held in Padua in June 2011, followed by the 2nd Round Table meeting in Paris in June 2012. The 3rd Round Table in Barcelona in June 2013 has once again followed a format where all attendees review the literature and present their individual experience on a topic with ample time for an informal discussion of the subject. There is no distinction between faculty and delegates. Mark Rogers and Derek Park were responsible for recording opinions and capturing the essence of the debates, many of which resulted in consensus being reached on areas of foot and ankle practice. This booklet collates the literature review and the views of all those who participated. The opinions on consent, particularly, will hopefully guide practice and form the basis for a wider discussion at BOFAS. This booklet does not represent Level 1 evidence derived from prospective randomized controlled trials but represents the compilation of anecdotal reports and small case studies based on the combined experience of 34 British orthopaedic surgeons as well as Judith Baumhauer from the USA and Harvinder Bedi from Australia. I hope that you will find something of use and relevant to your own practice. Dishan Singh, MBChB, FRCS, FRCS (Orth) Consultant Orthopaedic Surgeon Royal National Orthopaedic Hospital Stanmore, UK Consensus of the 3rd Round Table Barcelona 2013 Mark Rogers Derek Park Dishan Singh Aspects of Orthopaedic Foot & Ankle Surgery 1.