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Glossary of WCB Terms

Substantive changes in Proposed Medical Treatment Guidelines
January 19, 2010 revision

All Guides | Low Back (LB)/Cervical Spine(C-Spine) | Shoulder | Knee

Note: the language in italics is the new language

Knee

  1. Physical Examination: the following is added.
    [Basis: Comments from treating orthopedists]
    • B.1. c vi. Examination for a displaced or abnormally displaceable patella;
  2. Imaging Studies: Computed Axial Tomography (CT) section revised.
    • Computed Axial Tomography (CT) provides excellent visualization of bone and is used to further evaluate bony masses and suspected fractures not clearly identified on radiographic window evaluation. Instrument scatter-reduction software provides better resolution when metallic artifact is of concern. When ferrous/metallic materials are present in the tissues, CT should be ordered rather than MRI. CT examinations entail exposure to ionizing radiation, with associated radiation-related risks.
  3. Other Tests- Electrodiagnostic Testing-revised.
    • Electrodiagnostic testing for the knee includes, but is not limited to, Electromyography (EMG) and Nerve Conduction Studies (NCS). Evaluation of Somatosensory Evoked Potentials (SSEP) is not recommended for conditions of the knee. Electrodiagnostic studies have limited use with knee disorders. It is recommended and preferred that EDS in the out-patient setting be performed and interpreted by physicians board-certified in Neurology or Physical Medicine and Rehabilitation.
  4. Other Procedures-Joint Aspiration-revised
    [Basis: Comments from treating orthopedists]
    • Joint Aspiration is a procedure used when specifically indicated and performed by individuals properly trained in these techniques. This is true at the initial evaluation when history and/or physical examination are of concern for a septic joint or bursitis. Aspiration should not be performed through an infected area.

      Particularly at the knee, aspiration of a large effusion can help to decrease pain and speed functional recovery. Persistent or unexplained effusions may be examined for evidence of infection, rheumatologic, or inflammatory processes. The presence of fat globules in the effusion strongly suggests occult fracture. A large hemorrhagic effusion should prompt suspicion that a fracture or ligament tear may be present.
  5. Anterior Cruciate Ligament (ACL) Injury-revised
    [Basis: Comments from treating orthopedists that there are no therapeutic injections for ACL injuries.]
    • Non-Operative Treatment: Active and/or passive therapy, bracing.
  6. Posterior Cruciate Ligament (PCL) Injury-revised.
    [Basis: Comments from treating orthopedists]
    • Non-Operative Treatment: Active and/or passive therapy, bracing.
  7. Therapeutic Procedures, Non-Operative: Intra-Capsular Acid Salts revised.
    [Basis: self-evident]
    • Intra-Capsular Acid Salts (also known as viscosupplementation) is a form of treatment for osteoarthritis or degenerative changes in the knee joint. It is recommended that these injections be considered a therapeutic alternative in patients who have failed non-pharmacological and analgesic treatment, and particularly, if non-steroidal anti-inflammatory drug treatment is contraindicated or surgery is not an option. The utility of viscosupplementation in severe osteoarthritis and its efficacy beyond 6 months is not well known.
      • Time to produce effect: One series of injections.
      • Frequency: If the first use is associated with decreased symptoms and increased function, repeat use may be considered after 6 months if symptoms recur.
      • Optimum/maximum duration: Varies. Efficacy beyond 6 months is not well known.
  8. Therapeutic Procedures, Operative: the following are added.
    [Basis: The current list omits these common procedures]
    • Intra-Capsular Acid Salts (also known as viscosupplementation) is a form of treatment for osteoarthritis or degenerative changes in the knee joint. It is recommended that these injections be considered a therapeutic alternative in patients who have failed non-pharmacological and analgesic treatment, and particularly, if non-steroidal anti-inflammatory drug treatment is contraindicated or surgery is not an option. The utility of viscosupplementation in severe osteoarthritis and its efficacy beyond 6 months is not well known.
      1. Meniscectomy

        Description/Definition
        The surgical excision of a meniscus.

        Evaluation and Management
        See tables 7 and 8.
      2. Ligament Repair

        Description/Definition
        Surgical reattachment of torn anterior or posterior cruciate ligaments or medial or lateral collateral ligaments.

        Evaluation and Management
        See table 6.