No. The request for ongoing postoperative physical therapy from 08/15/2017 and forward is not reasonable, medically necessary and appropriate. Rationale Supporting Determination: ODG-TWC Shoulder Procedure Summary Online Version last updated 07/07/2017 identifies best practice physical therapy guidelines for sprains and strains of shoulder and upper arm as that which allows for fading of treatment frequency (from up to 3 visits per week to 1 or less), plus active self-directed home PT, in 10 visits over 8 weeks for medical treatment, 20 visits over 10 weeks for medical treatment of a partial tear, 24 visits over 14 weeks for post-surgical (RC repair/acromioplasty) arthroscopic treatment, and 30 visits over 18 weeks for post-surgical (open) …show more content…
Left shoulder examination showed tenderness, a decreased strenght, and positive impingement signs. An MRI dated 01/31/2017 revealed moderate supraspinatus/infraspinatus/subscapularis tendinosis with associated long head biceps tendinosis, as well as superior and anterior labral tear. She was diagnosed with a left shoulder partial rotator cuff tear, superior labral tear with biceps tendinitis, subacromial bursitis, and adhesive capsulitis. Due to persistent pain despite medications, home exercises, sling, and splint, the claimant underwent a left shoulder manipulation under anesthesia, left shoulder arthroscopy with bursal debridement, and subpectoral biceps tenodesis. The procedure revealed an intact rotator cuff. Postoperative physical therapy treatment was recommended. The submitted documentation revealed that the claimant completed a total of 50 postoperative physical therapy sessions for the left shoulder with noted improvement in pain and strength. However, she continued having left shoulder tightness, stiffness, limited internal rotation, limited glenohumeral joint glides, and a pain with stretching and when reaching above the chest height. The request for additional physical therapy visits exceeded guideline recommendation. Moreover, there were no special circumstances documented that would prevent a safe transition to a self-directed home exercise
Based on the medical report dated 9/22/16, the patient presents for right shoulder pain. It was noted that the patient is over 5 months status post right shoulder arthroscopic superior capsular reconstruction for nonrepairable rotator cuff tear. The patient continues to complain of significant shoulder pain with any overhead activity. Pain keeps him up at night. He is very distressed by his pain. Musculoskeletal examination notes that the right shoulder has an active forward elevation to 100 degrees with pain and guarding beyond going any further with forward passive motion up
The rotator cuff is a group of tendons and muscles that form a cuff over the humerus to the scapula. This group of muscle includes teres minor, infraspinatus, supraspinatus, and subscapularis. These muscles provide stability to the shoulder and allow the shoulder to rotate and function properly during shoulder movement. The tendons and muscle can be damage by overuse, injury, or gradual aging. This damage may cause significant pain, fluid accumulation within the joint due to inflammation, arthritis, calcium deposits, and decrease range of motion. Rotator cuff tear, rotator cuff tendinitis, rotator cuff impingement, frozen shoulder, subacromial bursitis are conditions or injuries for rotator cuff. (Ma, 2015)
Physical examination revealed that the left shoulder is swelling. There is tenderness of the greater tuberosity and the bicipital groove noted upon bony palpation. Soft tissue palpation revealed tenderness of the glenohumeral joint region, the trapezius, and the lateral cuff insertion. Active range of motion of the left shoulder revealed a forward flexion of 80 degrees, external rotation of 0 degrees, abduction of 5 degrees, and internal rotation of “L5” degrees. Special test that resulted positive are Hawkin’s test, Neer’s test, O’Brien’s test, and Speed’s test. Empty can sign is also noted to be positive. Subscapularis weakness is noted. Strength of the left shoulder revealed flexion 4/5, abduction /5(4-), and internal rotation 4/5. Skin inspection revealed large incisions of the anterior left shoulder. As per assessment and plan, the provider notes that he is unable to give opinion regarding treatment options as the patient has not had an MRI arthrograms to determine any recommended surgical options. It was also noted that given the past medical history, there is some question whether further surgery in this patient would be recommended. As per emergency documentation from Sharp Grossmont Hospital dated 5/17/16, impression includes rotator cuff injury, possible complete
Occupational therapy was a career choice I fell into. When I first arrived to Keiser University back in 2009 I was going to apply for the physical therapy assistant program. Physical and speech therapy where the only therapeutic disciplines I had any knowledge of at that time. When I met with the admissions counselor she informed me the waiting list for the PTA program was about two years, I was floored I wasn’t going to wait that long I needed to start school ASAP. The counselor then asked me “ what is your goal?” and my response was “to work with children in the medical field without being too medically involved”. She then handed me an occupational therapy pamphlet and I just signed the paper work to start that month. I honestly
Patient returned the next day still complaining of pain. The PT applied heat, then initiated the exercise program, but the patient could not perform theem to same extent as previously, secondary to pain. Therefore, the PT told the patient to schedule an appointment with his physician. The patient was seen by the MD the next day and an arthrogram performed that revealed a reinjure to the repaired site. And a second surgery repaired the rotator cuff.
This confers some stability to the shoulder joint, however it is less significant than the surrounding skeletal muscle and the help of their associated tendons and ligaments, which provide the most stability to this joint. Between tendons of this joint there also exist bursas, which are extensions of the synovial membrane outside of the capsule, forming a sack filled with synovial fluid. The four main bursas found are the subacromial bursa, the subdeltoid bursa, the subcoracoid bursa, and the subscapular bursa. These help reduce friction between the tendons and other tissues at the joint (Martini et al.). Sometimes after rotator cuff tendons are injured the bursa can also become inflamed and painful, augmenting the soreness of the
My journey to pursue an education in physical therapy actually originates from my early childhood. I endured a very impoverished upbringing and my family’s socioeconomic status was below the poverty line. At a very young age, money became the central issue of my life. I found myself worrying about mortgages, health bills, and grocery money. As I grew older, I vowed to myself that I would not endure my family’s financial burdens into my adulthood. I knew the best way to accomplish this was by obtaining a college degree and having a professional career. However, I was unsure what career I wanted to pursue. I experimented with many different career ideas, but during my sophomore, I discovered my passion and skill for physical medicine. For my
All athletes get injured right? So who exactly allows them to run the fields again? There is a specific person meant for just that, a Physical Therapist. A career that would be fit for someone who enjoys being active and being involved in sports. As a way to help people, Physical Therapy is a very important career to any individual who is looking to get better, Physically. They attend any person,it doesn’t matter what age or gender. Over all this career is most important to athletes, who may get injured and need someone to help them get back in shape. As you continue to read, you will learn about the conditions and requirements needed to be a Physical Therapist. You will read about how not everyone is fit
... RS, Davenport TE. Direct access compared with referred physical therapy episodes of care: A systematic review. Phys Ther. 2014;94(1):14-30. http://search.proquest.com/docview/1494384704?accountid=35715. Accessed April 10,2014
ERWOSA (external rotation without sedation and analgesia) is an effective non-pharmacologic treatment approach for an acute anterior shoulder dislocation that is being practiced in a busy emergency department. It is a promising technique with a lot of potential for success. Patient has to be relaxed, and the physician must provide the intervention slowly and gently without eliciting any pain. If pain occurs, a muscle spasm can also be triggered resulting in resistance. If this happens, the patient has to rest before continuing with this technique. The advantages of this approach
Orthopedic surgeons are responsible for mending and operating on the musculoskeletal system. “Orthopedics is a medical specialty that focuses on the diagnosis, care, and treatment of patients with disorders of the bones, joints, muscles, ligaments, tendons, nerves, and skin” (Career in Orthopaedics). Depending on the damage the patient has sustained determines how the orthopedic surgeon is able to correct the patient’s injury. In many cases there are multiple ways of correcting the patient’s injury such as; using medical, physical, and rehabilitative techniques to using complex surgical methods. “Typically, as much as 50 percent of the orthopedic surgeon’s practice is devoted to no surgical or medical management of injuries or disease and 50 percent to surgical management” (Career in Orthopaedics). The majority of surgeons, including orthopedic surgeons, prefer to choose the least invasive procedures such as; arthroscopy which is a technological advancement allowing orthopedic surgeons to use special cameras in order to diagnose and treat a joint with minimal cutting and trauma to...
Since pain is a subjective measurement, the participants will report their pain level using the self-administer SPADI. The reliability coefficient of ICC ≥ 0.89 and the internal consistency is high with Cronhach α > 0.90 in a variety of population (Breckenridge & Mcauley, 2011). “The SPADI demonstrates good construct validity, correlating well with other region-specific shoulder questionnaires” (Breckenridge & Mcauley, 2011, p. 197).
Physical therapy is a fun and exciting healthcare profession that helps people. It is all about helping other people who have problems with their body, muscles, joints and other parts of their body. Patients includes accident victims and individuals with disabling conditions such as low back pain, arthritis, heart disease, fractures, head injuries, and cerebral palsy. Physical therapy will perform an evaluation of your problem or difficulty. They evaluate your problem by performing tests and measures to assess the problem. These tests includes muscle strength, joint motion, sensory and neurological, coordination, balance, observation, palpation, flexibility, postural screening, movement analysis, and special tests are designed for a particular problem. Next, they develop a treatment plan and goals and then manage the appropriate treatment to aid in recovery of a problem or dysfunction. Physical therapists are able to treat their patients by using many different treatments depending on the type of injury. Some of the treatments are electrical stimulation, hot and cold packs, infrared and ultrasound to reduce swelling or relieve pain. These treatments are used to help decrease pain and increase movement and function. Therapeutic exercises instructions will help restore strength, movement, balance, or skill as a guide towards full functional recovery. Physical therapy provides "hands on techniques" like massage or joint mobilizations skills to restore joint motion or increase soft tissue flexibility. They will focus on basic skills such as getting out of bed, walking safely with crutches or a walker, moving specific joints and muscles of the body. Physical therapists treatment includes patient education to teach them how to deal with a current problem and how to prevent the problem in the future. Such documentation is used to track the patient's progress, and identify areas requiring more or less attention. They encourage patients to use their own muscles. Their main goal is to improve how an individual functions at work and home.
Physiotherapy is the study of the movement and function of the human anatomy and the relationship between the persons’ health and wellbeing (Dhrs.uct.ac.za, 2015). A physiotherapist’s speciality is treating “individuals across the life-span who have illness, injury or disability affecting the neuro-musculoskeletal, cardiopulmonary, vascular, and neurological systems” (Ontario Physiotherapy Association, 2015:3). A physiotherapist’s main goal is for their patient to receive the highest level of independence by educating patients how to “prevent reoccurring injuries” that disrupt their daily routine (Ontario Physiotherapy Association, 2015:3). Physiotherapists would deal with “long term ailments” (Zweigenthal et al., 2009:235) that cannot simply be treated with the dosage of medication but with the dedication from both the physiotherapist and patient in the appointed interactive physical sessions, a treatment plan can be formulated to guarantee the most efficient road to
A physical therapist is a health professional that anyone may need at some point in their life. Physical therapist's