Future Medical Cost Projections Module 6 Common Conditions, Part 1

Common Injuries and Conditions Overview Discusses common medical conditions and typical treatment protocol Objectives Be able to discuss causal connection of an injury with medical condition Be able to explain primary injury, secondary condition, potential complication for major diagnoses or medical conditions Be able to list the non-surgical and surgical needs for at least 5 major conditions, including the lumbar spine, the knee, spinal cord injury, lower extremity amputation, and chronic pain Copyright InSitu Academy

Copyright InSitu Academy Conditions Mechanism of injury Causal relationship Primary Injuries Secondary Conditions Potential Complications Common diagnoses/conditions for spine and joints Copyright InSitu Academy

Copyright InSitu Academy Mechanism of Injury MVA Falls Crush Blunt force trauma Electrical Inhalation, toxic exposure Lifting Amputation Burns Copyright InSitu Academy

Copyright InSitu Academy Causal Relationship Direct injury Aggravation of pre-existing condition Exacerbation of pre-existing condition Acceleration of pre-existing condition Resulting from treatment (secondary condition) Contra-lateral condition (secondary condition) Potential complications Copyright InSitu Academy

Copyright InSitu Academy Common Conditions Spine Shoulder Elbow Wrist Hip Knee Ankle Respiratory Copyright InSitu Academy

Copyright InSitu Academy Spine Levels Cervical Thoracic Lumbar Copyright InSitu Academy

Copyright InSitu Academy Spine Epidural steroid and facet injections: determine number of levels, unilateral or bilateral Radio-frequency ablation: requires 2 sets of medial branch blocks prior to ablation Fusion: maximum 3 level fusion in lifetime Hardware: allow for hardware removal MRI may be contra-indicated if hardware in place Copyright InSitu Academy

Copyright InSitu Academy Cervical Spine Non-surgical Diagnostics every 5 years to monitor status of cervical spine Annual liver and kidney function studies due to chronic use of medication Annual orthopedic evaluation to monitor status of spine Quarterly physician visits (family practice or pain management) for medication management, monthly physician visits if narcotics are prescribed Monthly prescription per individual formulary Periodic interventional injection therapy if indicated in medical records Periodic urine drug screens if narcotics prescribed Periodic physical therapy for flare-up of condition Potential use of TNS Consider installation of bathroom safety bars Medical mileage reimbursement if Worker’s Compensation coverage Surgical Fusion, up to 3 levels Spinal cord stimulator placement Hardware removal Copyright InSitu Academy

Copyright InSitu Academy Thoracic Spine Non-surgical Diagnostics every 2 years to monitor status of thoracic spine (degree of angle) Annual liver and kidney function studies due to chronic use of medication Annual orthopedic evaluation to monitor status of spine Quarterly physician visits (family practice or pain management) for medication management, monthly physician visits if narcotics are prescribed Monthly prescription per individual formulary Periodic interventional injection therapy if indicated in medical records Periodic urine drug screens if narcotics prescribed Periodic physical therapy for flare-up of condition Potential use of TNS Consider installation of bathroom safety bars Medical mileage reimbursement if Worker’s Compensation coverage Surgical Kyphoplasty Spinal cord stimulator placement Copyright InSitu Academy

Copyright InSitu Academy Lumbar Spine Non-surgical Diagnostics every 5 years to monitor status of lumbar spine Annual liver and kidney function studies due to chronic use of medication Annual orthopedic evaluation to monitor status of spine Quarterly physician visits (family practice or pain management) for medication management, monthly physician visits if narcotics are prescribed Monthly prescription per individual formulary Periodic interventional injection therapy if indicated in medical records Periodic urine drug screens if narcotics prescribed Periodic physical therapy for flare-up of condition Potential use of TNS Consider installation of bathroom safety bars Medical mileage reimbursement if Worker’s Compensation coverage Surgical Fusion, up to 3 levels Spinal cord stimulator placement Hardware removal Copyright InSitu Academy

Copyright InSitu Academy Shoulder Non-surgical Diagnostics every 5 years to monitor status of shoulder Annual liver and kidney function studies due to chronic use of medication Periodic urine drug screen if narcotics prescribed Quarterly physician evaluations for medication management, monthly if narcotics prescribed Monthly prescriptions based on individual formulary Up to 2 joint injections in lifetime Allowance for periodic physical therapy for flare-up of condition Consider installation of bathroom safety bars Medical mileage reimbursement if worker’s compensation coverage Surgical Possible arthroscopy Possible replacement, with revisions Copyright InSitu Academy

Copyright InSitu Academy Elbow Non-surgical Initial diagnostics to confirm diagnosis Lifetime allowance of physician visits to monitor residual problems Limited prescription allowance for acute or flare-up pain Up to 2 joint injections lifetime Consider installation of bathroom safety bars Consider medical mileage reimbursement if extended recovery anticipated/worker’s compensation coverage only Complex elbow fractures require more treatment, including physician visits, and especially physical therapy Surgical Nerve transposition Surgical repair for major fractures, dislocations Copyright InSitu Academy

Copyright InSitu Academy Wrist Non-surgical Initial diagnostics to confirm diagnosis Lifetime allowance of physician visits to monitor residual problems Limited prescription allowance for acute or flare-up pain Up to 2 joint injections lifetime Consider installation of bathroom safety bars Consider medical mileage reimbursement if extended recovery anticipated/worker’s compensation coverage only Complex wrist fractures require more treatment, including physician visits, and especially physical therapy Surgical Carpal tunnel release Surgical repair for major fractures, dislocations Copyright InSitu Academy

Copyright InSitu Academy Hip Non-surgical Diagnostics every 5 years to monitor status of hip Annual liver and kidney function studies due to chronic use of medication Periodic urine drug screen if narcotics prescribed Quarterly physician evaluations for medication management, monthly if narcotics prescribed Monthly prescriptions based on individual formulary Up to 2 joint injections in lifetime Allowance for periodic physical therapy for flare-up of condition Consider installation of bathroom safety bars Medical mileage reimbursement if worker’s compensation coverage Surgical Pinning for fractured hip Hip replacement for joint disease, revision in 18-20 years Copyright InSitu Academy

Copyright InSitu Academy Knee Non-surgical Periodic diagnostics to monitor status of knee Annual liver and kidney function studies due to chronic use of medication Periodic urine drug screening if narcotics prescribed Quarterly physician evaluations to monitor status of knee, monthly if narcotics prescribed Monthly prescriptions dependent on individual formulary Joint injections: 2 in lifetime Periodic physical therapy for fare-up of condition Consider installation of bathroom safety bars Medical mileage reimbursement if worker’s compensation coverage Surgical Arthroscopy Knee replacement, with revisions Copyright InSitu Academy

Copyright InSitu Academy Ankle Non-surgical Periodic diagnostics to monitor status of ankle Annual liver and kidney function studies due to chronic use of medication Periodic urine drug screening if narcotics prescribed Quarterly physician evaluations to monitor status of knee, monthly if narcotics prescribed Monthly prescriptions dependent on individual formulary Joint injections: 2 in lifetime Periodic physical therapy for fare-up of condition Consider installation of bathroom safety bars Medical mileage reimbursement if worker’s compensation coverage Surgical Arthroscopy Replacement or fusion Copyright InSitu Academy

Copyright InSitu Academy Respiratory Lifelong treatment Annual diagnostics to monitor status of lungs Regular physician evaluations for medication management with in-office pulmonary function studies, determined by medications prescribed Medications include inhalers and oral medications depending on restrictive vs. obstructive airway disease Annual liver and kidney function studies due to potential use of corticosteroids Ophthalmology evaluation every 2-3 years due to potential use of corticosteroids Medical mileage reimbursement if worker’s compensation coverage Copyright InSitu Academy

Copyright InSitu Academy Homework Contact local ENT or audiologist to determine cost of digital hearing aids, along with annual maintenance and supplies List all the possible injuries resulting from a fall of 15 feet onto a hard surface Copyright InSitu Academy

Copyright InSitu Academy Contact Information info@insitutraining.com Copyright InSitu Academy