Hand, Wrist and Forearm Injuries

1 DRAFT For Public Comment NYS WCB MTG Hand, Wrist and Forearm Injuries 1 Hand, Wrist and Forearm Injuries Effective date will coincide with the launch of OnBoard: Limited Release DRAFT For Public Comment NYS WCB MTG Hand, Wrist and Forearm Injuries 2 Contributors The NYS Workers Compensation Board would like to thank the members of the New York Workers Compensation Board Medical Advisory Committee (MAC). The MAC served as the Board s advisory body to adapt the American College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines to a New York version of the Medical Treatment Guidelines (MTG). In this capacity, the MAC provided valuable input and made recommendations to help guide the final version of these Guidelines.

2 With full consensus reached on many topics, and a careful review of any dissenting opinions on others, the Board established the final product. New York state Workers Compensation Medical Advisory Committee Joseph Canovas, Esq. Special Counsel New York State AFL-CIO Kenneth B. Chapman, MD Director Pain Medicine, SIUH Northwell Health Systems Assistant Clinical Professor, NYU Langone Medical Center Adjunct Assistant Professor, Hofstra Medical School Lev Ginsburg, Esq. Senior Director of Government Affairs The Business Council of New York State Robert Goldberg, DO Attending Physician Department of Rehabilitation, Beth Israel Hospital and Medical Center of NYC Professor of Physical Medicine and Rehabilitation and Health Policy Clinical Associate Professor of Rehabilitation Medicine, New York Medical College Clinical Professor of Rehabilitation Medicine, Philadelphia College of Osteopathic Medicine Member Council on Medical Education of the American Medical Association Brian M.

3 Gordon, MD Former Medical Director, New York State Workers Compensation Board Roy G. Kulick, MD Associate Professor of Orthopaedic Surgery, Albert Einstein College of Medicine Chief, Section of Hand Surgery, Department of Orthopaedic Surgery, Montefiore Medical Center. Joseph Pachman, MD, PhD, MBA, MPH Licensed Psychologist and Physician Board Certified in Occupational Medicine Fellow in ACOEM Vice President and National Medical Director, Liberty Mutual DRAFT For Public Comment NYS WCB MTG Hand, Wrist and Forearm Injuries 3 Elaine Sobol-Berger, MD, JD Former Medical Director and Senior Policy Advisor, New York State Workers Compensation Board James A. Tacci, MD, JD, MPH Medical Director and Executive Medical Policy Director, New York State Workers Compensation Board (At the time of drafting: Attending Physician, Associate Professor, and Medical Director, University of Rochester Medical Center) Edward C.

4 Tanner, MD, Chair, Department of Orthopaedics at Rochester General Hospital Past President, New York State Society of Orthopaedic Surgeons (NYSSOS) Member, American Academy of Orthopaedic Surgeons (AAOS) Member, American Association of Hip and Knee Surgeons (AAHKS) Contributors to ACOEM Hand, Wrist , and Forearm Disorders Guideline Editor-in-Chief: Kurt T. Hegmann, MD, MPH, FACOEM, FACP Evidence-based Practice Hand, Wrist , and Forearm Panel Chair: J. Mark Melhorn, MD, FAAOS, FACOEM, FAADEP, FACS, FASSH, FAAHS Evidence-based Practice Hand, Wrist , and Forearm Panel Members: James Ausfahl, MD M. Felix Freshwater, MD Charles P. Prezzia, MD, MPH, MMM, FACOEM David M. Rempel, MD, MPH, FACOEM, FACP Shawn C. Roll, PhD, OTR/L, RMSKS, FAOTA Arlen J.

5 Rollins, DO, MSc, FACOEM, FACPM Robert A. Werner, MD, MS, FAAPMR Jason L. Zaremski, MD, CAQSM These panel members represent expertise in occupational medicine, orthopedic surgery, hand surgery, occupational therapy, physical medicine and rehabilitation, sports medicine, internal medicine, family practice, forensic medicine, and electrodiagnostic medicine. As required for quality guidelines (Institute of Medicine s [IOM] Standards for Developing Trustworthy Clinical Practice Guidelines and Appraisal of Guidelines for Research and Evaluation [AGREE]), a detailed application process captured conflicts of interest. The above Panel has none to declare relevant to this guideline. Methodology Committee Consultant: Kurt T. Hegmann, MD, MPH, FACOEM, FACP Managing Editors: Production: Marianne Dreger, MA Research: Julie A.

6 Ording, MPH Research Conducted By: Kurt T. Hegmann, MD, MPH, FACOEM, FACP Matthew A. Hughes, MD, MPH Matthew S. Thiese, PhD, MSPH Ulrike Ott, PhD, MSPH Deborah Gwenevere Passey, PhDc, MS DRAFT For Public Comment NYS WCB MTG Hand, Wrist and Forearm Injuries 4 Atim Effiong, MPH Kristine Hegmann, MSPH, CIC Emilee Eden, MPH Jenna L. Praggastis, BS Weijun Yu, BM, BA, MS Michael L. Northrup, BS Komal Kaur, BS Alzina Koric, MPP Brenden Ronna, BS Chapman B. Cox Jenny Dang Helena Tremblay Amrinder Kaur Thind Melissa Gonzalez Austen J. Knudsen Pranjal A. Muthe Skyler Walker Anh Tran Jenna K. Lindsey Dillon J. Fix Leslie MC Echeverria, BS Jeremiah L. Dortch, BS Specialty Society and Society Representative Listing: ACOEM acknowledges the following organizations and their representatives who served as reviewers of the Hand, Wrist , and Forearm Disorders Guideline.

7 Their contributions are greatly appreciated. By listing the following individuals or organizations, it does not infer that these individuals or organizations support or endorse the hand, Wrist , and Forearm treatment guidelines developed by ACOEM. American Academy of Physical Medicine & Rehabilitation American Association of Occupational Health Nurses David A. Allcott, MSN, APRN, ANP-BC, COHN-S, FAAOHN Association for Applied Psychophysiology and Biofeedback Gabriel E. Sella, MD, MPH, MSC, PhD, FAADP, FAAFP, FACPM American College of Emergency Physicians Charles Gerardo, MD, MHS, FACEP American Society of Anesthesiologists Richard W. Rosenquist, MD The American Occupational Therapy Association, Inc. Debbie Amini, EdD, OTR/L, CHT, FAOTA DRAFT For Public Comment NYS WCB MTG Hand, Wrist and Forearm Injuries 5 Table of Contents Contents Contributors.

8 2 Contents .. 5 A. General Guideline Principles .. 7 Medical Care .. 7 Rendering Of Medical Services .. 7 Positive Patient Response .. 7 Re-Evaluate Treatment .. 7 Education .. 7 Acuity .. 8 Initial Evaluation .. 8 Diagnostic Time Frames .. 8 Treatment Time Frames .. 8 Delayed Recovery .. 8 Active Interventions .. 9 Active Therapeutic Exercise Program .. 9 Diagnostic Imaging And Testing Procedures .. 9 Surgical Interventions .. 10 Pre-Authorization .. 10 Psychological/Psychiatric Evaluations .. 10 Personality/Psychological/Psychosocial Intervention .. 11 Functional Capacity Evaluation (FCE) .. 11 Return To Work .. 12 Job Site Evaluation .. 12 Guideline Recommendations And Medical Evidence.

9 13 Experimental/Investigational Treatment .. 13 Injured Workers As Patients .. 13 Scope Of Practice .. 13 B. Introduction to Hand, Wrist and Forearm Injuries .. 14 History Taking and Physical 14 C. Conditions .. 22 Carpal Tunnel Syndrome (CTS) .. 24 Triangular Fibrocartilage Complex (TFCC) Tears .. 40 Crush Injuries and Compartment Syndrome .. 46 Kienb ck Disease .. 51 DRAFT For Public Comment NYS WCB MTG Hand, Wrist and Forearm Injuries 6 Wrist Sprains .. 57 Mallet Finger .. 61 Flexor Tendon Entrapment (Tenosynovitis and Trigger Digit) .. 65 Extensor Compartment Tenosynovitis (Including de Quervain s Stenosing Tenosynovitis and Intersection Syndrome) .. 69 Ulnar Nerve Entrapment at the Wrist (Including Guyon s Canal Syndrome and Hypothenar Hammer Syndrome).

10 74 Radial Nerve Entrapment .. 80 Non-Specific Hand, Wrist and Forearm Pain .. 85 Scaphoid Fracture .. 90 Distal Phalanx Fractures and Subungual Hematoma .. 96 Middle and Proximal Phalangeal and Metacarpal Fractures .. 102 Distal Forearm Fractures .. 109 Ganglion Cyst .. 116 Hand / Arm Vibration Syndrome (HAVS) .. 121 Laceration Management .. 125 Human Bites, Animal Bites and Associated Lacerations .. 129 Hand / Finger Osteoarthrosis .. 133 Dupuytren s Disease .. 140 Appendix One - Evidence Tables .. 145 Appendix Two Medical Studies .. 572 Appendix Three - References .. 644 DRAFT For Public Comment NYS WCB MTG Hand, Wrist and Forearm Injuries 7 A. GENERAL GUIDELINE PRINCIPLES The principles summarized in this section are key to the intended application of the New York State Medical Treatment Guidelines (MTG) and are applicable to all Workers Compensation Medical Treatment Guidelines.