Occupational Therapy Case Summary
Regarding Occupational Therapy - 6 sessions; CA MTUS Chronic Pain Medical Treatment Guidelines support an initial course of physical therapy with objective functional deficits and functional goals. The latest progress report noted that the patient has left upper extremity pain. The exam revealed moderate spasticity and tenderness over the flexor-extensor forearm. She has a positive compression of the left median and radial nerves of the extensor and flexor forearms. It was noted that she has not received medications or occupational therapy. The guidelines support an initial trial of 6 sessions of PT. Additional requests should include objective functional improvement. Recommend certification.
Regarding Ultrasound injection to medial and radial
nerves in the left forearm; AECOM hand, wrist & forearm chapter states that radial nerve entrapment usually presents as radial nerve palsies affecting the hand and wrist, most commonly occurring at points along the course of the arm and forearm, well proximal to the wrist. The medical history should include a search for sensory symptoms. Overall, the literature suggests patients most often appear to respond to non-operative treatments including no treatment; avoidance of exposures thought to be contributing (if present); avoidance of wearing a watch, tight jewelry or shirt sleeves on the affected side; corticosteroid injection; and temporary thumb spica splinting. The most recent progress report noted that the patient has left upper extremity pain. The exam revealed moderate spasticity and tenderness over the flexor-extensor forearm. She has a positive compression of the left median and radial nerves of the extensor and flexor forearms. However, there are no motor or sensory deficits, indicating a nerve entrapment. AROM was also full. There is limited clinical evidence to support that there is significant compressive neuropathy. It was noted that the EMG and nerve conduction study showed left median, radial and ulnar nerve neuropathies, however, there are no imaging reports available to corroborate significant nerve entrapment findings. Furthermore, it was noted that the patient has not received medications or occupational therapy yet. Medical necessity has not been established. Recommend non-certification.
Regarding Lyrica 25 mg #60; MTUS states that Lyrica has been documented to be effective in treatment of diabetic neuropathy and postherpetic neuralgia, has FDA approval for both indications, and is considered first-line treatment for both. However, in this case, there are no focal neurological deficits, indicating neuropathy. Motor strength is 5/5 throughout both upper extremities. She has intact sensibility. Medcial necessity has not been substantiated. Recommend non-certification.
Regarding Ultrasound injection to medial and radial
nerves in the left forearm; AECOM hand, wrist & forearm chapter states that radial nerve entrapment usually presents as radial nerve palsies affecting the hand and wrist, most commonly occurring at points along the course of the arm and forearm, well proximal to the wrist. The medical history should include a search for sensory symptoms. Overall, the literature suggests patients most often appear to respond to non-operative treatments including no treatment; avoidance of exposures thought to be contributing (if present); avoidance of wearing a watch, tight jewelry or shirt sleeves on the affected side; corticosteroid injection; and temporary thumb spica splinting. The most recent progress report noted that the patient has left upper extremity pain. The exam revealed moderate spasticity and tenderness over the flexor-extensor forearm. She has a positive compression of the left median and radial nerves of the extensor and flexor forearms. However, there are no motor or sensory deficits, indicating a nerve entrapment. AROM was also full. There is limited clinical evidence to support that there is significant compressive neuropathy. It was noted that the EMG and nerve conduction study showed left median, radial and ulnar nerve neuropathies, however, there are no imaging reports available to corroborate significant nerve entrapment findings. Furthermore, it was noted that the patient has not received medications or occupational therapy yet. Medical necessity has not been established. Recommend non-certification.
Regarding Lyrica 25 mg #60; MTUS states that Lyrica has been documented to be effective in treatment of diabetic neuropathy and postherpetic neuralgia, has FDA approval for both indications, and is considered first-line treatment for both. However, in this case, there are no focal neurological deficits, indicating neuropathy. Motor strength is 5/5 throughout both upper extremities. She has intact sensibility. Medcial necessity has not been substantiated. Recommend non-certification.