Right Knee Case Studies
DOI: 4/11/2015. Patient is a 56-year-old right-hand dominant female housekeeper who sustained a work-related injury to her left hand and right knee after being trapped in an elevator for one hour.
MRI of the right knee on 8/12/15 shows thinned cartilage of the medial femoral condyle and medial tibial plateau which causes narrowing of the joint space. Linear increased signal in the posterior horn of the medial meniscus is noted, which likely reflects internal degeneration. There is a 7.6 mm osteochondral defect at the anterior aspect of the medial femoral condyle. Foci of osteochondral defects at the anterior aspect of the lateral femoral condyle are noted, largest of which measures 8.4 mm. Marginal osteophyte at the lateral femoral condyle …show more content…
Suggested deformity in the proximal fibula is appreciated at the lateral view. Clinical correlation is recommended.
On 5/26/16 QME, the examiner recommends intraarticular corticosteroid injection of the carpometacarpal joint, oral anti-inflammatory and wearing of thumb immobilizing brace for the left thumb. Intraarticular cortisone injection to the right knee and/or viscosupplementation, as well as usage of a patellar neoprene stabilizing brace is recommended. If these fail, consideration for a total knee replacement will be forthcoming.
Based on the progress report dated 10/19/16 by Dr. Wile, the patient complains of pain to her left hand and right knee. She complains of a pinching pain and a tingling sensation in the left hand in the thenar eminence region. Her symptoms tend to wax and wane, and will awaken her at night at times. She also complains of a stabbing type of right knee pain, which is anteriorly, but somewhat diffuse. At times, she will limp. Pain is described as medial and lateral. Pain increases when she tends to bend or flex her knee. Pain also increases when she walks a little as half an hour. She does have occasional swelling and frequent popping, and tendency for the knee to give way. She does wear a knee brace to prevent the knee to buckle. She takes ibuprofen, which provide symptom …show more content…
Treatment plan includes a series of 3 right knee Orthovisc injections, as well as EMG/NCV testing to rule out carpal tunnel syndrome. It was noted ultimately, the IW will be a candidate for a patellofemoral arthroplasty or a total knee arthroplasty.
Per previous reviews, there was a previous certification for 1 Right Knee Corticosteroid Injection last 08/24/16.
Requested verification from the provider’s office if the IW has had a steroid injection to the right knee; however, no callback/report was received prior to the submission of this request to PA.
Current request is for 1 Series of 3 Orthovisc 15 mg/ml Injection to the Right Knee between 10/31/2016 and
MRI of the right knee on 8/12/15 shows thinned cartilage of the medial femoral condyle and medial tibial plateau which causes narrowing of the joint space. Linear increased signal in the posterior horn of the medial meniscus is noted, which likely reflects internal degeneration. There is a 7.6 mm osteochondral defect at the anterior aspect of the medial femoral condyle. Foci of osteochondral defects at the anterior aspect of the lateral femoral condyle are noted, largest of which measures 8.4 mm. Marginal osteophyte at the lateral femoral condyle …show more content…
Suggested deformity in the proximal fibula is appreciated at the lateral view. Clinical correlation is recommended.
On 5/26/16 QME, the examiner recommends intraarticular corticosteroid injection of the carpometacarpal joint, oral anti-inflammatory and wearing of thumb immobilizing brace for the left thumb. Intraarticular cortisone injection to the right knee and/or viscosupplementation, as well as usage of a patellar neoprene stabilizing brace is recommended. If these fail, consideration for a total knee replacement will be forthcoming.
Based on the progress report dated 10/19/16 by Dr. Wile, the patient complains of pain to her left hand and right knee. She complains of a pinching pain and a tingling sensation in the left hand in the thenar eminence region. Her symptoms tend to wax and wane, and will awaken her at night at times. She also complains of a stabbing type of right knee pain, which is anteriorly, but somewhat diffuse. At times, she will limp. Pain is described as medial and lateral. Pain increases when she tends to bend or flex her knee. Pain also increases when she walks a little as half an hour. She does have occasional swelling and frequent popping, and tendency for the knee to give way. She does wear a knee brace to prevent the knee to buckle. She takes ibuprofen, which provide symptom …show more content…
Treatment plan includes a series of 3 right knee Orthovisc injections, as well as EMG/NCV testing to rule out carpal tunnel syndrome. It was noted ultimately, the IW will be a candidate for a patellofemoral arthroplasty or a total knee arthroplasty.
Per previous reviews, there was a previous certification for 1 Right Knee Corticosteroid Injection last 08/24/16.
Requested verification from the provider’s office if the IW has had a steroid injection to the right knee; however, no callback/report was received prior to the submission of this request to PA.
Current request is for 1 Series of 3 Orthovisc 15 mg/ml Injection to the Right Knee between 10/31/2016 and