Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 2 - Medical Guidelines › Chapter 22 - Neurological and Neuromuscular Disorder Medical Treatment Guidelines › Subchapter A - Carpal Tunnel Syndrome (CTS) Medical Treatment Guidelines › Section I-2211 - Therapeutic Procedures-Non-Operative

Current through Register Vol. 50, No. 6, June 20, 2024
A. Before initiation of any therapeutic
					 procedure, the authorized treating provider, employer, and insurer must
					 consider these important issues in the care of the injured worker.
B. First, patients undergoing therapeutic
					 procedure(s) should be released or returned to modified or restricted duty
					 during their rehabilitation at the earliest appropriate time. Refer to
					 "Return-to-Work" in this section for detailed information.
C. Second, cessation and/or review of
					 treatment modalities should be undertaken when no further significant
					 subjective or objective improvement in the patient's condition is noted. If
					 patients are not responding within the recommended duration periods,
					 alternative treatment interventions, further diagnostic studies or
					 consultations should be pursued.
D.
					 Third, providers should provide and document education to the patient. No
					 treatment plan is complete without addressing issues of individual and/or group
					 patient education as a means of facilitating self-management of
					 symptoms.
E. Lastly, formal
					 psychological or psychosocial screening should be performed on patients not
					 making expected progress within 6 to 12 weeks following injury and whose
					 subjective symptoms do not correlate with objective signs and tests.
F. In cases where a patient is unable to
					 attend an outpatient center, home therapy may be necessary. Home therapy may
					 include active and passive therapeutic procedures as well as other modalities
					 to assist in alleviating pain, swelling, and abnormal muscle tone. Home therapy
					 is usually of short duration and continues until the patient is able to
					 tolerate coming to an outpatient center.
G. Non-operative treatment procedures for CTS
					 can be divided into two groups: conservative care and rehabilitation.
					 Conservative care is treatment applied to a problem in which spontaneous
					 improvement is expected in 90 percent of the cases within three months. It is
					 usually provided during the tissue-healing phase and lasts no more than six
					 months, and often considerably less. Rehabilitation is treatment applied to a
					 more chronic and complex problem in a patient with de-conditioning and
					 disability. It is provided during the period after tissue healing to obtain
					 maximal medical recovery. Treatment modalities may be utilized sequentially or
					 concomitantly depending on chronicity and complexity of the problem, and
					 treatment plans should always be based on a diagnosis utilizing appropriate
					 diagnostic procedures.
H. The
					 following procedures are listed in alphabetical order.
1. Acupunctur e is an accepted and widely
					 used procedure for the relief of pain and inflammation and there is some
					 scientific evidence to support its use. The exact mode of action is only
					 partially understood. Western medicine studies suggest that acupuncture
					 stimulates the nervous system at the level of the brain, promotes deep
					 relaxation, and affects the release of neurotransmitters. Acupuncture is
					 commonly used as an alternative or in addition to traditional Western
					 pharmaceuticals. While it is commonly used when pain medication is reduced or
					 not tolerated, it may be used as an adjunct to physical rehabilitation and/or
					 surgical intervention to hasten thereturn of functional activity. Acupuncture
					 should be performed by licensed practitioners.
a. Definition : Acupuncture is the insertion
					 and removal of filiform needles to stimulate acupoints (acupuncture points).
					 Needles may be inserted, manipulated, and retained for a period of time.
					 Acupuncture can be used to reduce pain, reduce inflammation, increase blood
					 flow, increase range of motion, decrease the side effect of medication-induced
					 nausea, promote relaxation in an anxious patient, and reduce muscle spasm.
					 Indications include joint pain, joint stiffness, soft tissue pain and
					 inflammation, paresthesia, post-surgical pain relief, muscle spasm, and scar
					 tissue pain.
i. Time to produce effect: three
					 to six treatments
ii. Frequency:
					 one to three times per week
iii.
					 Optimum duration: one to two months
iv. Maximum duration: 14 treatments