Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 2 - Medical Guidelines › Chapter 23 - Upper and Lower Extremities Medical Treatment Guidelines › Subchapter A - Lower Extremities › Section I-2305 - Initial diagnostic procedures

Current through Register Vol. 50, No. 6, June 20, 2024
A. The OWCA recommends the following
					 diagnostic procedures be considered, at least initially, the responsibility of
					 the workers' compensation carrier to ensure that an accurate diagnosis and
					 treatment plan can be established. Standard procedures that should be utilized
					 when initially diagnosing a work-related lower extremity complaint are listed
					 below.
1. History-taking and physical
					 examination (Hx & PE) are generally accepted, well-established and widely
					 used procedures that establish the foundation/basis for and dictates subsequent
					 stages of diagnostic and therapeutic procedures. When findings of clinical
					 evaluations and those of other diagnostic procedures are not complementing each
					 other, the objective clinical findings should have preference. The medical
					 records should reasonably document the following:
a. History of Present Injury
i. Mechanism of injury. This includes details
					 of symptom onset and progression. It should include such details as: the
					 activity at the time of the injury, patient description of the incident, and
					 immediate and delayed symptoms. The history should elicit as much detail about
					 these mechanisms as possible.
ii.
					 Relationship to work. This includes a statement of the probability that the
					 illness or injury is work-related.
iii. History of locking, clicking, popping,
					 giving way, acute or chronic swelling, crepitation, pain while ascending or
					 descending stairs (e.g. handrail used, foot by foot' instead of foot over
					 foot') inability to weight bear due to pain, intolerance for standing or
					 difficulty walking distances on varied surfaces, difficulty crouching or
					 stooping, and wear patterns on footwear. Patients may also report instability
					 or mechanical symptoms.
iv. Any
					 history of pain in back as well as joints distal and proximal to the site of
					 injury. The use of a patient completed pain drawing, Visual Analog Scale (VAS),
					 is highly recommended, especially during the first two weeks following injury
					 to assure that all work related symptoms are addressed.
v. Ability to perform job duties and
					 activities of daily living; and
vi.
					 Exacerbating and alleviating factors of the reported symptoms. The physician
					 should explore and report on non-work related as well as, work related
					 activities.
vii. Prior occupational
					 and non-occupational injuries to the same area including specific prior
					 treatment and any prior bracing devices.
viii. Discussion of any symptoms present in
					 the uninjured extremity.
ix. Lower
					 extremity injuries are frequently not isolated, but are accompanied by other
					 injuries. In the setting of a traumatic brain injury (TBI), long bone fracture
					 management must consider the effect of TBI on bone metabolism and may require
					 more aggressive treatment. Refer to the Traumatic Brain Injury Medical
					 Treatment Guidelines, Musculoskeletal Complications.