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 B - Shoulder Injury Medical Treatment Guidelines › Section I-2325 - Therapeutic Procedures-Non-Operative

Current through Register Vol. 50, No. 6, June 20, 2024
A. Treating providers, as well as employers
					 and insurers are highly encouraged to reference the General Guideline
					 Principles. 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 evaluation 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, skilled home therapy may be necessary. Skilled
					 home therapy may include active and passive therapeutic procedures as well as
					 other modalities to assist in alleviating pain, swelling, and abnormal muscle
					 tone. Skilled home therapy is usually of short duration and continues until the
					 patient is able to tolerate coming to an outpatient center.
1. Acupuncture 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 literature suggests 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
					 the return to functional activity. Acupuncture should be performed by licensed
					 practitioners.
a. 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.
i. Indications include joint
					 pain, joint stiffness, soft tissue pain and inflammation, paresthesia,
					 post-surgical pain relief, muscle spasm, and scar tissue pain.