Wisconsin Administrative Code › Department of Workforce Development › DWD 80-81 - Worker's Compensation › Chapter DWD 81 - Worker's compensation treatment guidelines › Section DWD 81.09 - Upper extremity disorders

Current through June 24, 2024
(1) DIAGNOSTIC
				PROCEDURES FOR TREATMENT OF UPPER EXTREMITY DISORDERS.
(a) A health care provider shall determine
				the nature of an upper extremity disorder before initiating
				treatment.
(b) A health care
				provider shall perform and document an appropriate history and physical
				examination. Based on the history and physical examination a health care
				provider shall at each visit assign the patient to the appropriate clinical
				category according to subds. 1. to 6. A health care provider shall document the
				diagnosis in the medical record. Patients may have multiple disorders requiring
				assignment to more than one clinical category. This section does not apply to
				upper extremity conditions due to a visceral, vascular, infectious,
				immunological, metabolic, endocrine, systemic neurologic, or neoplastic disease
				process, fractures, lacerations, amputations, or sprains or strains with
				complete tissue disruption.
1.
				'Epicondylitis.' This clinical category includes medial epicondylitis and
				lateral epicondylitis, including ICD-9-CM codes 726.31 and 726.32.
2. `Tendonitis of the forearm, wrist, and
				hand.' This clinical category encompasses any inflammation, pain, tenderness,
				or dysfunction or irritation of a tendon, tendon sheath, tendon insertion, or
				musculotendinous junction in the upper extremity at or distal to the elbow due
				to mechanical injury or irritation, including the diagnoses of tendonitis,
				tenosynovitis, tendovaginitis, peritendinitis, extensor tendinitis, de
				Quervain's syndrome, intersection syndrome, flexor tendinitis, and trigger
				digit, including ICD-9-CM codes 726.4, 726.5, 726.8, 726.9, 726.90, 727, 727.0,
				727.00, 727.03, 727.04, 727.05, and 727.2.
3. `Nerve entrapment syndromes.' This
				clinical category encompasses any compression or entrapment of the radial,
				ulnar or median nerves, or any of their branches, including carpal tunnel
				syndrome, pronator syndrome, anterior interosseous syndrome, cubital tunnel
				syndrome, Guyon's canal syndrome, radial tunnel syndrome, posterior
				interosseous syndrome, and Wartenburg's syndrome, including ICD-9-CM codes 354,
				354.0, 354.1, 354.2, 354.3, 354.8, and 354.9.
4. `Muscle pain syndromes.' This clinical
				category encompasses any painful condition of any of the muscles of the upper
				extremity, including the muscles responsible for movement of the shoulder and
				scapula, characterized by pain and stiffness, including the diagnoses of
				chronic nontraumatic muscle strain, repetitive strain injury, cervicobrachial
				syndrome, tension neck syndrome, overuse syndrome, myofascial pain syndrome,
				myofasciitis, nonspecific myalgia, fibrositis, fibromyalgia, and fibromyositis,
				including ICD-9-CM codes 723.3, 729.0, 729.1, 729.5, 840, 840.3, 840.5, 840.6,
				840.8, 840.9, 841, 841.8, 841.9, and 842.
5. `Shoulder impingement syndromes, including
				tendonitis, bursitis, and related conditions.' This clinical category
				encompasses any inflammation, pain, tenderness, dysfunction, or irritation of a
				tendon, tendon insertion, tendon sheath, musculotendinous junction, or bursa in
				the shoulder due to mechanical injury or irritation, including the diagnoses of
				impingement syndrome, supraspinatus tendonitis, infraspinatus tendonitis,
				calcific tendonitis, bicipital tendonitis, subacromial bursitis, subcoracoid
				bursitis, subdeltoid bursitis, and rotator cuff tendinitis, including ICD-9-CM
				codes 726.1 to 726.2, 726.9, 726.90, 727 to 727.01, 727.2, 727.3, 840, 840.4,
				840.6, 840.8, and 840.9.
6.
				`Traumatic sprains or strains of the upper extremity.' This clinical category
				encompasses an instantaneous or acute injury that occurred as a result of a
				single precipitating event to the ligaments or the muscles of the upper
				extremity including ICD-9-CM codes 840 to 842.19. Injuries to muscles as a
				result of repetitive use, or occurring gradually over time without a single
				precipitating trauma, are considered muscle pain syndromes under subd. 4.
				Injuries with complete tissue disruption are not subject to this
				section.
(c) A health
				care provider may order certain laboratory tests in the evaluation of a patient
				with upper extremity disorder to rule out infection, metabolic-endocrinologic
				disorders, tumorous conditions, systemic musculoskeletal disorders such as
				rheumatoid arthritis, or side effects of medications. Laboratory tests may be
				ordered at any time a health care provider suspects any of these conditions,
				but a health care provider shall justify the need for the tests ordered with
				clear documentation of the indications.
(d) Medical imaging evaluation of upper
				extremity disorders shall be based on the findings of the history and physical
				examination and may not be ordered before a health care provider's clinical
				evaluation of the patient. Medical imaging may not be performed as a routine
				procedure and shall comply with the guidelines in s.
				DWD
				81.05. A health care provider shall document the
				appropriate indications for any medical imaging studies obtained.
(e) Electromyography and nerve conduction
				studies are only necessary for nerve entrapment disorders and recurrent nerve
				entrapment after surgery.
(f) A
				health care provider may not order the use of any of the following diagnostic
				procedures or tests for diagnosis of upper extremity disorders:
1. Surface electromyography.
2. Thermography.
3. Somatosensory evoked potentials and motor
				evoked potentials.
(g)
				All of the following diagnostic procedures or tests are considered adjuncts to
				the physical examination and are not necessary separately from the office
				visit:
1. Vibrometry.
2. Neurometry.
3. Semmes-Weinstein monofilament
				testing.
4. Algometry.
(h) A health care provider may not
				order computerized range of motion or strength measuring tests during the
				period of initial nonsurgical management but may order these tests during the
				period of chronic management when used in conjunction with a computerized
				exercise program, work hardening program, or work conditioning program. During
				the period of initial nonsurgical management, computerized range of motion or
				strength testing may be performed but shall be done in conjunction with an
				office visit with a health care provider's evaluation or treatment.
(i) A health care provider may order
				personality or psychosocial evaluations for evaluating patients who continue to
				have problems despite appropriate initial nonsurgical care. A treating health
				care provider may perform this evaluation or may refer the patient for
				consultation with another health care provider in order to obtain a
				psychological evaluation. These evaluations may be used to assess the patient
				for a number of psychological conditions that may interfere with recovery from
				the injury. Since more than one of these psychological conditions may be
				present in a given case, a health care provider performing the evaluation shall
				consider all of the following:
1. Is symptom
				magnification occurring?
2. Does
				the patient exhibit an emotional reaction to the injury, such as depression,
				fear, or anger, that is interfering with recovery?
3. Are there other personality factors or
				disorders that are interfering with recovery?
4. Is the patient chemically
				dependent?
5. Are there any
				interpersonal conflicts interfering with recovery?
6. Does the patient have a chronic pain
				syndrome or psychogenic pain?
7. In
				cases in which surgery is a possible treatment, are psychological factors
				likely to interfere with the potential benefit of the surgery?
(j) Diagnostic analgesic blocks
				and injection studies are used to localize the source of pain and to diagnose
				conditions which fail to respond to appropriate initial nonsurgical management.
				All of the following guidelines apply to diagnostic analgesic blocks and
				injection studies:
1. Selection of patients,
				choice of procedure, and localization of the site of injection shall be
				determined by documented clinical findings indicating possible pathologic
				conditions and the source of pain symptoms.
2. These blocks and injections may also be
				used as therapeutic modalities and as such are subject to the guidelines of
				sub. (5).
(k) Functional
				capacity assessment or evaluation is a comprehensive and objective assessment
				of a patient's ability to perform work tasks. The components of a functional
				capacity assessment or evaluation include neuromusculoskeletal screening, tests
				of manual material handling, assessment of functional mobility, and measurement
				of postural tolerance. A functional capacity assessment or evaluation is an
				individualized testing process and the component tests and measurements are
				determined by the patient's condition and the requested information. Functional
				capacity assessments and evaluations are performed to determine and report a
				patient's physical capacities in general or to determine work tolerance for a
				specific job, task, or work activity.
1.
				Functional capacity assessment or evaluation is not necessary during the first
				12 weeks of initial nonsurgical treatment.
2. Functional capacity assessment or
				evaluation is necessary after the first 12 weeks of care in any of the
				following circumstances:
a. To identify the
				patient's activity restrictions and capabilities.
b. To assess the patient's ability to return
				to do a specific job.
3.
				A functional capacity evaluation is not necessary to establish baseline
				performance before treatment or for subsequent assessments to evaluate change
				during or after treatment.
4. Only
				one completed functional capacity evaluation is necessary per injury.
(L) Consultations with
				other health care providers may be initiated at any time by a treating health
				care provider consistent with accepted medical practice.