Lateral epicondyle steroid injection cpt code

The clinical presentation is consistent with lateral epicondylitis, which is caused from pathologic changes at the origin of the extensor carpi radialis brevis (ECRB).

Physical exam findings consistent with lateral epicondylitis include tenderness over the lateral epicondyle at the origin of the ECRB, and pain that is reproduced with gripping, resisted long finger extension, resisted wrist extension while the elbow is fully extended, and maximum passive wrist flexion. This should be distinguished with the pain with resisted supination with the arm and wrist in extension characteristically seen with radial tunnel syndrome.

Nirschl et al looked at their surgical cohort of patients with lateral epidondylitis that were treated with surgery. They found the lesion that was consistently identified at surgery was immature fibroblastic and vascular infiltration of the origin of the extensor carpi radialis brevis (ECRB). There was an over-all improvement rate of per cent, and per cent of the patients returned to full activity including rigorous sports following surgical treatment.

Morris et al used indwelling EMG to look at muscle activity about the elbow during tennis strokes in nine professional and collegiate level players. They concluded the predominant activity of the wrist extensors in all strokes may be one explanation for predisposition to injury.

Regarding diagnosis:

  • Does individual's occupation or hobby involve forceful of stressful use of the forearm, often in combination with repetition?
  • Does individual report elbow pain, swelling, and the inability to use the wrist and arm?
  • Has pain spread to the forearm?
  • Is the affected elbow on the dominant or nondominant side?
  • Does individual have a history of neck or shoulder injuries?
  • On physical examination, is the pain localized over either epicondyle?
  • Does pain increase with resisted wrist motion?
  • Is weakness noted in the forearm?
  • Has the individual experienced numbness and tingling in the affected arm?
  • Does the individual report occasional locking?
  • Did individual have an injection test done? X-ray? MRI?
  • Have conditions with similar symptoms been ruled out?
Regarding treatment:
  • Has individual responded favorably to treatment consisting of rest from the aggravating activity, ice packs, NSAIDs, and a splint?
  • Has individual received a corticosteroid injection?
  • Has individual allowed enough time for conservative treatments to be effective?
  • Was surgery necessary?
Regarding prognosis:
  • Is individual active in physical therapy? Does individual have a home exercise program?
  • Is individual's employer able to accommodate any necessary restrictions?
  • Has individual had an ergonomic evaluation of his or her work area?
  • Does individual have any conditions that may affect the ability to recover?
  • Does individual experience any complications such as radial or ulnar neuropathy ?
Source: Medical Disability Advisor

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Lateral epicondyle steroid injection cpt code

lateral epicondyle steroid injection cpt code

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