ࡱ> 8;7e bjbjϺ .$إf\إf\ 28 ,!(:::!>!>!>!>!>!$#7&jb!-b!::!wwwd:: T:  KNEE MRI NONTRAUMATIC KNEE PAIN Indicated for ANY ONE of the following: Acute traumatic injury Bone abnormality on x-ray or CT Bone scan with well-localized increased uptake Chronic knee pain and ALL of the following are present: Normal x-ray Normal physical exam No other explanation, such as patellofemoral syndrome, degenerative joint disease, stress fracture, reflex sympathetic dystrophy, or inflammatory arthritis is present Bakers cyst or other cystic lesion Regional sympathetic dystrophy Suspected osteonecrosis due to presence of ANY ONE of the following: Focal radiolucency on plain x-ray Bone scan demonstrates well-localized, increased uptake Knee pain and history suggestive of increased risk for osteonecrosis due to the presence of ANY ONE of the following: Previous trauma Hemoglobinopathy, particularly sickle cell anemia Chronic corticosteroid usage Suspected stress fracture due to the presence of ALL of the following: Concerns regarding infection or inflammatory process make bone scan suboptimal History of overuse or excessive activity Localized pain Symptoms persist or recur despite rest Two normal plain films at least 3 weeks apart Loose body in joint space Synovial pathology MENISCAL INJURY Indicated when ALL of the following are present: Skilled orthopedic clinical exam cannot yield diagnosis of a torn meniscus. Presence of ANY ONE of the following symptoms or physical findings: Restricted range of motion, buckling, or locking Gradual onset of effusion over several hours, reaching maximum on the day after injury Symptoms worse with ANY ONE of the following: Twisting or rotating motions of knee Going up and down stairs Standing up from a sitting position Effusion with acute injury or with subsequent episodes of minor injury or vigorous activity Sensitivity to palpation along the medial or lateral joint line Positive McMurray test or Apley test Fracture with high association of meniscal tear CRUCIATE LIGAMENT TEAR Indicated for ANY ONE of the following: Positive anterior or posterior drawer sign Positive Lachmans test Posttraumatic effusion, usually bloody Inability to bear weight after injury History of tearing or popping after acute injury Symptoms of instability with chronic injury COLLATERAL LIGAMENT INJURY Indicated for ANY ONE of the following: Laxity with valgus or varus stresses to the knee at 30p of flexion Posttraumatic effusion without ligamentous instability Symptoms of instability with chronic injury OSTEOMYELITIS Indicated for ANY ONE of the following: Patient with diabetes or severe peripheral vascular disease and ANY ONE of the following: Abscess or cellulitis Persistent leg pain, even without ulcers present Persistent or worsening ulcer without obvious bone exposure Suspected osteomyelitis due to presence of ANY ONE of the following: Pain associated with chills or fever, particularly after trauma or orthopedic surgery Overlying cellulitis that responds poorly to antibiotics Chronic skin ulcer or sinus tract Focal lesion seen on bone scan SUSPECTED BONE TUMOR Indicated for ANY ONE of the following: Abnormal finding on x-ray or bone scan Palpable bony abnormality with normal x-ray Known diagnosis of cancer elsewhere and ANY ONE of the following: Unexplained pain Abnormal x-ray or bone scan Persistent pain or unclear etiology Follow-up after treatment for either primary or metastatic cancer of the bone. Suspected or known soft tissue neoplasm Known chondrosarcoma, Ewing sarcoma or osteosarcoma References Milliman Care Guidelines, Ambulatory Care, 23rd Edition, Knee MRI; 2/26/2019.     Page  PAGE 3 of  NUMPAGES 3   "K Wefl{knyhMT0JmHnHu h90Jjh90JUhvjhvU h9>*h9OJQJ^Jhr h95 hr5hrhr5>*h9<  "#Kb : \  L i ( 7 ^  & F & F & F & F^ I ChAf & F^ & F & F & F & F & Fgdr & FAg RJ!Z| & F & F^ & F-o7klmnyz & F & F & F^^,1h/ =!"#$8%  s666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH66666666666666666666666666666666666666666666666666666666666666666p62&6FVfv2(&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ OJPJQJ_HmH nH sH tH H`H Normal CJOJQJ_HaJmH sH tH DA`D Default Paragraph FontViV 0 Table Normal :V 44 la (k ( 0No List D@D List Paragraph ^m$44 Header  !4 @4 Footer  !.)@!.  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