ࡱ> NPM` )bjbjss 44)$L.@VVVVVVVf.h.h.h.h.h.h.$0h2n.:VV::.VV.RRR: VVf.R:f.RR+|,V4 _lSD^+b-.0.,Y3Y3$,Y3,hV"xRVVV..H VVV.:::: D ICD-9 Code: 840.0 840.9 Narrative: Sprain/Strain Shoulder/Upper Arm Other Names: Sprained shoulder; strained shoulder; tear, rupture, partial tear, or avulsion of tendon, muscle, or ligament in the shoulder joint. Common diagnosis leading to more specific diagnosis. (Note: 840.4 represents complete rupture (tear) of the rotator cuff from traumatic event) ODG Ohio Specific Disability Outcomes: 30th Percentile 50th Percentile All Claims including Surgical Cases 3 5  HYPERLINK "http://www.odg-twc.com/bp/840.htm" \l "840" ODG RTW Best Practices: Condition SeveritySurgical ProcedureSedentary Work: < 10 lbsClerical/Light Work: < 20 lbsManual Work:< 50 lbsMildNone0 days14 daysModerateNone5-7 days21 daysSevereNone7-10 days42 daysMild characterized by some symptoms or limitation of normal activity, but functional. Moderate characterized by significant symptoms or limitations of normal activity. May required analgesics and restrictions. Severe characterized by significant symptoms and/or limitations of activity requiring restrictions of activity, analgesics, and perhaps complete restriction of use of extremity. Description: Injury to the ligament (sprain) or muscle (strain) of the shoulder or upper arm usually accompanied by tearing of the tissue with symptoms of pain, limited motion, swelling, bruising, and change in sensation. BWC Required Diagnostics: None Common Treatment Procedures (CPT Codes): Work restrictions with reduction in restrictions with improvement Medications NSAIDs/Narcotics/Sometimes muscle relaxants Trial of Physical Therapy/Manipulation MRI if failure to improve after 3-4 weeks Specialist Consult (orthopedist) if failing to improve after 3-4 weeks Physical Therapy Guidelines: 10 visits over 60 days after injury (Presumptive Authorization) Additional services may be necessary based on clinical course Chiropractic Treatment Guidelines: 10 visits over 60 days after injury (Presumptive Authorization) Additional services may be necessary based on clinical course Common Surgical Procedures: None (Diagnostic arthroscopy may be considered if failing to improve after sufficient conservative treatment.) Common Restrictions: Restrictions lessen (less restrictive) with improvement of symptoms. Sedentary: No overhead work (or reaching above shoulder), no holding arm in abduction or flexion (elevation of arm), no pulling or pushing more than 8 lbs up to 4 time/hr or lifting and carrying up to 5 lbs 3 times/hr; focus on single arm upper extremity work using injured arm for light work only. May require immobilization with brace, sling, or clavicle brace. No climbing ladders. Manual: Reaching above shoulder level limited to no more than 12 times/hr with up to 15 lbs of weight; reaching to shoulder level limited to 15 times/hr with up to 25 lbs of weight; pushing and pulling up to 60 lbs of force 20 times/hr; single upper extremity work using injured arm for moderate work only; immobilization probably not practical; limit climbing of ladders up to 50 rungs. Early Case Management: 10 days Essential Case Management: 17 days Common Case Management Issues: Early Clinical Status Planned Treatment Work Restrictions and whether Restricted Duty Work Available Placement in alternative job or accommodation to avoid above shoulder activity, repetitive push/pull with extremity, or moderate to heavy lifting Additional Services Necessary Diagnostic or Consultation Possibility of Consultation or Surgery Follow-up Clinical Status Consultations Why Unable to Return to Work Address any Barriers If not progressing as expected Identify any reason for failing to improve as expected Any need for diagnostic studies/consults Any need for ergonomic analysis/job modifications Address any barriers Additional Allowances Consider IME by Orthopedist   %'GHV l m o s ûïq_q_qJ(h;qh) I5B*CJOJQJaJph#h;qh) I5B*CJH*aJph h;qh) I5B*CJaJph+h;qh) I56B*CJOJQJaJphh;qh) I5B*phh) I5B*phhPh) I5CJaJh) ICJaJh) I5CJaJhCJaJhP5CJaJhPCJaJh?2WCJaJh?2W5CJaJh ,5CJaJH  m n o * + , @ S f $IfgdXn@&gd) Igd) I) # $ % ( ) * + ,   q r o tllhpCJaJhphXnCJaJhphpCJaJh?2W5CJaJh~Qh~QCJaJhXn5CJaJh1h15CJOJQJaJ#h1h10J5CJOJQJaJ.jh1h15CJOJQJUaJh15CJOJQJaJ"jh15CJOJQJUaJ) MDDDDD $IfgdXnkd$$IflrqZ <,"P t044 la MDDDDD $IfgdXnkd_$$IflrqZ <,"P t044 la  MDDDDD $IfgdXnkd$$IflrqZ <,"P t044 la       MDDDDD $IfgdXnkd$$IflrqZ <,"P t044 la  r MHHHFFFFgdXnkd9$$IflrqZ <,"P t044 la IJpq}~ !=AD꼴괝괆괩}uumdhH5CJaJhCJaJh~QCJaJhP5CJaJhphpCJaJhphp5CJaJhph ,5CJaJhph ,CJaJhpCJaJhp5CJaJhXn5CJaJh?2Wh ,CJaJh?2WCJaJh?2W5CJaJh ,5CJaJh ,h ,5CJaJ# Jq@~ = 12gd[tgd & Fgd~Q & F & Fgdp & Fgdp@&gd) I '/012MTVtz{n #$%&'()ɭݭݭ݆zznh ,h[t5CJaJh ,h2!5CJaJhYh2!CJaJh#CJaJhh2!CJaJh2!5CJaJh2!CJaJhKh[t5CJaJh[tCJaJh~Q5CJaJhhCJaJh~QCJaJhCJaJh5CJaJh[t5CJaJ 2UVu~o,-L % & Fgd2! & Fgd2! & Fgd2! & Fgd2!@&gd) Igd2!%&'()gd[tgd2!21h:p~Q/ =!"#$% DyK  yK Dhttp://www.odg-twc.com/bp/840.htm840$$If!vh5555P5#v#v#v#vP#v:Vl t5555P5$$If!vh5555P5#v#v#v#vP#v:Vl t5555P5$$If!vh5555P5#v#v#v#vP#v:Vl t5555P5$$If!vh5555P5#v#v#v#vP#v:Vl t5555P5$$If!vh5555P5#v#v#v#vP#v:Vl t5555P5@@@ NormalCJ_HaJmH sH tH DA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List j@j  , Table Grid7:V06U@6 1 Hyperlink >*B*phZY@Z ) I Document Map-D M CJOJQJ^JaJ)4Hmno*+,@Sf  rJq@~ =   1 2 U V u ~ o ,-L %&'(+00@0@0000000000, 0, 0, 0, 0,0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0,0,0,0,0,0,0,0,0 0 0 0 0 000 0 000 0 00 0 0 000000 0 0 0 0V  0u V  0u V  0u V  0u V  0u V  0u V 0V  0V  0 V  0 V  0 V  0 V 0V  0V  0-V  0-V  0-V  0-V  0-V  0-V 0V 0V 0V 0V *~ =1 2 u ~ o ,-L %&'(+{00{00?x {00 {00=x {00{00= {00{00{00{00{00{00{00{00{00{00{00{00{00{00){00{00!l {00@0@0@0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 0A 00 0 @0 @0 @0 )    2%) )$()Xu,6u8ss+ww+9*urn:schemas-microsoft-com:office:smarttagsState9*urn:schemas-microsoft-com:office:smarttagsplace :+$ *=D5 u +333333@Jq =V u L(++~+*(^xB,PKtRphܤ+3p$P{;~ͬh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHxB,;~PK~+*+3pRph                                                      1H2! ,;,'-) I~Q?2Wpmp[t#P;qXn@Sf  +@|7\)@@UnknownGz Times New Roman5Symbol3& z Arial3z Times5& z!Tahoma?5 z Courier New;Wingdings"hFfC C $24d"" 2QHX)? ,2 ICD-9 Code:Gregory M. 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