Guidelines for Joint Injections Shoulder
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1 Guidelines for Joint Injections Shoulder Clinic Manual The shoulder is the site of multiple injuries and inflammatory conditions that lend themselves to diagnostic and therapeutic injection. Joint injection should be considered after other therapeutic interventions such as non-steroidal anti-inflammatory drugs, physical therapy, and activitymodification have been tried. Indications for glenohumeral joint injection include osteoarthritis, adhesive capsulitis, and rheumatoid arthritis. For the acromioclavicular joint, injection may be used for diagnosis and treatment of osteoarthritis and distal clavicular osteolysis. Sub-acromial injections are useful for a range of conditions including adhesive capsulitis, sub-deltoid bursitis, impingement syndrome, and rotator cuff tendinosis. Scapulothoracic injections are reserved for inflammation of the involved bursa. Persistent pain related to inflammatory conditions of the long head of the biceps responds well to injection in the region. The proper technique, choice and quantity of pharmaceuticals, and appropriate follow-up are essential for effective outcomes.
2 Treatment Protocols Week One Radiographic Assessment Shoulder Pain and Disability Index Functional Outcome Assessment (3x's per week) Week Two (3x's per week) Week Three Shoulder Pain and Disability Index Functional Outcome Assessment (If score shows less than a 15% decrease, move Joint Injection Treatment tract) (If score shows greater that 15% decrease, continue with conservative treatment) (3x's per week) Week Four (3x's per week) Week Five Shoulder Pain and Disability Index (If score shows less than a 50% decrease, Joint Injection Treatment) (If score shows greater that 50% decrease, release from care and reschedule for 3-month follow-up) Patient will be fitted for a TENS unit for pain control. Patient will be fitted with a shoulder brace for support and comfort.
3 Joint Injection Treatment Week One Shoulder Pain and Disability Index Strapping of Shoulder Patient will be fitted for a TENS unit for pain control Week Two Strapping of Shoulder Week Three Strapping of Shoulder Week Four Strapping of Shoulder Week Five Shoulder Pain and Disability Index Patient will be fitted for shoulder brace for support and comfort. Reschedule patient for a follow-up in three months
4 CPT Codes Billed Week One or if new patient or if established patient Radiological Assessment Cervical Spine; 2 or 3 views Cervical Spine; 4or 5 views Cervical Spine; 6 or more views Thoracic Spine; 2 views Thoracic Spine; 3 views Thoracic Spine; 4 or more views Clavicale; complete Scaupula; complete Shoulder; 1 view Shoulder; 2 or more views Acromioclavicular joints adjusted Week Two Week Three or established patient
5 Week Four (at least 3 times per week) Week Five or established patient J or L code based upon which brace is prescribed (If no chiropractic available, physical therapy is substituted.)
6 Week One or established patient Injection, anesthetic agent; intercostal nerve, single Injection, anesthetic agent; multiple, regional block Week Two
7 64420 Injection, anesthetic agent; intercostal nerve, single Injection, anesthetic agent; multiple, regional block Week Three Injection, anesthetic agent; intercostal nerve, single Injection, anesthetic agent; multiple, regional block
8 Week Four Injection, anesthetic agent; intercostal nerve, single Injection, anesthetic agent; multiple, regional block Week Five Injection, anesthetic agent; intercostal nerve, single
9 64421 Injection, anesthetic agent; multiple, regional block Week Six or established patient J or L code based upon which brace is prescribed
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