Lateral Epicondyle Debridement (Tennis Elbow). In a throwing athlete, appropriate treatment of a medial epicondyle fracture is important to prevent valgus instability of the elbow. CPT Code: 24359. Although commonly referred to as “ golfer's elbow ”, the condition may in fact be caused by a variety of sports and occupational activities. Alternative: Inside–out technique for indirect reduction and fixation. Medial epicondylopathy or ‘golfer’s elbow’ is mostly a tendinous overload injury leading to tendinopathy. Do not soak or put the operative elbow in a tub, pool, hot tub, sink or ocean/river/lake for 2 weeks after surgery. ... debridement. • Gentle hand, wrist, and elbow range of motion (ROM) exercises. … To describe an alternative positioning technique for the fixation of pediatric medial epicondyle fractures which offers some significant advantages over traditional supine positioning.At our institution, 27 patients with a displaced medial epicondyle fracture requiring open reduction and fixation were positioned prone for the procedure. Accurate diagnosis requires a thorough understanding of the anatomic, epidemiologic, and pathophysiologic factors. Debridement arthroplasty through a posteromedial approach can provide stable and reliable long-term results with regard to relief of pain, gains in range of motion, and the patient's ability to return to his or her previous occupation. Technique / Procedure Steps Always start with informed consent from the patient, and then a time-out to verify correct patient and injection site. Mark the injection site with the pen tip in order to leave an impression in the skin — Point of maximal tenderness (usually just distal to lateral epicondyle). 1 (a) AP radiograph depicting incarcerated medial epicondyle fracture in ulnohumeral joint. Provider wants to bill CPT 24101 & 24359. In our series, a modest loss of extension was observed at ten ye … arthroscopic medial epicondyle debridement. Given its increased prevalence, surgical outcomes regarding the arthroscopic management of lateral epicondylitis have been investigated more extensively than has medial epicondylitis. These arthroscopic techniques have continued to evolve beyond simple debridement, with ECRB repair and plication utilizing both simple suture and suture anchor devices being described . Medial epicondylitis, also called golfer's elbow, was first described in 1882 by Henry J Morris. General considerations. Flexor-pronator tendon degeneration occurs with repetitive forced wrist extension and forearm supination during activities involving wrist flexion and forearm pronation[1]. CPT Codes: 24358 Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or bone, open 0 Open Medial Epicondylitis Tendon Debridement … This classic discusses the original publication ‘Elbow Arthroscopy: A New Technique’ by Poehling et al, published in 1989 in The Journal of Arthroscopic and Related Surgery on the introduction of the prone position and the proximal medial portal to elbow arthroscopy. FIGURE 3-3 Landmarks outlined include the medial epicondyle, ulnar nerve, olecranon tip, lateral epicondyle, and radial head. Once this debridement is complete, the tendon is secured back to the medial epicondyle (on the inside of the elbow) with strong suture. . Technique Summary Medial epicondyle fractures constitute approximately 14 % of fractures involving the distal humerus and 11.5 % of all fractures in the elbow region [1–3]. MEDIAL/LATERAL EPICONDYLE DEBRIDEMENT Rehab Protocol OkorohaPA@gmail.com Secretary 313-651-1926 Henry Ford Health System 690 Amsterdam St., Detroit MI 48202 Ph: 313-972-4216 www.KelechiOkorohaMD.com 14500 Hall Rd., Sterling Hgts. The medial epicondyle is also debrided in order to remove any scar tissue or inflammatory tissue that has developed as a result of long term golfer’s elbow. 5. Surgical treatment results in a high degree of subjective … Golfer's elbow, or medial epicondylitis, is tendinosis of the medial epicondyle on the inside of the elbow.It is in some ways similar to tennis elbow, which affects the outside at the lateral epicondyle.. Keep your incision dry, but it is okay to take a shower and wash your hands. MI 48313 586-247-3714 37000 Woodward Ave., Ste.300, Bloomfield Hills, MI 248-952-9200 Weeks 0-6: Just curious if anyone has ever billed 24359 Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or bone, open with tendon repair or reattachment with modifier 22 for the additional work for both the Medial & Lateral? Fig. Tennis Elbow surgery (called lateral epicondylitis debridement) involves creating a series of small incisions around the elbow and accessing the diseased bones, cartilage, ligaments, or tendons via an arthroscopic. An 18-gauge spinal needle is introduced into the lateral soft spot, which can be found in the center of a triangle formed by the palpable radial head, lateral epicondyle, and olecranon. Post-Op Protocol for Lateral/Medial Epicondyle Debridement/Repair Phase 1: Days 10-14 • Position the extremity in a sling for comfort. Medial epicondyle release surgery is what doctors often use to treat golfer's elbow. Medial Epicondyle Debridement; Open Carpal Tunnel Release; Shoulder Arthroscopy; Trigger Finger Release; Wound Care. The anterior forearm contains several muscles that are involved with flexing the digits of the hand, and flexing and pronating the wrist. We describe a technique for debridement and repair of the extensor carpi radialis brevis tendon to the lateral epicondyle of the humerus using a knotless suture anchor, allowing for a watertight anatomic repair, maximum preservation of grip strength, and absence of … 1999). The limb is exsanguinated, and the tourniquet is inflated to 250 mm Hg. Medial Epicondyle Debridement And Repair Please note that all procedure codes and descriptions include the application of the first cast. There were no infections in the 48 surgeries and there were no other intraoperative or postoperative MEDIAL EPICONDLYITIS REPAIR REHABILITATION PROTOCOL IMMEDIATE POSTOPERATIVE PHASE Protect healing tissue Decrease pain/inflammation Retard muscular atrophy Avoid strengthening the flexor mass muscle group during this initial phase to allow for healing at medial epicondyle Weeks 1-2 • Brace: 90 degrees elbow flexion The surgical technique involves excision of the pathologic portion of the tendon, repair of the resulting defect, and reattachment of the origin of the flexor pronator muscle group to the medial epicondyle. Medial epicondylitis commonly known as Golfer’s elbow is a painful condition occurring from repeated muscle contractions in the forearm that leads to inflammation and micro tears in the tendons that attach to the medial epicondyle. 10.1055/b-0040-177432 17 Lateral Epicondylar DebridementFrederic E. Liss Abstract This chapter on lateral epicondylar debridement will review some of the techniques available for surgical treatment of recalcitrant lateral epicondylitis (LE) and focus on the author's preferred methods of treatment. Graston Technique helps break up the scar tissue, enhances healing, increases blood flow and fibroblast activity. Detailed step by step desription of ORIF - Screw fixation for Extraarticular, avulsion of medial epicondyle located in our module on Distal humerus. 1977; Cheng et al. Rehabilitation Guidelines for Medial/Lateral Epicondyle Debridement The intent of this protocol is to provide the clinician with a general guideline of the post-operative course of the patient that has undergone the above stated procedure. In the past, percutaneous release was reported but is currently not recommended . Repetitive activity damages the wrist muscle flexor tendon and leads to pain with activity, often called Golfer's elbow. Price: $4,600*. For subsequent, additional application of cast use code in Fractures section (16.3). Operative management of type I medial epicondylitis involves medial common flexor origin debridement alone (2,5,7,12). OP note says : The right upper extremity was exsanguinated and tourniquet inflated to 250 mmHg. CCI edits do allow both (24101 with a 59), however I'm not sure both should be reported. However, there is no consensus for optimal fixation technique for medial epicondyle fractures in a throwing athlete. Graston Technique helps break up scar tissue and enhance tendon healing around the elbow associated with medial epicondylitis. I just need a second opinion please. (b) Lateral radiograph also showing incarcerated fragment Assessment Clinical Presentation Patients presenting with medial epicondyle fractures tend to be older children and younger adolescents and are generally male (Smith 1950; Chessare et al. Non-union, bony fragmentation, and osteonecrosis are potential complications which can have huge implications on an athlete’s sporting career. This condition can be very painful. Thereby tendon degeneration appears instead of repair. The goal of the surgery is to remove the damaged tendon that's causing pain. • Control edema and inflammation: Apply ice for 20 minutes two to three times a day. Medial epicondylitis of the elbow involves pathologic alteration in the musculotendinous origins at the medial epicondyle. Occasionally patients present with symptoms consistent with both lateral and medial epicondylitis. Use of the medial epicondyle as a landmark for posteromedial portal placement is a reliable technique. retrospectively reviewed surgical cases of medial epicondylitis and found good to excellent outcomes in 34 of 35 elbows treated with open debridement and repair. Mark the injection site with the pen tip in order to leave an impression in the skin — Point of maximal tenderness (usually just distal to medial epicondyle). The medial epicondyle is the bony prominence that is felt on inside of the elbow. The medial epicondyle and flexor/pronator origin are reflected medially and distally to identify the metaphyseal surface of the avulsed apophysis. The doctor then reattaches a healthy tendon in its place. Type II medial epicondylitis may require ulnar nerve decompression … Technique / Procedure Steps. Always start with informed consent from the patient, and then a time-out to verify correct patient and injection site. Using this technique, each wire can be exchanged for its screw, skipping the drilling step. Exercises should be done in a pain-free ROM. Non-Union, bony fragmentation, and then a time-out to verify correct patient and injection site to correct! 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