SIERRA NEVADA MEDICAL ASSOCIATES, INC. (IPA)
UTILIZATION GUIDELINES
PRIMARY CARE MANAGEMENT GUIDELINES
ORTHOPEDICS
The Primary Care Physician should:
1.
Treat low back pain with history, exam, rest and exercises as appropriate. (See
separate protocol.)
2.
Treat sprains, strains, pulled muscles, overuse syndromes with ice, non-steroidal
ant-inflammatory drugs, analgesics, splints and stretching modalities.
a)
One to two physical therapy visits to instruct on a home program may be
beneficial.
3.
Treat acute inflammatory conditions (such as tennis elbow) with ice, analgesics,
non-steroidal anti-inflammatory drugs, splints, steroid and/or anesthetic injections
and other physical modalities for up to six weeks.
a)
Most patients are not professional athletes and will recover from injuries if
they use RICE (rest, ice, compression, elevation). Early ambulation
exercises and stretching can be helpful.
4.
Treat chronic hip and knee problems. Conservative symptomatic care is
appropriate for most patients.
a)
Referrals should be made if there is a fracture, aseptic necrosis, a locked
knee, an unstable knee, an obvious or apparent ligament tear.
b)
The PCP may perform knee arthrocentesis if indicated.
c)
If progressive disability occurs despite conservative treatment and a
standing x-ray shows joint narrowing or gross destruction of the articular
surface, consultation is appropriate.
5.
Manage chronic pain problems if consultation has ruled out surgery.
6.
Diagnose and treat common foot problems. Conservative care should include
removal of ingrown nails, paring or chemical treatment of corns and/or calluses
and specific changes in footwear.
a)
Bunions should be treated conservatively. Those causing skin problems
or diagnosed in adolescents should be referred.
b)
Consultation should occur for deep abscess, gangrene, osteomyelitis if
intractable difficulty persists despite conservative treatment.
7.
Place:
a)
short arm cast
PC MGMT -ORTHOPEDICS
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b)
c)
d)
8.
short arm thumb spica
upper and lower extremity splints
short leg walking cast
Manage uncomplicated nondisplaced fractures which do not include epiphyseal
injuries.
PC MGMT -ORTHOPEDICS
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