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MRI Upper Extremity, Non Joint – 73218 – 73219 – 73220

Nonsteroidal anti-inflammatory drugs for at least three weeks (Requirement is waived if NSAIDS are not tolerated or contraindicated, or if condition worsens while under treatment.)

Activity modification or physical therapy if appropriate

1.1.1 X-ray, CT or Ultrasound nondiagnostic

1.2.1 X-ray and/or Ultrasound nondiagnostic

1.2.2 Failed conservative management

1.3.1 See Compartment Syndrome

2.1.1 Pain with passive stretching of muscle

2.1.2 Pain, more severe than expected from trauma

2.1.3 Paresthesias

2.1.4 Plulseless Paralysis

2.2.1 X-rays non diagnostic on two occasions

2.3.1 Defect palpable

2.3.2 Pain on movement

2.3.3 Visible abnormality

2.4.1 Movement at fracture site by PE,x-ray or statement of patient

2.4.2 No evidence of healing for at least 3 months

2.4.3 Pain

2.5.1 Pain

2.5.2 Swelling

2.5.3 Fever

2.5.4 Warm, shiny or discolored skin over the affected area

2.5.5 Elevated WBC count (Leukocytoisis)

2.5.6 Lymphangitis and/or Lymphadenitis.

2.5.7.1 Tubbs Robert J, Savitt Daniel L, Suner Selim, “Chapter 12. Extremity Conditions” (Chapter). Knoop KJ, Stack LB, Storrow AB, Thurman RJ: The Atlas of Emergency Medicine, 3e: http://www.accessmedicine.com/content.aspx?aID=6003337.

2.5.7.2 Fugitt JB, Puckett ML, Quigley MM, Kerr SM. Necrotizing fasciitis. RadioGraphics 2004;24 : 1472-1476

2.6.1 Decreased or Painful Range of Motion (ROM)

2.6.2 Failed conservative management

2.6.3 Pain

2.6.4 X-rays nondiagnostic on two occasion

2.7.1 Failed conservative management

2.7.2.1 Pain that with stretching

2.7.2.2 Tenderness

2.8.1 Lesion on prior imaging

2.8.2 Pain

2.9.1.1 Failed Conservative Management

2.9.2 Palable gap in tendon

2.9.3 Evidence of tendon abnormality on US

2.10.1.1 C reactive Protein elevated

2.10.1.2 Elevated ESR

2.10.1.3 Fever

2.10.1.4 Leukocytosis

2.10.1.5 Positive Blood Cultures

2.10.2.1 Parsonnet Jeffrey, “Chapter 120. Osteomyelitis” (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison’s Principles of Internal Medicine, 17th Edition: http://www.accessmedicine.com/content.aspx?aID=2893649.

2.10.2.2 Alok Kapoor, Stephanie Page, Michael LaValley, Daniel R. Gale, and David T. Felson Magnetic Resonance Imaging for Diagnosing Foot Osteomyelitis: A Meta-analysis Arch Intern Med, Jan 2007; 167: 125 – 132.

2.10.2.3 J. Herman Kan, Melissa A. Hilmes, Jeffrey E. Martus, Chang Yu, and Marta Hernanz-Schulman Value of MRI After Recent Diagnostic or Surgical Intervention in Children with Suspected Osteomyelitis Am. J. Roentgenol., Nov 2008; 191: 1595 – 1600.

2.10.2.4 Kuo-Chen Lee, Yi-Ting Tsai, Chih-Yuan Lin, and Chien-Sung Tsai Vertebral osteomyelitis combined streptococcal viridans endocarditis Eur. J. Cardiothorac. Surg., Jan 2003; 23: 125.

2.10.2.5 D Allen, S Ng, K Beaton, and D Taussig Sternal osteomyelitis caused by Aspergillus fumigatus in a patient with previously treated Hodgkin’s disease J. Clin. Pathol., Aug 2002; 55: 616 – 618.

2.10.2.6 M Ida, H Watanabe, A Tetsumura, and T Kurabayashi CT findings as a significant predictive factor for the curability of mandibular osteomyelitis: multivariate analysis Dentomaxillofac. Radiol., Mar 2005; 34: 86 – 90.

2.10.2.7 Jyri K. Koort, Tatu J. Mäkinen, Juhani Knuuti, Jari Jalava, and Hannu T. Aro Comparative 18F-FDG PET of Experimental Staphylococcus aureus Osteomyelitis and Normal Bone Healing J. Nucl. Med., Aug 2004; 45: 1406 – 1411.

2.10.2.8 Susan A. Connolly, Leonard P. Connolly, Laura A. Drubach, David Zurakowski, and Diego Jaramillo MRI for Detection of Abscess in Acute Osteomyelitis of the Pelvis in Children Am. J. Roentgenol., Oct 2007; 189: 867 – 872.

3.1.1 Prior imaging nondiagnostic (US or X-ray)

3.2 Palpable gap in muscle or tendon

3.3 Pulselss paralysis

4.1 Imaging suggestive of bone destruction (tumor or osteomyelitis)

4.2 Mass of bone or soft tissue

5.1.1 Interval routine follow up of primary or meastatic tumor

5.1.2 New or worsening symptoms

5.2.1 Interval follow up during and after treatment

5.2.2 Preoperative

5.2.3 Worsening clinical situation

5.2.4.1 Parsonnet Jeffrey, “Chapter 120. Osteomyelitis” (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison’s Principles of Internal Medicine, 17th Edition: http://www.accessmedicine.com/content.aspx?aID=2893649.

5.2.4.2 Alok Kapoor, Stephanie Page, Michael LaValley, Daniel R. Gale, and David T. Felson Magnetic Resonance Imaging for Diagnosing Foot Osteomyelitis: A Meta-analysis Arch Intern Med, Jan 2007; 167: 125 – 132.

5.2.4.3 J. Herman Kan, Melissa A. Hilmes, Jeffrey E. Martus, Chang Yu, and Marta Hernanz-Schulman Value of MRI After Recent Diagnostic or Surgical Intervention in Children with Suspected Osteomyelitis Am. J. Roentgenol., Nov 2008; 191: 1595 – 1600.

5.2.4.4 Kuo-Chen Lee, Yi-Ting Tsai, Chih-Yuan Lin, and Chien-Sung Tsai Vertebral osteomyelitis combined streptococcal viridans endocarditis Eur. J. Cardiothorac. Surg., Jan 2003; 23: 125.

5.2.4.5 D Allen, S Ng, K Beaton, and D Taussig Sternal osteomyelitis caused by Aspergillus fumigatus in a patient with previously treated Hodgkin’s disease J. Clin. Pathol., Aug 2002; 55: 616 – 618.

5.2.4.6 M Ida, H Watanabe, A Tetsumura, and T Kurabayashi CT findings as a significant predictive factor for the curability of mandibular osteomyelitis: multivariate analysis Dentomaxillofac. Radiol., Mar 2005; 34: 86 – 90.

5.2.4.7 Jyri K. Koort, Tatu J. Mäkinen, Juhani Knuuti, Jari Jalava, and Hannu T. Aro Comparative 18F-FDG PET of Experimental Staphylococcus aureus Osteomyelitis and Normal Bone Healing J. Nucl. Med., Aug 2004; 45: 1406 – 1411.

5.2.4.8 Susan A. Connolly, Leonard P. Connolly, Laura A. Drubach, David Zurakowski, and Diego Jaramillo MRI for Detection of Abscess in Acute Osteomyelitis of the Pelvis in Children Am. J. Roentgenol., Oct 2007; 189: 867 – 872.

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