Orthopedic Clinic

Musculoskeletal Referral Guidelines for MAP Handbook

Scope:

• To provide consultation and orthopaedic care for musculoskeletal complaints including problems involving joints, tendons, and muscles AFTER appropriate screening and adequate conservative care in primary clinics.

Required documents for referral:

• Past medical history
• Current medication list
• Most recent progress note describing condition for which patient is being referred
• X-ray performed on symptomatic region within the last 2 years
• ICD-10 Diagnosis Codes on referral form or Paperwork

Urgent Referrals:

• After consulting with our on call provider and it is determined that an urgent referral is appropriate
• Recent fracture of the upper extremity (within the last week)
• Any lower extremity fracture that is deemed appropriate by a call to the consulting provider

Routine Referrals:

• Osteoarthritis without signs of infection
• Chronic knee or hip pain without acute flare up or recent injury
• Old healing fractures of the upper and lower extremities

Conditions covered by MAP to be treated in the MSK IPU:

• Osteoarthritis
• Internal derangement of the knee or hip
• Shoulder, elbow, and hand conditions of all types
• Upper extremity fractures
• Old, healing lower extremity fractures or fractures (not in need of urgent surgical repair)
• Knee or hip pain in the presence of normal x-rays. If considering advanced imaging, please contact specialist through MSK Consult line (information above) for advice on most appropriate test.

Conditions NOT to be treated in the MSK IPU:

• Back and Neck pain (Not currently a covered service unless a surgical consult is needed)
• Foot and Ankle problems (Seton “Podiatry Clinic”)
• Acute emergent fractures of the lower extremity (refer to ED)
• Chronic pain patients in need of long term pain management (Currently this is not a covered service by MAP)
• Tumors, Malignant Lesions, or cancer of the musculoskeletal system (Work within current MAP Referral Guidelines to determine diagnosis; once diagnosis has been established then refer to Seton Infusion Center for management).

Elective Joint Replacement Surgical Considerations:

In order to minimize the risk of surgical complications, we will work with patients seeking elective joint replacement to address modifiable risk factors prior to surgery.  We will continue to see and treat patients conservatively in conjunction with the primary care provider but would like to share the following goals for the benefit of patient expectations and education prior to consultation about joint replacement.  All of these factors have been shown to increase the risk of perioperative infection.

• Uncontrolled diabetes (A1C >7.2)
• Currently smokers (must be smoke free for 2 months prior to surgery)
• BMI over 40