Name of the Procedure:

Addition to Upper Extremity Joint (Wrist or Elbow), Concentric Adjustable Torsion Style Mechanism for Custom Fabricated Orthotics
Common Names: Wrist or Elbow Support Adjustment, Adjustable Mechanism for Custom Orthotics
Technical/Medical Terms: HCPCS Code L3891, Concentric Adjustable Torsion Mechanism

Summary

This procedure involves adding or adjusting a concentric adjustable torsion mechanism to a custom-fabricated orthotic brace for the wrist or elbow. The mechanism allows for controlled movement and support of the joint, improving functionality and comfort.

Purpose

This procedure addresses:

• Joint instability in the wrist or elbow
• Limited range of motion
• Chronic pain due to overuse or injury

The expected outcomes include improved joint stability, increased range of motion, pain relief, and enhanced overall function of the affected limb.

Indications

This procedure is indicated for patients with:

• Arthritis or degenerative joint conditions
• Tendonitis or bursitis
• Post-surgical recovery requiring joint support
• Injury-related instability or weakness

Patients should have a medical evaluation to ensure that custom orthotics are appropriate for their condition.

Preparation

• Pre-Procedure Instructions: No specific preparation like fasting is usually required. Patients should discuss any current medications with their healthcare provider.
• Diagnostic Tests: An assessment of the joint's functionality through physical examination and possibly imaging tests (X-rays, MRI) to guide the customization of the orthotic.

Procedure Description

1. Customization of Orthotic: An orthotic specialist takes measurements and creates a mold of the affected joint area.
2. Adjustment Mechanism Integration: The concentric adjustable torsion mechanism is integrated into the custom orthotic design.
3. Fitting and Adjustment: Once the orthotic is ready, it is fitted onto the patient. Adjustments are made to ensure optimal support and comfort.
4. Finalization: The orthotic is finalized, and the patient is instructed on its use.

Tools and Equipment

• Custom orthotic materials (molds, supports)
• Concentric adjustable torsion mechanism
• Measuring and fitting tools

Duration

The entire process, from customization to final fitting, typically takes a few weeks, but the fitting and adjustment procedure usually takes about 1-2 hours.

Setting

This procedure is performed in an outpatient setting, such as a clinic or specialized orthotic facility.

Personnel

• Orthotic Specialists or Technicians
• Physical Therapists
• Orthopedic Doctors or Surgeons (for oversight)

Risks and Complications

• Common Risks: Mild discomfort during the fitting process, adjustment period discomfort.
• Rare Risks: Skin irritation, incorrect fitting leading to improper support, mechanical failure of the torsion mechanism.

Benefits

• Improved joint stability and function
• Pain relief
• Enhanced mobility and quality of life Benefits can usually be realized soon after proper adjustment and some acclimatization to the orthotic device.

Recovery

• Post-Procedure Care: Patients are advised on how to wear and care for the orthotic. Follow-up appointments may be necessary for adjustments.
• Recovery Time: Immediate use is possible, though there may be an adjustment period of a few weeks where the patient gets used to the orthotic.
• Restrictions: Minimal, mostly related to activity levels and ensuring the orthotic is worn as directed.

Alternatives

• Other Treatments: Standard braces or supports, physical therapy, surgical interventions.
• Pros and Cons: Custom orthotics with an adjustable mechanism offer tailored support and flexibility, unlike standard braces which may lack customization. Surgical options are more invasive and entail longer recovery times.

Patient Experience

• During the Procedure: Minimal discomfort; mostly involves measuring and fitting.
• After the Procedure: Some initial adjustment discomfort as the patient gets used to the orthotic. Pain management usually involves over-the-counter pain relievers if needed. Comfort measures can include gradual acclimatization to wearing the device.