Official Disability Guidelines
MONONEURITIS OF UPPER LIMB AND MONONEURITIS MULTIPLEX
(3-digit ICD9 354)
6. DISEASES OF THE NERVOUS SYSTEM AND SENSE ORGANS (320-389)
354 Mononeuritis of upper limb and mononeuritis multiplex 354.0 Carpal tunnel syndrome
Capabilities & Activity Modifications for Restricted Work:
RTW Claims Data (Calendar-days away from work by decile)
Return-To-Work Summary Guidelines Midrange: 28 days At-Risk: 84 days Return-To-Work "Best Practice" Guidelines
Conservative treatment, modified work (no repetitive use of hand/wrist): 0 days
Conservative treatment, regular work (if not cause or aggravating to disability/use of splint): 0-5 days
Conservative treatment, regular work (if work related & electrodiagnostically confirmed): 28 days
Conservative treatment, regular work (with severe nerve impairment): indefinite
Endoscopic surgery, modified work: 3-5 days
Endoscopic surgery, regular work, non-dominant arm: 28 days
Endoscopic surgery, regular/repetitive/heavy manual work, dominant arm: 42 days to indefinite
Open surgery, modified work: 10-14 days
Open surgery, regular work, non-dominant arm: 42 days
Open surgery, regular/repetitive/heavy manual work, dominant arm: 56 days to indefinite
Open surgery, regular/repetitive/heavy manual work, bilateral: 84 days to indefinite
Pregnancy comorbidity, modified work until 28 days after delivery
Modified work: Repetitive motion activities (w or w/o splint) not more than 4 times/hr; repetitive keying up to 15 keystrokes/min not more than 2 hrs/day; gripping and using light tools (pens, scissors, etc.) with 5-minute break at least every 20 min; no pinching; driving car up to 2 hrs/day; light work up to 5 lbs 3 times/hr; avoidance of prolonged periods in wrist flexion or extension.
Regular work (if not cause or aggravating to disability) : Repetitive motion activities not more than 25 times/hr; repetitive keying up to 45 keystrokes/min 8 hrs/day; gripping and using moderate tools (pliers, screwdrivers, etc.) fulltime; pinching up to 5 times/min; driving car or light truck up to 6 hrs/day or heavy truck up to 3 hrs/day; moderate to heavy work up to 35 lbs not more than 7 times/hr.
Description: Compression of the nerve that travels through the wrist to the thumb side of the hand causing pain, tingling, or numbness along the wrist, palm, and fingers. Pain may also be felt in the arm or shoulder, and is often worse while sleeping.
Median nerve entrapment
Partial thenar atrophy
ICD-10 Code: G56.0
ODG Treatment Guidelines: ODG/TWC Index
Other Links: Click below for detailed information on this condition:
American Academy of Neurology | Merck Manual | Merck Home Edition | Mayo Clinic | Patient Guide | Alternative Medicine | State Guidelines
Medical Costs: $7,963 (average of 1,557 cases)
Procedure Codes: 20526 29125 29126 29840 29848 64721 95904
CM Triage: Level 2 (case management), inflection point 20 days, algorithms 2A
Physical Therapy Guidelines:
Allow for fading of treatment frequency (from up to 3 visits per week to 1 or less), plus active self-directed home PT
Medical treatment: 6-8 visits over 5 weeks
Post-surgical treatment (endoscopic): 14 visits over 8 weeks
Post-surgical treatment (open): 20 visits over 10 weeks
Chiropractic Guidelines:
Allow for fading of treatment frequency (from up to 3 visits per week to 1 or less), plus active self-directed home therapy
9 visits over 8 weeks
Disability Duration Adjustment Factors by Age Age Group 18-24 25-34 35-44 45-54 55-64 65-74 Adjustment Factor 0.34 0.75 1.08 1.15 1.10 NA At-Risk Days 20 44 63 67 64 NA 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Mean 13 14 15 22 28 32 42 52 58 365 43.20 CDC NCHS LOD (Length Of Disability, in days)*
Median (mid-point) 14.0 Mean (average) 29.66
Mode (most frequent) 2 Calculated rec. 15
Percent of Cases
(2178 cases)
14.6
11.3
7.8
6.4
5.2
2.8 2.5 2.7 1.5
0.9 0.2 0.8 0.1 0.0
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
3 6 9 12 15 18 21 24 27 30 33 36 39 40+
Range of Days (up to)
*CDC NHIS cases with no lost workdays: 937 (43.0%)
Impact on Total Absence: Prevalence 0.3327% of total lost workdays; Incidence 2.83 days per 100 workers OSHA DAW (Days Away from Work, in days)
Median (mid-point) 27 - Benchmark Indemnity Costs $14,553
Percent of Cases
(27697 cases)
44.9
15.3
9.3 10.5 13.0
2.8 4.2
______ ______ ______ ______ ______ ______ ______
1 day 2 days 3 to 5 6 to 10 11 to 20 21 to 30 31 or more
Range of Days
Impact on Occupational Absence: Prevalence 7.4901% of occupational lost workdays; Incidence 1.20 days per 100 workers NHDS LOS (Hospital Length Of Stay, in days)*
Median (mid-point) 5.0 Mean (average) 0.69
Mode (most frequent) 1 Calculated rec. 3
Percent of Cases
(207 cases)
10.1
5.3
1.4 1.4
0.5 0.5 0.0 0.5 0.0 0.0
___ ___ ___ ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7 8 9 10+
Days
*NHDS cases with no overnight stay: 83 (40.1%)
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