Sinus tarsi syndrome: The importance of biomechanically-based evaluation and treatment, Archives of Physical Medicine and Rehabilitation, Volume 74, Issue 7, 1993, Pages 777-781. constitute "pre-erosions"), contrast enhancement may distinguish erosions or pre-erosions from degenerative subchondral cysts, ADVERTISEMENT: Supporters see fewer/no ads. Sagittal T1-weighted (Image 6A) and fat suppressed fast spin-echo T2-weighted (Image 6B) images demonstrate mild edema (asterisk) in the sinus tarsi adjacent to the cervical ligament (CL) and roots of the inferior extensor retinaculum (arrow), without evidence for ligament disruption. Enjoy access to millions of ebooks, audiobooks, magazines, and more from Scribd. Lee KB, Bai LB, Park JG, Song EK, Lee JJ. 1997;21(2):274-279. Chin J Traumatol. Beltran J. Sinus tarsi syndrome. Dr. Masci is a specialist sport doctor in London. In some cases, this pain may be due to hip flexor tendonitis. Rheumatoid arthritis is a synovial-based process, with a predilection for the: proximal interphalangeal and metacarpophalangeal joints (especially those of the index and middle fingers). Lawrence DA, Rolen MF, Haims AH, Zayour Z, Moukaddam HA. One study showed that needling improved pain from trochanteric tendonitis in about 80% of people after 2-3 months. It is roughly cone-shaped, with the wider portion directed anteriorly and laterally. I had a total right hip replacement 2 yrs ago and still have severe pain , bursitis , tendonitis, and I get sudden cramping in the right groin daily , ,, what should I do next ? Contiguous sagittal T1-weighted images in the same patient from lateral to medial (Images 4B through 4E) show the cervical ligament (CL) anteriorly in the sinus, with the lateral root (L) on image 4B, intermediate root (I) on 4C, and portions of the medial root (M) on images 4D and 4E. Thacker P, Mardis N. Ligaments of the tarsal sinus: improved detection, characterisation and significance in the paediatric ankle with 3-D proton density MR imaging. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Stanislavsky A, Worsley C, Yap J, et al. Cortisone injections have been shown to improve pain after six weeks. We often start with simple exercises such as side lying hip raises, seated hip abduction with a band, and hamstring bridges with a band. Hi Joanne, Sorry to hear about your hip. 2020 Spring;8(2):153-156. Administrative | Durable Medical Equipment (DME) | Laboratory | Medicine | Mental Health | OB/GYN Reproduction | Other | Pharmacology | Radiology | Surgery | Therapy. My x ray shows that new hip is in place ? Id avoid further cortisone injections. Sonographic visibility of the sinus tarsi with a 12 MHz transducer. It worked great but in two weeks the pain was back again. CT and MR imaging of patients with lateral hindfoot symptoms have demonstrated features of extra-articular osseous impingement laterally, involving the talus, calcaneus and fibula. It appears that you have an ad-blocker running. Clipping is a handy way to collect important slides you want to go back to later. inversion (supination) test Anterolateral soft-tissue impingement. MRI of the sinus tarsi in acute ankle sprain injuries. Pediatr Radiol. 2006;27(7):533-538. A more medially located sagittal image (Image 2F) visualizes part of the tarsal canal. Signature Orthopedics - South County Formerly Premier Care Orthopedics & Sports Medicine 12639 Old Tesson Road Suites 100 and 115 St. Louis, MO 63128 J Orthop Sci. I think youve given me an idea for another blog. For example, shockwave therapy works for some people. MRI of the ankle was performed. Klein MA, Spreitzer AM. The angle is formed by the acetabular roof to the vertical cortex of the ilium and thus reflects the depth of the bony acetabular roof. 1990;177(2):455-458. Hindfoot is composed of 2 bones: calcaneus and talus. Subtalar arthroscopy for sinus Tarsi syndrome: arthroscopic findings and clinical outcomes of 33 consecutive cases. The kinetic chain (sometimes called the kinematic chain) is an engineering concept used to describe human movement. Bali K, Prabhakar S, Gahlot N, Dhillon MS. Neglected lateral process of talus fracture presenting as a loose body in tarsal canal. Foot Ankle Int. On practical example is reducing the step count to 50% of normal or reducing running intensity. Research suggests cortisone injections for greater trochanteric pain syndrome are effective (but less so than exercise). Rheumatoid arthritis (RA) is a chronic multisystem disease with predominant musculoskeletal manifestations.It is a disease that primarily affects synovial tissues, i.e. Publishes content for an international readership on topics related to physical therapy. The technical storage or access that is used exclusively for statistical purposes. The decision is made to proceed with operative stabilization of the distal radius. She reports left ankle injury 3 weeks ago. 1993;186(1):233-240. Cortisone is a potent anti-inflammatory that reduces pain by lowering inflammation. The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user. Coronal fat suppressed fast spin-echo proton density-weighted (Image 24A) and sagittal T1-weighted (Image 24B) images show complete bony fusion of the middle subtalar joint (dotted lines). 1999;20(3):185-191. Generally, investigations are needed if youre not responding to therapy or present with unusual symptoms. 77 year-old male with sinus tarsi syndrome and history of previous calcaneal fracture. Finally, weakness of the hip muscles is an essential factor. A bone contusion is also visible in the lateral talus (asterisks). It is also referred to as trochanteric tendonitis or bursitis and is common and readily treatable. Rominger M, Bernreuter W, Kenney P, Morgan S, Blackburn W, Alarcon G. MR Imaging of the Hands in Early Rheumatoid Arthritis: Preliminary Results. View the list for Blue Shield of California plan members, View the list for Blue Shield Promise Medicare, Medi-Cal and Cal MediConnect members. Foot Ankle Surg. Dozier TJ, Figueroa RT, Kalmar J. Sinus tarsi syndrome. Now customize the name of a clipboard to store your clips. 2020;40(5):1339-54. It is essential to see an expert in therapy to guide you through hip tendonitis exercises. 2022, BlueCross and BlueShield of Alabama is an independent licensee of the BlueCross and BlueShield Association. Refer to the related articles for a general discussion of rheumatoid arthritis and for the particular discussion of its respiratory and/or cardiac manifestations. 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The sinus tarsi syndrome was first described in the medical literature in 1958.1 Overall incidence is unknown, but it is generally considered uncommon and without consistent gender predilection.2,3, Components of the sinus tarsi syndrome include lateral hindfoot pain, tenderness to palpation over the sinus tarsi, a sensation of instability in the hindfoot, and relief by injection of local anesthetic into the sinus.2,3,4,5 Patients typically present in the third to fourth decade of life with a history of ankle sprain. (SBQ17SE.86) J Foot Ankle Surg. There is an anterolateral, posteromedial and lateral compartment of the ankle typically superficial to the joint. Posterior ankle impingement, FHL entrapment. General imaging differential considerations include: avulsion fracture of lateral tubercle of talus (Shepherd fracture) fracture of Stieda process 2 ; -, 5. recommended views. 36 year- old male with history of ankle sprain several years ago, subtalar instability and sinus tarsi syndrome. The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network. All rights reserved. Treatment of trochanteric bursitis includes exercise and injections. 52 year-old female with direct trauma to the left foot 2 days ago. If there is significant edema in the sinus, the ligaments may be better visualized on fat suppressed intermediate or T2-weighted images, being outlined by T2-hyperintense edema.10,17. In particular: synovial proliferation and inflammation of the superficial joints, which is often evident before bone changes are visible on radiographs, tenosynovitis:extensor carpi ulnaris tendoninvolvement is common in early disease and may lead to erosion of the ulnar styloid 2. The technical storage or access that is used exclusively for anonymous statistical purposes. (Case 18) Gout or other deposition diseases can cause synovitis and crystal deposition in the sinus. Sagittal (Image 7A), coronal (Image 7B), and axial (Image 7C) fat-suppressed fast spin-echo T2-weighted images reveal small cysts (arrowheads) and edema adjacent to the cervical ligament and roots of the inferior extensor retinaculum, without disruption of the ligaments. Generally, we start with exercise therapy. Sagittal T1-weighted (Images 21A and 21B) and fat suppressed fast spin-echo T2-weighted (Images 21C and 21D) images reveal a corticated ossicle (arrow) with internal fatty marrow in the usual location of the cervical ligament. (2004) ISBN: 9780781750066 -, 6. Tarsal Tunnel Syndrome Deep Peroneal Nerve Entrapment Tibiotalar Impingement is a source of anterior ankle pain that is most often caused by osteophyte impingement in the anterior tibiotalar joint. Jotoku T, Kinoshita M, Okuda R, Abe M. Anatomy of ligamentous structures in the tarsal sinus and canal. Case 20 Gout involving the subtalar joint and sinus tarsi. Numerous alternative etiologies have been proposed in the literature, including irritation or damage to the proprioceptive and nociceptive nerve endings in the sinus, hypertrophy of adipose tissue in the sinus, synovial herniation or protrusion into the sinus from the adjacent subtalar joints, impeded venous outflow from the sinus, or compression of the sinus due to alteration of hindfoot alignment. In refractory cases, subtalar arthrodesis may be indicated.4,5,16,18,34,35. os trigonum syndrome / posterior ankle impingement (PAI) syndrome 1,2; Differential diagnosis. Jung ST, Kong IK. Efficacy of MRI versus arthroscopy for evaluation of sinus tarsi syndrome. Arthrography is invasive and relatively insensitive compared to MRI.6,11,20,21,22, Ultrasound evaluation of the sinus is feasible, although published reports are limited. 7. (Cases 6 through 10) Fibrosis with amorphous T1- and T2-hypointense material occupying part or all of the sinus is frequently seen in chronic sinus tarsi syndrome, but is relatively nonspecific.6,11,20,21,22 (Cases 11 and 12). Looks like youve clipped this slide to already. MRI provides excellent definition of sinus tarsi anatomy and good detection of findings associated with the clinical syndrome, including abnormalities in the tarsal canal. Our hip joints are one the largest and strongest in our body. J Rheumatol Suppl. Superior to the cervical ligament, 3 hypointense foci correspond to the medial, intermediate, and lateral roots of the inferior extensor retinaculum. Lateral talocalcaneal impingement secondary to posterior tibial tendinopathy. Daniel D. Buss, MD. Therefore, you should only see a doctor who has experience in ultrasound-guided injections. Alternatively, we can use needle tenotomy or PRP injections. If ineffective, then we recommend shockwave therapy or injections. Hi Jerome, I suggest physiotherapy. 4% (74/1868) L 2 A coronal fat suppressed fast spin-echo proton density-weighted image (Image 25A) reveals prominent valgus angulation of the calcaneus. Finally, repair of the gluteal tendon may be considered in cases that fail other treatments. We often call this problem greater trochanteric pain syndrome. Li SY, Hou ZD, Zhang P, Li HL, Ding ZH, Liu YJ. Evaluate the TCO of your PACS download >, 750 Old Hickory Blvd, Suite 1-260Brentwood, TN 37027, Focus on Musculoskeletal and Neurological MRI, Developmental Talocalcaneal Coalitions and Associated Conditions, Hammer, Mallet, and Claw Toe Deformities of the Lesser Toes, The roots of the inferior extensor retinaculum anchor the lateral stem of the retinaculum to the calcaneus, restricting excursion of the extensor tendons and limiting ankle inversion. These sessions should be added gradually 1-2x/week. Check for errors and try again. A clinical entity. Coronal fat suppressed fast spin-echo proton density-weighted (Image 24C) and sagittal T1-weighted (Image 24D) images through the sinus tarsi reveal severe narrowing of the sinus (arrowheads). Recent evidence suggests that exercises are better than no treatment or injections. painful os peroneum syndrome (with minimal tendon involvement) refractory to conservative treatment. extra-articular lateral hindfoot impingement syndrome (ELHIS) One large cohort study showed that radiographically demonstrable erosions were present in 30% of patients at diagnosis, and in 70% three years later 4. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. Please read this blog on psoas injections with a short reference to hip replacement. PRP is particularly effective in partial tears. Sagittal T1-weighted (Image 13A) and fat suppressed fast spin-echo T2 (Image 13B), along with axial T1-weighted (Image 13C) images demonstrate hypointense soft tissue material occupying the sinus tarsi (asterisks) on all imaging sequences, consistent with fibrosis. With orthopedic specialists in St. Louis and Kansas City, we have treated a host of orthopedic bone and joint issues that have impacted the lives of hundreds of thousands of patients, young and old, for decades. PRP injection if you fail other treatments. 1993;13(1):37-46. J. These MRI findings are consistent with posttraumatic sinus tarsi syndrome. The disease tends to affect the proximal joints in a bilaterally symmetrical distribution. One study showed that needling improved pain from trochanteric tendonitis in about 80% of people after 2-3 months, doctor who has experience in ultrasound-guided injections, ortisone injections have been shown to improve pain after six weeks. Arthroscopy. A sagittal T1-weighted image (Image 14C) demonstrates hypointense fibrosis and edema occupying much of the sinus tarsi. International Orthopaedics 1981; 5, 117130. 3. document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); This site uses Akismet to reduce spam. Download and print the most commonly requested prior authorization fax forms forprocedures, injectable drugs (office administered and home self-administered) and oral/topical drugs, choosing from the lists below.. Non-Formulary Exception and Quantity Limit Exception (PDF,129 KB), Prior Authorization/Coverage Determination Form (PDF,136 KB), Prior Authorization Generic Fax Form (PDF,201 KB), Prior Authorization Urgent Expedited Fax Form (PDF,126 KB), Office drugs prior authorization request (PDF, 301 KB), Home Self-Administered Injectable Drug authorization request (PDF, 288 KB). Galeazzi fractures . 19% (147/766) 5. Sonography can assess the soft tissue manifestations of rheumatoid arthritis. Subtalar Arthroereisis; Surgery for Athletic Pubalgia ; Surgical Deactivation of Headache Trigger Sites; Surgical Management of Morbid Obesity; Surgical Treatment of Femoroacetabular Impingement; Surgical Ventricular Restoration; Therapeutic Apheresis with Extracorporeal Column Immunoadsorption and Plasma Reinfusion The anatomy and function of the contents of the human tarsal sinus and canal. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you. Fundamentals of diagnostic radiology. The cervical spine is frequently involved in rheumatoid arthritis (in approximately 50% of patients), whereas thoracic and lumbar involvement is rare. An anteverted femur will also affect the biomechanics of the patellofemoral joint at the knee and of the subtalar joint in the foot The effect of femoral anteversion may also be seen at the knee joint 18. Other treatments we use are shockwave therapy and injections. 67 year- old female with chronic hindfoot pain. subchondral cyst formation: the destruction of cartilage presses synovial fluid into the bone, ulnar deviation of the metacarpophalangeal joints, carpal instability: scapholunate dissociation, ulnar translocation, scallop sign: erosion of the ulnar aspect of the distal radius which may be predictive of extensor tendon rupture (Vaughan-Jackson syndrome), pencil-in-cup deformity: classically psoriatic arthropathy but well-recognized in rheumatoid arthritis, similar to the hands, there is a predilection for the proximal interphalangeal and metatarsophalangeal joints (especially of the fourth and fifth toes), marginal erosions of the humeral head: the superolateral aspect is a typical location 2, reduction in the acromiohumeral distance: "high-riding shoulder" due to subacromial-subdeltoid bursitis and high incidence of rotator cuff tear, concentric loss of joint space,compared with osteoarthritis (OA) where there is a tendency for superior loss of joint space, typically involves the lateral or non-weight bearing portion of the joint, loss of joint space involving all three compartments, lack of subchondral sclerosis and osteophytes,compared with osteoarthritis. A coronal T1-weighted image (Image 4A) includes most of the cervical ligament coursing from superomedial to inferolateral, surrounded by fat signal. Is It Possible to Predict Radiological Damage in Early Rheumatoid Arthritis (RA)? Sagittal T1-weighted and fat suppressed proton density-weighted images (Images 1A and 1B), coronal T1-weighted and fat suppressed T2-weighted images (Images 1C and 1D), axial fat suppressed T2-weighted (Image 1E), and a more medial sagittal fat suppressed T2-weighted image (Image 1F) are provided. Related topics: Patellar tendonitis; Pain at front of the knee; Causes of inner knee pain; Plica knee syndrome Usually, youll first notice pain on the outside of the hip. Orthopedic Imaging. This effect lasts for up to a year. Axial (Image 19A) and sagittal (Image 19B) T1-weighted images demonstrate hypointense fibrosis (asterisks) in the sinus tarsi. Pain localized to the lateral subtalar region is often clinically felt to represent either subtalar joint degeneration or sinus tarsi syndrome. Generally, hip exercises are performed once per day. Mittlmeier T, Rammelt S. Update on Subtalar Joint Instability. Occasionally the coronal images will visualize most of the cervical or interosseous ligaments on a single slice. The cervical ligament (CL) is visible anterior to the roots of the inferior extensor retinaculum on Images 5G through 5I. It is used in a wide variety of clinical conditions, including musculoskeletal, sports medicine, neuro-rehabilitation as well as prosthetics and orthotics. Instant access to millions of ebooks, audiobooks, magazines, podcasts and more. Dixey J, Solymossy C, Young A, Young A. Akiyama K, Takakura Y, Tomita Y, Sugimoto K, Tanaka Y, Tamai S. Neurohistology of the sinus tarsi and sinus tarsi syndrome. Ultrasound also has a role in guiding corticosteroid injectionsin this setting. J Ultrasound. 2-12%. You should also limit stretching, such as a piriformis stretch. Foot Ankle Surg 2006;12:15760. Midfoot is made up of 5 bones: navicular, cuboid and 3 cuneiforms (medial, intermediate and lateral). 2016 Apr;41(4):e208-10. A bone contusion in the neck of the talus (asterisks)and osteochondral injury at the medial talar dome (arrowhead) are also visible. I received a corticosteroid injection in my left hip for bursitis. Usually, ultrasound shows trochanteric tendonitis and bursitis. Tap here to review the details. Medial portion of the posterior surface of the tibia, inferior to the soleal line.It is also connected to the fibula by a broad tendon.. Calcaneal cystic changes extend further anteriorly than the common incidental cysts and are accompanied by marrow edema. First, about 15-30 ml of whole blood is taken from a vein in the elbow. synovial joints, tendons, and bursae. Brant WE, Helms CA. You can read the details below. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and The. Other causes include a muscle or tendon tear, a fall onto the outside of your hip, or acute inflammation such as rheumatoid arthritis. Also, avoid crossing your legs if you can. Usmani S, Abu Al Huda F, Al Kandari F. Three-Phase 99mTc MDP Bone Scintigraphy and SPECT-CT in Sinus Tarsi Syndrome. The cervical ligament (CL), intermediate (I) and lateral (L) roots of the inferior extensor retinaculum are increased in signal and not well defined, consistent with sprains. A post-traumatic entity, Foot and Ankle Surgery, 1996; Volume 2, Issue 3, 181-188. Space occupying lesions in the sinus such as ganglion cyst or tumor; and inflammatory processes such as crystal deposition arthropathy, inflammatory arthritis, or PVNS have been reported to cause sinus tarsi syndrome.6,18, Because of the heterogeneity of reported causes, some authors have even questioned the use of the term sinus tarsi syndrome and advocated its replacement by more specific diagnoses such as interosseous ligament tear, arthrofibrosis, or subtalar arthritis.15 Currently, however, the terminology is still considered useful, since most patients will respond to conservative therapy and identifying a specific underlying etiology is not required for effective treatment of these patients.19, MRI is considered the best imaging modality for evaluation of the sinus tarsi and surrounding structures. Orthopedic surgery; They form the subtalar joint. Early detection of sinus tarsi lesions by imaging facilitates appropriate patient management. We've updated our privacy policy. The rare presentation of sinus tarsi syndrome secondary to metastasis in a patient with endometrial carcinoma. In another study, pain improved six weeks after one cortisone injection and lasted for at least a year. Tarsal Tunnel Syndrome Deep Peroneal Nerve Entrapment inserts on calcaneus 13mm distal to subtalar joint and deep to peroneal tendon sheaths. Foot Ankle Int. What are the findings, and what is the diagnosis? Greater trochanteric pain syndrome or trochanteric tendonitis is a common cause of hip pain. We think that the needling of a tendon causes an acute inflammation leading to the healing of trochanteric tendonitis. 3D renders illustrate the major ligamentous structures within the sinus tarsi region including the interosseous talocalcaneal ligament (ITCL), the lateral (L), intermediate (I), and medial (M) roots of the inferior extensor retinaculum, and the cervical ligament (CL). Pain is worse with lying directly on your hip, walking up and down stairs, and prolonged walking and running. Asia Ocean J Nucl Med Biol. Summary. Measurement. described a more severe variant called the canalis tarsi syndrome, which includes medial hindfoot pain in addition to the typical lateral symptoms.5, Taillard et al. Ive had three cortisone shots but nothing lasts long enough. 2009;4(1):29-37. Unable to process the form. 2020 Sep 16:S1268-7731(20)30183-1. Cahill DR. Foot Ankle Int. Subtalar Dislocations Calcaneus FX Other Trauma Topics ulnar impaction syndrome . What is the next step in management? Case 8 Subacute injury with tear of the roots of the inferior extensor retinaculum in a 17 year-old male. Just having trochanteric bursitis means you also have gluteal tendonitis. Shiraishi M, Fukuda T, Igarashi T, Tokashiki T, Kayama R, Ojiri H. Differentiating Rheumatoid and Psoriatic Arthritis of the Hand: Multimodality Imaging Characteristics. 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Combination of Serum Markers for Liver Fibrosis in the Evaluation and Monitoring of Patients with Chronic Liver Disease, Detection of Circulating Tumor Cells in the Management of Patients with Cancer, DNA-Based Testing for Adolescent Idiopathic Scoliosis, End-Tidal Carbon Monoxide Measurement (ETCOc), Epidermal Growth Factor Receptor (EGFR) Mutation Analysis for Patients with Non-Small-Cell Lung Cancer (NSCLC), Facet Joint Injections, Trigger Point Injections, and Epidural Injections of Corticosteroids and/or Local Anesthetics, Fecal Analysis in the Diagnosis of Intestinal Dysbiosis, Gamma Interferon Blood Test for Diagnosis of Latent Tuberculosis, Gene Expression Testing to Predict Coronary Artery Disease, Gene-Based Tests for Screening, Detection, and/or Management of Prostate Cancer, Genetic Cancer Susceptibility Panels Using Next Generation Sequencing, Genetic Testing for Alpha-1 Antitrypsin Deficiency, Genetic Testing for Hereditary Breast and/or Ovarian Cancer, Genetic Testing for Hereditary Hemochromatosis, Genetic Testing for Inherited Cancer Predisposition and or Pharmacogenetics related to Cancer Treatment, Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment, Genetic Testing for Mental Health Conditions, Genetic Testing for Non-Cancerous Inheritable Diseases, Genetic Testing, Including Chromosomal Microarray (CMA) Analysis and Next Generation Sequencing Panels, for the Genetic Evaluation of Patients with Developmental Delay/Intellectual Disability or Autism Spectrum Disorder, Genotyping for 9p21 Single Nucleotide Polymorphisms to Predict Risk of Cardiovascular Disease or Aneurysm, High-Density Lipoprotein Subclass Testing in the diagnosis and Management of Cardiovascular Disease, Homocysteine Testing in the Screening, Diagnosis, and Management of Cardiovascular Disease, Human Leukocyte Antigen (HLA) Testing for Celiac Disease, Immunoassay/Immunochemical Fecal Occult Blood Testing, In Vitro Chemoresistance and Chemosensitivity Assays, JAK2 and MPL Mutation Analysis in Myeloproliferative Neoplasms, KIF6 Genotyping for Predicting Cardiovascular Risk and/or Effectiveness of Statin Therapy, KRAS Mutation Analysis in Non-Small-Cell Lung Cancer (NSCLC), Laboratory and Genetic Testing for Use of 5-Flourouracil (5-FU) in Patients with Cancer, Laboratory Tests of Sperm Maturity, Function and DNA Integrity, Lipoprotein-Associated Phospholipase A2: PLAC Test, Magnetic Resonance Cholangiopancreatography (MRCP), Measurement of Long-Chain Omega-3 Fatty Acids in Red Blood Cell Membranes as a Cardiac Risk Factor, Measurement of Serum Antibodies to Infliximab, Measurement of Small Low Density Lipoprotein (LDL) Particles and Lipoprotein (a) [lp(a)] Enzyme Immunoassay in the Management of Cardiovascular Disease, Microarray-Based Gene Expression Profile Testing for Multiple Myeloma Risk Stratification, Microarray-Based Gene Expression Testing for Cancers of Unknown Primary, Molecular Markers in Fine Needle Aspirates of the Thyroid, Molecular Profiling for the Evaluation of Malignant Tumors, Pharmacogenomic and Metabolite Markers for Patients Treated with Thiopurines, Proteomics-Based Testing Related to Ovarian Cancer, Routine Human Papillomavirus (HPV) Testing, Serum Biomarker Human Epididymis Protein 4 (HE4), Serum Holotranscobalamin as a Marker of Vitamin B12 (Cobalamin) Status, Systems Pathology for Predicting Risk of Recurrence in Prostate Cancer, Urea Breath Test for Diagnosis of Helicobacter Pylori, Use of Common Genetic Variants to Predict Risk of Nonfamilial Breast Cancer, Acoustic Cardiography Correlated Audioelectric Cardiography, Aerosolized Antibiotics as a Treatment of Chronic Sinusitis, Analysis of Proteomic Patterns in Serum to Identify Cancer, Anti-CCP Testing for Rheumatoid Arthritis, Automated Ambulatory Blood Pressure Monitoring, Automated Point-of-Care Nerve Conduction Tests, Bioimpedance Devices for Detection of Lymphedema, Biomarker Genes for Detection of Lymph Node Metastases in Breast Cancer, Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting, Cardiopulmonary Exercise Stress Test (CPET/CPX), Catheter Ablation for Cardiac Arrhythmias, Cellular Immunotherapy for Prostate Cancer, Computerized 2-lead Resting Electrocardiogram Analysis for the Diagnosis of Coronary Artery Disease, COPES Scoliosis Treatment Recovery System, Diagnosis and Management of Idiopathic Environmental Intolerance (i.e., Multiple Chemical Sensitivities), Diagnosis and Treatment of Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis, Diagnosis and Treatment of Sacroiliac Joint Pain, Electrocardiographic Body Surface Mapping, Electrostimulation and Electromagnetic Therapy for the Treatment of Chronic Wounds, Enhanced External Counterpulsation (EECP), Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions, Identification of Microorganisms Using Nucleic Acid Probes, Immune Cell Function Assay in Solid Organ Transplantation, Intra-articular Hyaluronan Injections for Osteoarthritis, Intraoperative Neurophysiologic Monitoring, Intravenous Anesthetics for the Treatment of Chronic Pain, KRAS and BRAF Mutation Analysis in Metastatic Colorectal Cancer, Left-Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation, Magnetic Esophageal Ring to Treat Gastroesophageal Reflux Disease (GERD), Management of Obstructive Sleep Apnea Syndrome, Measurement of Exhaled Nitric Oxide and Exhaled Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders, Mobile Cardiac Outpatient Telemetry and Hybrid Devices, Monitoring of Regional Cerebral Blood Flow Using an Implanted Cerebral Thermal Perfusion Probe, Navigated Transcranial Magnetic Stimulation (nTMS), Neuromuscular and Electrodiagnostic Testing (EDX): Nerve Conduction Studies (NCS) and Electromyography (EMG) Studies, Non-Contact Ultrasound Treatment for Wounds, Non-Oncologic Uses of Rituximab (Rituxan), Nutritional Treatment of Childhood Medical Conditions, Ophthalmologic Techniques for Evaluating Glaucoma, Optical Diagnostic Devices for Evaluating Skin Lesions Suspected of Malignancy, Oral Lesion Identification System (ViziLite, Velscope), Orthopedic Applications of Stem Cell Therapy, Paraspinal Surface Electromyography (SEMG) to Evaluate and Monitor Back Pain, Peripheral Subcutaneous Field Stimulation, Photodynamic Therapy for Dermatological Applications, Photodynamic Therapy, Ocular: Visudyne (Verteporfin), Placental/Umbilical Cord Blood as a Source of Stem Cells, Quantitative Assay for Measurement of HER2 Total Protein Expression and HER2 Dimers, Retinal Telescreening for Diabetic Retinopathy, Serum Antibodies for the Diagnosis of Inflammatory Bowel Disease, Serum Tumor Markers for Breast and Gastrointestinal Malignancies, Transanal Radiofrequency Treatment of Fecal Incontinence, Transcatheter Ablation of Arrhythmogenic Foci as a Treatment of Atrial Fibrillation, Transcatheter Closure Devices for Patent Foramen Ovale (PFO) Defects, Transcatheter Closure Devices for Septal Defects, Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric Disorders, Transvaginal and Transurethral Radiofrequency Tissue Remodeling for Urinary Stress Incontinence, Ultrafiltration in Decompensated Heart Failure, Ultrasonographic Measurement of Carotid Intimal-Medial Thickness as an Assessment of Subclinical Atherosclerosis, Urodynamic Testing to Evaluate Urinary Incontinence, Uses of Monoclonal Antibodies for the Treatment of Non-Hodgkin Lymphoma, including Chronic Lymphocytic Leukemia, and Acute Myeloid Leukemia in the Non-Hematopoietic Stem-Cell Transplant Setting, Opioid Antagonists Under Heavy Sedation or General Anesthesia as a Technique of Opioid Detoxification, First-Trimester Detection of Down Syndrome Using Fetal Ultrasound Assessment of Nuchal Translucency Combined with Maternal Serum Assessment, Injectable Progesterone Therapy as a Technique to Reduce Preterm Birth in High-Risk Pregnancies, Levonorgestrel-releasing Intrauterine System (LNG-IUS) (Mirena), Noninvasive Prenatal Testing for Trisomy 21 Using Cell Free Fetal DNA, Surgical Interruption of Pelvic Nerve Pathways for Primary and Secondary Dysmenorrhea, Bispectral Index Monitoring During General Anesthesia, Conjunctival Incision with Posterior Juxtascleral Placement of Anecortave Acetate Depot Suspension, Intraoperative Transesophageal Echocardiography, Nutritional Supplements for Phenylketonuria (PKU), Recombinant and Autologous Platelet-Derived Growth Factors as a Treatment of Wound Healing and Other Conditions, Suprachoroidal Delivery of Pharmacological Agents, Transciliary Fistulization for the Treatment of Glaucoma, Use of Anesthesia Services for Routine Gastrointestinal Endoscopy, Xiaflex (collagenase clostridium histolyticum) for Fibroproliferative Disorders, Ado-Trastuzumab Emtansine (Trastuzumab-DM1) for Treatment of HER-2 Positive Malignancies, Growth Hormone and Insulin-Like Growth Factor-1 (IGF-1) Analogues, Immune Prophylaxis for Respiratory Syncytial Virus: Synagis (Palivizumab), Intravenous Antibiotic Therapy and Associated Diagnostic Testing for Lyme Disease, Tysabri (natalizumab) for the Treatment of Multiple Sclerosis, Beta Amyloid Imaging with Positron Emission Tomography (PET) for Alzheimers disease, Cardiac Computed Tomography (CCT), Cardiac Computed Tomography Angiography (CCTA), Charged-Particle (Proton or Helium Ion) Radiation Therapy, Chromoendoscopy as an Adjunct to Colonoscopy, Computed Tomography and Computed Tomographic Angiography of Extremity or Joint, Computed Tomography and Computed Tomographic Angiography of the Abdomen and Pelvis, Computed Tomography and Computed Tomographic Angiography of the Chest and Thorax, Computed Tomography and Computed Tomographic Angiography of the Head and Neck, Computed Tomography of Cervical, Thoracic, and Lumbar Spine, Computed Tomography to Detect Coronary Artery Calcification, Computer-aided Detection (CAD) Mammography, Dopamine Transporter Imaging with Single Photon Emission Computed Tomography (DAT-SPECT), Electromagnetic Navigational Bronchoscopy, Functional Magnetic Resonance Imaging (MRI), High-Dose Rate Temporary Prostate Brachytherapy, Intensity-Modulated Radiation Therapy (IMRT), Intracavitary Balloon Catheter Brain Brachytherapy for Malignant Gliomas or Metastasis to the Brain, Intraocular Radiation Therapy for Age-Related Macular Degeneration, Locoregional Therapies for Hepatocellular Carcinoma and Metastatic Liver Carcinoma and Metastatic Carcinoid Tumors of the Liver, Lung Cancer Screening Using Computed Tomography (CT) or Chest Radiographs, Magnetic Resonance Angiography (MRA) of the Chest (excluding the heart), Magnetic Resonance Angiography of Vessels of the Head, Neck, Abdomen, Pelvis, Spinal Canal, and Upper and Lower Extremity, Magnetic Resonance Imaging (MRI) of Neck, Face, Orbit, Magnetic Resonance Imaging (MRI) of the Abdomen and Pelvis, Magnetic Resonance Imaging (MRI) of the Brain, Magnetic Resonance Imaging (MRI) of the Breast, Magnetic Resonance Imaging (MRI) of the Cervical, Thoracic, and Lumbar Spine, Magnetic Resonance Imaging (MRI) of the Chest, Magnetic Resonance Imaging (MRI) of the Extremities and Extremity Joints, Magnetic Resonance Imaging (MRI) of the Heart, Magnetic Resonance Imaging (MRI) of the Temporomandibular Joint (TMJ), Magnetic Resonance Imaging for Bone Marrow Blood Supply, Magnetoencephalography/Magnetic Source Imaging, Myocardial Sympathetic Innervation Imaging in Patients with Heart Failure, Oncologic Applications of Photodynamic Therapy, Including Barretts Esophagitis, Optical Coherence Tomography (OCT) for Imaging of Coronary Arteries, Percutaneous Vertebroplasty, Kyphoplasty, Mechanical Vertebral Augmentation and Sacroplasty, Positron Emission Tomography (PET)-Cardiac Applications, Positron Emission Tomography (PET)-Miscellaneous Applications, Positron Emission Tomography (PET)-Oncologic Applications, Radioimmunoscintigraphy Imaging with Indium-111 Capromab Pendetide (ProstaScint) for Prostate Cancer, Real-Time Intra-Fraction Motion Management During Radiation Therapy, Scintimammography and Gamma Imaging of the Breast and Axilla, Standing Magnetic Resonance Imaging (MRI) (Vertical or Positional MRI), Three-D (3-D) Reconstruction for Computed Tomography, Magnetic Resonance Imaging, Ultrasound, or Other Tomographic Modalities, Ultrasonographic Evaluation of Skin Lesions, Vertebral Fracture Assessment with Dual X-Ray Absorptiometry (DEXA), Whole Body Dual X-Ray Absorptiometry (DEXA) to Determine Body Composition, Wireless Capsule Endoscopy (Given Video Capsule), Adjustable Gastric Banding for Morbid Obesity, Allogeneic Hematopoietic Stem-Cell Transplantation for Genetic Diseases and Acquired Anemias, Allogeneic Stem-Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms, Arthroscopic Debridement and Lavage as Treatment for Osteoarthritis of the Knee, Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions, Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions, Autologous Fat Grafting to the Breast and Adipose-derived Stem Cells, Autologous Hematopoietic Stem-Cell Transplantation for Malignant Astrocytomas and Gliomas, Automated Percutaneous and Endoscopic Discectomy, Balloon Ostial Dilation for Treatment of Chronic Sinusitis, Bi-Ventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure, Blepharoplasty, Brow Lift and Ptosis Repair, Composite Tissue Allotransplantation (CTA) of the Hand and Face, Computer-Assisted Endoscopic Sinus Surgery, Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure, Cranial Electrotherapy Stimulation (CES) and Auricular Electrostimulation, Cryosurgical Ablation of Miscellaneous Solid Tumors Other than Liver, Prostate, or Dermatologic Tumors, Decompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty), Donor Lymphocyte Infusion for Malignancies Treated with an Allogeneic Hematopoietic Stem-Cell Transplant, Endoscopic Radiofrequency Ablation or Cryoablation for Barretts Esophagus, Endovascular Procedures (Angioplasty and/or Stenting) for Intracranial Arterial Disease (Atherosclerosis and Aneurysms), Extracorporeal Shock Wave Lithotripsy (ESWL) for Pancreatic Stones, Extracorporeal Shock Wave Lithotripsy of Renal Stones, Extracranial Carotid Angioplasty/Stenting, Eyelid Thermal Pulsation for the Treatment of Dry Eye Syndrome, Fetal Surgery for Prenatally Diagnosed Malformations, Handheld Radiofrequency Spectroscopy for Intraoperative Assessment of Surgical Margins During Breast-Conserving Surgery, Hematopoietic Stem Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma, Hematopoietic Stem-Cell Transplantation for Acute Lymphoblastic Leukemia, Hematopoietic Stem-Cell Transplantation for Autoimmune Diseases, Hematopoietic Stem-Cell Transplantation for Breast Cancer, Hematopoietic Stem-Cell Transplantation for Chronic Myelogenous Leukemia, Hematopoietic Stem-Cell Transplantation for CNS Embryonal Tumors and Ependymoma, Hematopoietic Stem-Cell Transplantation for Epithelial Ovarian Cancer, Hematopoietic Stem-Cell Transplantation for Hodgkin Lymphoma, Hematopoietic Stem-Cell Transplantation for Miscellaneous Solid Tumors in Adults, Hematopoietic Stem-Cell Transplantation for Primary Amyloidosis, Hematopoietic Stem-Cell Transplantation for Solid Tumors of Childhood, Hematopoietic Stem-Cell Transplantation for Waldenstrom Macroglobulinemia, Hematopoietic Stem-Cell Transplantation in the Treatment of Germ-Cell Tumors, Image-Guided Minimally Invasive Lumbar Decompression for Spinal Stenosis, Implantable Bone Conduction and Bone-Anchored Hearing Aids (BAHA), Implantable Sinus Spacers and Stents for Postoperative Use Following Endoscopic Sinus Surgery, Injectable Bulking Agents for the Treatment of Urinary and Fecal Incontinence, Interspinous and Interlaminar Stabilization/Distraction Devices (Spacers), Intrastromal Corneal Ring Segments, ICRS, INTACS, Intratympanic Dexamethasone for the Treatment of Menieres Disease and-or Sudden Hearing Loss, Isolated Limb Perfusion/Infusion for Malignant Melanoma, Joint Manipulation under Anesthesia (Excluding Spine), Laparoscopic and Percutaneous Techniques for the Myolysis of Uterine Fibroids, Lung Volume Reduction Surgery for Severe Emphysema, Management of Excessive Skin and Subcutaneous Tissue, Meniscal Allografts and Collagen Meniscus Implants, Minimally Invasive Lumbar Interbody Fusion, Natural Orifice Transluminal Endoscopic Surgery (NOTES), Nerve Graft in Association with Radical Prostatectomy, Occlusion of Uterine Arteries Using Transcatheter Embolization or Laparoscopic Occlusion to Treat Uterine Fibroids, Ocriplasmin for Symptomatic Vitreomacular Adhesion, Ocular Photoscreening in the Primary Care Physician?s Office as a Screening Tool to Detect Amblyogenic Factors, Ovarian and Internal Iliac Vein Embolization as Treatment of Pelvic Congestion Syndrome, Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PTN), Percutaneous Intradiscal Electrothermal Annuloplasty (IDET) and Percutaneous Intradiscal Radiofrequency Thermocoagulation, Periureteral Bulking Agents as a Treatment of Vesicoureteral Reflux, Peroral Endoscopic Myotomy (POEM) for Treatment of Esophageal Achalasia, Posterior Tibial Nerve Stimulation for Voiding and Sexual Dysfunction, Progenitor Cell Therapy for the Treatment of Damaged Myocardium due to Ischemia, Pulsed Dye Laser Treatment of Recalcitrant Verrucae, Radiofrequency Ablation of Solid Tumors Excluding Liver Tumors, Radiofrequency Ablation of the Renal Sympathetic Nerves as a Treatment for Resistant Hypertension, Sacral Nerve Modulation/Stimulation for Pelvic Floor Dysfunction, Saturation Biopsy for Diagnosis and Staging of Prostate Cancer, Semi-Implantable/Implantable Middle Ear Hearing Aid for Moderate to Severe Sensorineural Hearing Loss, Single or Tandem Courses of Hematopoietic Stem-Cell Transplantation for Multiple Myeloma, Small Bowel/Liver and Multivisceral Transplant, Stem Cell Therapy for Peripheral Arterial Disease, Stimulation of the Sacral Anterior Root Combined with Posterior Sacral Rhizotomy in Patients with Spinal Cord Injury, Surgical Deactivation of Headache Trigger Sites, Surgical Treatment of Femoroacetabular Impingement, Therapeutic Apheresis with Extracorporeal Column Immunoadsorption and Plasma Reinfusion, Thermal Capsulorrhaphy as a Treatment of Joint Instability, Transcatheter Aortic-Valve Implantation for Aortic Stenosis, Transcatheter Closure of Patent Ductus Arteriosus, Transcatheter Pulmonary Valve Implantation, Transcoronary Ablation of Septal Hypertrophy (TASH), Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease-GERD, Treatment of Cervicogenic Headache and Occipital Neuralgia, Treatment of Twin-Twin Transfusion Syndrome with Amnioreduction and/or Fetoscopic Laser Therapy, Unicondylar Interpositional Spacer as a Treatment of Unicompartmental Arthritis of the Knee, Ventricular Assist Devices and Total Artificial Hearts, Vertical Expandable Prosthetic Titanium Rib, Videofluoroscopic/Cineradiography Evaluation of Velopharyngeal Dysfunction, Wireless Pressure Sensors in Endovascular Aneurysm Repair, Brachytherapy for Clinically Localized Prostate Cancer Using Permanently Implanted Seeds, Constraint Induced Movement or Language Therapy, Hematopoietic Stem-Cell Transplantation for Acute Myeloid Leukemia, Hematopoietic Stem-Cell Transplantation for Non-Hodgkin Lymphomas, Inpatient Intestinal Rehabilitation Therapy, Low Level Laser and High Power Laser Therapies, Manipulation under Anesthesia for Treatment of Chronic Spinal or Pelvic Pain, Sensory Integration Therapy, Auditory Integration Therapy and Facilitated Communication, Spinal Manipulation of Non-Neuromusculoskeletal Conditions, Sympathetic Therapy and Bioelectrical Nerve Block or Electroanalgesic Nerve Block for the Treatment of Pain. 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