SOP Bulletin No. 144

Decision Support Unit

Intranet site: http://sharepoint/servingourcustomers/compensation/dsu

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28 June 2010

THE FOLLOWING RMA SOPS ARE TO TAKE EFFECT ON 30 JUNE, 2010

New SOPs	Acute articular cartilage tear Acute meniscal tear of the knee Dupuytren's disease
Revocations & Replacements	Methaemoglobinaemia Sinus barotrauma Internal derangement of the knee
Amendments	Fibrosing interstitial lung disease Vascular dementia

NOTEWORTHY FEATURES

Acute articular cartilage tear#

New  – 53 & 54 of '10

Acute meniscal tear of the knee#

New  – 55 & 56 of '10

• These two new SOPs have come out of a general review by the RMA of SOPs for injury to joints.  A package of other SOPs are part of this review including: internal derangement of the knee (see below);  joint instability (a new SOP issued in May '10); dislocation (reissued in May '10); acute sprains and acute strains;  chondromalacia patella (both currently under review); and acute labrum tear (current non-SOP investigation).
• The two conditions covered by these new SOPs were (in 2009) the two most common non-SOP MRCA claims.
• Cartilage tears will commonly involve the knee, but the SOP covers tears in any joint.
• Both SOPs have a single onset factor – having a significant physical force to/through the affected joint.
• For joint injuries there are three types of SOPs available.

1.Those that cover the initial injury e.g. these two SOPs and the acute sprain and acute strain SOP.

2.For joint injuries that don't fully resolve and go on to cause ongoing or recurrent problems over a longer time frame there are SOPs such as internal derangement of the knee (IDK) and joint instability plus other SOPs for conditions that may be trauma related e.g. rotator cuff syndrome, chondromalacia patella (CMP) and adhesive capsulitis.

3.Injuries that progress to degenerative joint disease are covered by the SOPs for osteoarthritis (OA) and spondylosis.

• The OA SOP has factors for IDK and CMP.  The new IDK SOP in turn has factors for acute sprain and acute meniscal tear.  So where appropriate there are pathways from one SOP to the next for a joint injury that progresses over time from the acute phase through to chronic degenerative change.

Dupuytren's disease#

New  – 57 & 58 of '10

• Dupuytren's disease (or contracture) is a thickening of the fascia in the palm of the hand that can lead to fixed flexion of the fingers and can require surgery.
• Dupuytren's disease can be unilateral or bilateral.  The SOP has onset and worsening factors for local trauma and local infection.  In some circumstances it may be appropriate to diagnose and determine Du — p — uytren's in each hand separately, but in other circumstances a diagnosis of bilateral Dupuytren's will be appropriate.
• There are other onset and worsening factors for smoking, alcohol, alcoholic liver disease, manual labour and diabetes.

Methaemaglobinaemia

Revocation – 47 & 48 of '10 Replaces 284 and 285 of '95

• This is a little used SOP that has been updated as part of the RMA's ongoing review and replacement of old SOPs.
• The condition results in a decrease in the oxygen available to tissues.  It is usually a short term problem, amenable to treatment, but it can be fatal in severe cases.
• The definition now excludes the congenital form and requires clinical manifestations to be present.
• The factors now cover more circumstances of exposure to relevant chemicals or drugs.

Sinus barotrauma

Revocation – 49 & 50 of ''0 Replaces 316 and 317 of '95

• This SOP has also been updated as part of the RMA's ongoing review and replacement of old SOPs.
• A new factor has been added for receiving mechanical ventilation involving a face mask.

Internal derangement of the knee

Revocation – 51 & 52 of '10 Replaces 59 and 60 of '97 as amended by 96 of '97

• The definition has been reworded slightly and now more explicitly excludes degenerative tears of the menisci.  Degenerative meniscal tears are part of osteoarthritis of the knee if they occur in that setting.  If a meniscal tear is an isolated, incidental finding, it may be of no clinical significance.
•                  The factors have been changed from:

"suffering a direct trauma or twisting or wrenching inj — ury" before onset or worsening,

to:

"having an acute sprain” or “having an acute meniscal tear".

These factors propagate to the corresponding existing SOP for “acute sprain and acute strain” and the new SOP for “acute meniscal tear of the k — nee”.

• There may be some overlap in coverage between the IDK SOP and the recently issued SOP for joint instability.  IDK will be the more appropriate diagnosis in most such cases.

Fibrosing interstitial lung disease

Amendment – 59 & 60 of '10 Amends 35 and 36 of '09

• In the RH SOP new onset and worsening factors for smoking (20 pk-yrs) have been added.
• In the BOP SOP the change is to the worsening factor for paraquat poisoning.  The time frame in that factor (within 3 months) is now the same as in the corresponding onset factor.

Vascular dementia

Amendment – 61 & 62 of '10 Amends 21 and 22 of '06 as amended by 63 and 64 of '06

• The amendment is to the disease definition.  The SOP coverage is unchanged, but t — he format of the definition is now similar to the one in the recently issue — d Alzheimer-type dementia SOP.

* Arthroscopic view of meni — s — cal tear.

#  Any claims held up by the non-SOP investigations into acute articular cartilage tear, acute meniscal tear or Dupuytren's contracture can now be processed.