Current RMA Instruments
| Reasonable Hypothesis SOP | 57 of 2019 |
| Balance of Probabilities SOP | 58 of 2019 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 718.3, 718.8, 728.4
- ICD-10-AM Codes: M22.0, M22.1, M24.2, M24.4, M25.3, M43.3, M43.4, M43.5
Brief description
This SOP covers on-going joint problems, that may be chronic or intermittent, where damage to the joint has resulted in instability that manifests as recurrent dislocation, subluxation, or sprain. One-off episodes of dislocation or acute sprain are covered by the respective SOPs for those conditions. A diagnosis of joint instability may subsume an earlier diagnosis of dislocation or acute sprain.
Confirming the diagnosis
Diagnosis is based on a history of joint instability as evidenced by repeated dislocations, subluxation or sprain, along with clinical findings on examination of joint instability or laxity. The diagnosis can be made by a general practitioner.
The relevant medical specialist is an orthopaedic surgeon.
Additional diagnoses that are covered by this SOP
- Recurrent dislocation of a joint
- Recurrent subluxation of a joint
- Recurrent dislocation or subluxation of an artificial joint
- Recurrent sprain of a joint
Conditions that are not covered by this SOP
- Congenital dislocation#
- Initial episode of dislocation* - dislocation SOP
- Initial episode of acute sprain* - sprain and strain SOP
- Internal derangement of the knee*
- Fracture*
- Looseness of a component of an artifical joint#
- Spondylolisthesis*
* another SOP applies
# non-SOP condition
Clinical onset
Clinical onset may date from the intital episode of injury/dislocation or from a subsequent episode. This will depend on the nature of each episode, the time between episodes and other circumstances of the particular case.
Clinical worsening
Clinical worsening will generally be the result of some further event or injury and may be evidenced by increased frequency of episodes or ease of dislocation/subluxation. The condition may be amenable to surgery.