ICD-10: M87.134

Osteonecrosis due to drugs of right ulna

Additional Information

Clinical Information

Osteonecrosis, particularly when associated with drug use, is a significant clinical condition that can lead to severe complications if not diagnosed and managed appropriately. The ICD-10 code M87.134 specifically refers to osteonecrosis of the right ulna due to drugs. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this condition.

Clinical Presentation

Definition and Pathophysiology

Osteonecrosis, also known as avascular necrosis, occurs when blood supply to a bone is disrupted, leading to bone cell death. In the case of M87.134, the osteonecrosis is specifically attributed to the use of certain medications, which can impair blood flow or directly affect bone metabolism. Common drugs associated with this condition include corticosteroids and bisphosphonates, among others[1][2].

Common Patient Characteristics

Patients who develop osteonecrosis due to drug use often share certain characteristics:
- Age: Typically affects adults, particularly those aged 30-60 years.
- Gender: More prevalent in males than females.
- Medical History: Often associated with chronic conditions such as rheumatoid arthritis, lupus, or other autoimmune diseases, which may require long-term medication use[3].
- Medication Use: History of corticosteroid therapy, chemotherapy, or other drugs known to affect bone health[4].

Signs and Symptoms

Initial Symptoms

  • Pain: The most common initial symptom is localized pain in the affected area, which in this case is the right ulna. The pain may be dull or throbbing and can worsen with activity or pressure on the bone.
  • Swelling: Patients may experience swelling around the ulna, which can be accompanied by tenderness upon palpation[5].

Progression of Symptoms

As the condition progresses, symptoms may evolve:
- Decreased Range of Motion: Patients may notice a reduced ability to move the arm or wrist, particularly in activities that require rotation or lifting.
- Joint Stiffness: Stiffness in the elbow or wrist joints may develop, making it difficult to perform daily tasks.
- Crepitus: A sensation of grinding or popping may be felt during movement of the affected joint, indicating joint involvement[6].

Advanced Symptoms

In advanced cases, the following may occur:
- Pathological Fractures: Weakened bone structure can lead to fractures with minimal trauma.
- Joint Deformity: Chronic osteonecrosis can result in joint deformities due to bone collapse or changes in joint architecture[7].

Diagnosis and Management

Diagnostic Imaging

  • X-rays: Initial imaging may show changes in bone density or structure.
  • MRI: Magnetic resonance imaging is the gold standard for diagnosing osteonecrosis, as it can detect early changes in bone marrow and identify the extent of necrosis[8].

Treatment Options

Management of osteonecrosis due to drugs typically involves:
- Medication Review: Assessing and potentially modifying the use of drugs contributing to the condition.
- Pain Management: Use of analgesics and anti-inflammatory medications to manage pain.
- Surgical Interventions: In severe cases, procedures such as core decompression or joint replacement may be necessary[9].

Conclusion

Osteonecrosis of the right ulna due to drugs, classified under ICD-10 code M87.134, presents with specific clinical features that require careful evaluation and management. Understanding the signs, symptoms, and patient characteristics associated with this condition is crucial for timely diagnosis and effective treatment. If you suspect osteonecrosis in a patient, a thorough medical history, including medication use, and appropriate imaging studies are essential steps in the management process.


References

  1. ICD-10 International statistical classification of diseases and ...
  2. Benefits and Harms of Bisphosphonates
  3. Diseases of the Musculoskeletal System and Connective ...
  4. Reference to Changes for ICD-10-AM/ACHI/ACS
  5. ICD-10 Coordination and Maintenance Committee Meeting
  6. Guidebook on Guidebook on
  7. ICD-10 Emergency Codes 10/1/2023 - DC Medicaid
  8. ICD-10-AM:ACHI:ACS Seventh Edition ...
  9. Trigger Codes

Approximate Synonyms

ICD-10 code M87.134 specifically refers to "Osteonecrosis due to drugs of the right ulna." This condition is characterized by the death of bone tissue due to a lack of blood supply, which in this case is induced by pharmacological agents. Understanding alternative names and related terms can help in better communication and documentation in medical settings.

Alternative Names for Osteonecrosis

  1. Avascular Necrosis (AVN): This is a broader term that encompasses osteonecrosis, indicating the death of bone tissue due to insufficient blood flow, regardless of the cause.

  2. Bone Infarction: This term describes the process where bone tissue dies due to a lack of blood supply, similar to how a heart attack occurs in heart tissue.

  3. Ischemic Bone Necrosis: This term emphasizes the role of ischemia (reduced blood flow) in the necrosis of bone tissue.

  4. Drug-Induced Osteonecrosis: This term highlights the specific cause of the condition, which is the use of certain medications.

  1. Osteonecrosis of the Ulna: A more general term that refers to osteonecrosis affecting the ulna bone, without specifying the cause.

  2. Medication-Induced Osteonecrosis: This term can be used interchangeably with drug-induced osteonecrosis, focusing on the pharmacological aspect.

  3. Corticosteroid-Induced Osteonecrosis: Since corticosteroids are a common cause of drug-induced osteonecrosis, this term is often used in clinical discussions.

  4. Non-Traumatic Osteonecrosis: This term is used to differentiate osteonecrosis caused by factors other than trauma, including drug use.

  5. Chronic Osteonecrosis: This term may be used to describe long-standing cases of osteonecrosis, which can occur due to prolonged drug exposure.

Conclusion

Understanding the alternative names and related terms for ICD-10 code M87.134 is essential for healthcare professionals involved in diagnosis, treatment, and documentation. These terms not only facilitate clearer communication but also enhance the understanding of the condition's etiology and implications for patient care. If you need further information on treatment options or management strategies for osteonecrosis, feel free to ask!

Diagnostic Criteria

Osteonecrosis, particularly when associated with drug use, is a serious condition that can lead to significant morbidity. The ICD-10 code M87.134 specifically refers to osteonecrosis of the right ulna due to drugs. Understanding the diagnostic criteria for this condition is essential for accurate coding and treatment.

Diagnostic Criteria for Osteonecrosis (ICD-10 Code M87.134)

1. Clinical History

  • Medication Use: A detailed history of the patient's medication use is crucial. Certain drugs, particularly corticosteroids and bisphosphonates, are known to increase the risk of osteonecrosis. Documentation of the specific drugs, dosages, and duration of use is necessary.
  • Symptoms: Patients typically present with symptoms such as pain in the affected area (in this case, the right ulna), which may be exacerbated by weight-bearing activities. The onset of pain can be gradual or sudden.

2. Physical Examination

  • Tenderness and Swelling: Physical examination may reveal tenderness over the ulna, swelling, or decreased range of motion. The clinician should assess for any signs of joint dysfunction or instability.
  • Neurological Assessment: Evaluating for any neurological deficits is important, as osteonecrosis can sometimes lead to complications affecting nerve function.

3. Imaging Studies

  • X-rays: Initial imaging often includes X-rays, which may show changes in bone density or the presence of subchondral lucency. However, early stages of osteonecrosis may not be visible on X-rays.
  • MRI: Magnetic Resonance Imaging (MRI) is the gold standard for diagnosing osteonecrosis. It can detect early changes in the bone marrow and identify the extent of necrosis. MRI findings typically include a "double-line sign" indicating the presence of necrotic bone.
  • CT Scans: In some cases, a CT scan may be used to provide a more detailed view of the bone structure and any associated changes.

4. Differential Diagnosis

  • It is essential to rule out other conditions that may mimic osteonecrosis, such as fractures, infections, or tumors. A thorough evaluation and possibly additional imaging or laboratory tests may be required to exclude these conditions.

5. Histological Examination

  • In certain cases, a biopsy may be performed to confirm the diagnosis, especially if the imaging findings are inconclusive. Histological examination can reveal necrotic bone and marrow changes consistent with osteonecrosis.

6. Documentation and Coding

  • Accurate documentation of all findings, including the patient's history, clinical examination, imaging results, and any treatments provided, is essential for proper coding under ICD-10. The specific code M87.134 should be used to indicate osteonecrosis of the right ulna due to drug use.

Conclusion

Diagnosing osteonecrosis due to drugs, particularly in the right ulna, involves a comprehensive approach that includes a detailed clinical history, physical examination, imaging studies, and possibly histological evaluation. Proper documentation is critical for accurate coding and effective management of the condition. If you have further questions or need additional information on this topic, feel free to ask!

Treatment Guidelines

Osteonecrosis, particularly when associated with drug use, is a serious condition that can lead to significant morbidity. The ICD-10 code M87.134 specifically refers to osteonecrosis of the right ulna due to drugs. Understanding the standard treatment approaches for this condition is crucial for effective management.

Overview of Osteonecrosis

Osteonecrosis, also known as avascular necrosis, occurs when blood flow to a bone is disrupted, leading to bone death. In the case of M87.134, the condition is specifically attributed to the use of certain medications, which can include corticosteroids, bisphosphonates, and other drugs that may compromise blood supply to the bone[1][2].

Standard Treatment Approaches

1. Medication Management

  • Pain Relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to manage pain associated with osteonecrosis. In some cases, stronger analgesics may be necessary.
  • Bisphosphonates: These medications are sometimes used to help reduce bone pain and prevent further bone loss, although their effectiveness in osteonecrosis specifically is still under investigation[3].
  • Anticoagulants: If the osteonecrosis is related to clotting disorders, anticoagulant therapy may be indicated to improve blood flow to the affected area[4].

2. Physical Therapy

  • Rehabilitation: Physical therapy can help maintain joint function and improve mobility. A tailored exercise program may be developed to strengthen surrounding muscles and support the affected limb[5].
  • Assistive Devices: The use of crutches or braces may be recommended to reduce weight-bearing on the affected ulna, thereby alleviating pain and preventing further damage[6].

3. Surgical Interventions

  • Core Decompression: This procedure involves removing a portion of the inner bone to reduce pressure and improve blood flow to the area. It is often considered in early stages of osteonecrosis[7].
  • Bone Grafting: In cases where there is significant bone loss, a bone graft may be performed to replace the necrotic bone with healthy bone tissue, promoting healing and stability[8].
  • Joint Replacement: In advanced cases where the joint is severely damaged, total joint replacement may be necessary to restore function and relieve pain[9].

4. Lifestyle Modifications

  • Avoiding Risk Factors: Patients are advised to avoid alcohol and smoking, as these can exacerbate bone health issues. Additionally, managing underlying conditions such as diabetes or hyperlipidemia is crucial[10].
  • Nutritional Support: A diet rich in calcium and vitamin D can support bone health. Supplements may be recommended based on individual needs[11].

Conclusion

The management of osteonecrosis due to drugs, particularly in the case of the right ulna (ICD-10 code M87.134), involves a multifaceted approach that includes medication, physical therapy, surgical options, and lifestyle modifications. Early diagnosis and intervention are key to improving outcomes and preventing further complications. Patients should work closely with their healthcare providers to develop a personalized treatment plan that addresses their specific needs and circumstances.

For ongoing management, regular follow-ups and imaging studies may be necessary to monitor the condition and adjust treatment as needed.

Description

Osteonecrosis, also known as avascular necrosis, is a condition characterized by the death of bone tissue due to a lack of blood supply. The ICD-10 code M87.134 specifically refers to osteonecrosis of the right ulna that is attributed to drug use. Below is a detailed clinical description and relevant information regarding this condition.

Clinical Description of Osteonecrosis

Definition and Pathophysiology

Osteonecrosis occurs when blood flow to a bone is disrupted, leading to the death of bone cells. This can result from various factors, including trauma, certain medical conditions, and the use of specific medications. In the case of M87.134, the osteonecrosis is induced by drugs, which can include corticosteroids, alcohol, and other medications that affect blood supply or bone metabolism.

Symptoms

Patients with osteonecrosis of the ulna may experience:
- Pain: Often the first symptom, which may start as mild and progressively worsen. Pain can be localized to the ulna or may radiate to nearby areas.
- Swelling: Inflammation around the affected area may occur.
- Limited Range of Motion: As the condition progresses, patients may find it difficult to move the wrist or elbow due to pain and stiffness.
- Joint Dysfunction: In advanced cases, the integrity of the joint may be compromised, leading to further complications.

Diagnosis

Diagnosis of osteonecrosis typically involves:
- Medical History: A thorough review of the patient's history, including medication use, previous injuries, and underlying health conditions.
- Imaging Studies: X-rays, MRI, or CT scans are used to visualize the extent of bone damage and to confirm the diagnosis. MRI is particularly useful in detecting early changes in bone marrow associated with osteonecrosis.

Causes and Risk Factors

The primary cause of M87.134 is the use of drugs that can lead to osteonecrosis. Common risk factors include:
- Corticosteroid Use: Long-term use of corticosteroids is one of the most significant risk factors for developing osteonecrosis.
- Alcohol Consumption: Excessive alcohol intake can interfere with blood supply to bones.
- Medical Conditions: Conditions such as lupus, sickle cell disease, and certain metabolic disorders can increase the risk.
- Trauma: Previous fractures or injuries to the ulna may predispose individuals to osteonecrosis.

Treatment Options

Management of osteonecrosis due to drugs involves several strategies:
- Medication Adjustment: If possible, discontinuing or changing the offending medication can halt the progression of the disease.
- Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to alleviate pain and inflammation.
- Physical Therapy: Rehabilitation exercises can help maintain joint function and mobility.
- Surgical Interventions: In severe cases, procedures such as core decompression, bone grafting, or joint replacement may be necessary to restore function and relieve pain.

Conclusion

ICD-10 code M87.134 identifies osteonecrosis of the right ulna due to drug use, highlighting the importance of recognizing the condition's clinical features, causes, and treatment options. Early diagnosis and intervention are crucial to prevent further joint damage and improve patient outcomes. If you suspect osteonecrosis, it is essential to consult a healthcare professional for a comprehensive evaluation and tailored treatment plan.

Related Information

Clinical Information

  • Osteonecrosis occurs when blood supply to bone is disrupted
  • Affects adults aged 30-60 years, more prevalent in males
  • Associated with chronic conditions and long-term medication use
  • Common drugs implicated include corticosteroids and bisphosphonates
  • Initial symptoms include localized pain and swelling around ulna
  • Pain worsens with activity or pressure on bone
  • Decreased range of motion, joint stiffness, and crepitus occur in advanced cases

Approximate Synonyms

  • Avascular Necrosis (AVN)
  • Bone Infarction
  • Ischemic Bone Necrosis
  • Drug-Induced Osteonecrosis
  • Osteonecrosis of the Ulna
  • Medication-Induced Osteonecrosis
  • Corticosteroid-Induced Osteonecrosis
  • Non-Traumatic Osteonecrosis
  • Chronic Osteonecrosis

Diagnostic Criteria

  • Detailed history of medication use
  • Documentation of specific drugs used
  • Pain in affected area (ulna)
  • Tenderness and swelling over ulna
  • Decreased range of motion
  • X-rays show changes in bone density
  • MRI detects early bone marrow changes
  • Double-line sign on MRI indicates necrosis
  • CT scans for detailed bone structure
  • Biopsy to confirm diagnosis (if needed)
  • Accurate documentation and coding

Treatment Guidelines

  • Pain relief with NSAIDs
  • Bisphosphonates for pain reduction
  • Anticoagulants for clotting disorders
  • Physical therapy for joint function
  • Assistive devices for weight-bearing reduction
  • Core decompression for early stages
  • Bone grafting for significant bone loss
  • Joint replacement for advanced cases
  • Avoiding risk factors like alcohol and smoking
  • Nutritional support with calcium and vitamin D

Description

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