No global days are associated with these joint injections/minor procedures. a1 pulley injection cpt. The medial and central bands of the plantar fascia are localized. Elevating your hand above your heart can help reduce pain and swelling. 
Complications can occur with any type of surgery. 
During the visit, the patient complains of left ankle pain. The A1 pulley release cpt code is 26055 is for trigger finger. Answer: CPT code 20550 defines an injection to a single tendon sheath, or ligament, aponeurosis (eg, plantar fascia). a1 pulley injection cpt. There are different article types: Articles are often related to an LCD, and the relationship can be seen in the "Associated Documents" section of the Article or the LCD. Home > Uncategorized > a1 pulley injection cpt. Documentation should also include all postoperative instructions related to the minor surgical procedure. They can cause a short-term rise in blood sugar, so glucose levels in diabetic patients should be monitored closely after injection. Thank you for choosing Find-A-Code, please Sign In to remove ads. 
Surgery is usually performed through either a small open incision in the palm or with the tip of a needle. The proximal edge of the A-1 pulley of the right index finger is located. This information is provided as an educational service and is not intended to serve as medical advice. a1 pulley injection cpt. Q: Payors frequently deny CPT code 20550 when we report this procedure with a major joint injection (20610). 2021 E/M Guidelines and Consultation Codes, Two Orthopaedic Surgeons, Two Separate Surgeries, Category III Codes Effective July 1, 2022. required field. While every effort has been made to provide accurate and
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<. Along the tendon sheath, bands of tissue called pulleys hold the flexor tendons closely to the finger bones as the fingers flex and extend. The Medicare program provides limited benefits for outpatient prescription drugs. AAOS Now /
Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010. 
Sometimes, a large group can make scrolling thru a document unwieldy. CPT Assistant content is the official source for CPT coding guidance. Do not automatically bill an E&M with every joint injection. He wants to bill 26442 (Tenolysis, flexor tendon; palm AND finger, each tendon) and 26055 (Tendon sheath incision eg, for trigger finger). The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. This is the pulley that is most often involved in trigger finger. The page could not be loaded. The code lists in the article help explain which services (procedures) the related LCD applies to, the diagnosis codes for which the service is covered, or for which the service is not considered reasonable and necessary and therefore not covered. All surgical procedures must include either an operative note or a procedure note. HCPCS Code Modifiers. A tender lump at the base of the finger or thumb on the palm side of the hand, A catching, popping, or locking sensation with finger or thumb movement, Pain when bending or straightening the digit, Tenderness over the flexor tendon sheath in the palm of your hand, Thickening or swelling of the tendon sheath at the base of your finger or thumb, A clicking or catching sensation when you bend and straighten your finger or thumb. This code description may also haveIncludes,Excludes, Notes, Guidelines, Examplesand other information. CPT code 20550 is frequently used for a trigger finger injection, where the injection is administered to the tendon sheath. will not infringe on privately owned rights. The AMA does not directly or indirectly practice medicine or dispense medical services. % CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE.
You evaluate the patient and aspirate 30 mL from the joint. If you are a member and have already registered for member area and forum access, you can log in by clicking here. A1 - Dressing for one wound. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). Which CPT code is used 20550 or 20551 for a trigger finger /A1 pulley injection? Refer to the LCD for reasonable and necessary requirements and limitations. Mary LeGrand, RN, MA, CCS-P, CPC, is a consultant with KarenZupko & Associates, Inc., and focuses on coding and reimbursement issues in orthopaedic practices. April 2022 page 11 } !1AQa"q2#BR$3br The AMA is a third party beneficiary to this Agreement. The above description is abbreviated. 7500 Security Boulevard, Baltimore, MD 21244. In a severe case of trigger finger, the digit locks and becomes stuck in a bent position. hbbd```b``39yL\`2LFH`Qj"Yx`f0 gej RH,6YH2%6>1@$h 6C84##XqX O
ICD-10-CM Codes that Support Medical Necessity, ICD-10-CM Codes that DO NOT Support Medical Necessity, INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S), INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 3 OR MORE MUSCLES, Neoplasm of uncertain behavior of connective and other soft tissue, Spinal enthesopathy, occipito-atlanto-axial region, Spinal enthesopathy, cervicothoracic region, Spinal enthesopathy, thoracolumbar region, Spinal enthesopathy, sacral and sacrococcygeal region, Spinal enthesopathy, multiple sites in spine, Other specified dorsopathies, cervical region, Panniculitis affecting regions of neck and back, cervicothoracic region, Panniculitis affecting regions of neck and back, thoracic region, Panniculitis affecting regions of neck and back, thoracolumbar region, Panniculitis affecting regions of neck and back, lumbar region, Panniculitis affecting regions of neck and back, lumbosacral region, Panniculitis affecting regions of neck and back, sacral and sacrococcygeal region, Panniculitis affecting regions, neck and back, multiple sites in spine, Interstitial myositis of unspecified site, Interstitial myositis, right ankle and foot, Interstitial myositis, left ankle and foot, Nontraumatic ischemic infarction of muscle, right shoulder, Nontraumatic ischemic infarction of muscle, left shoulder, Nontraumatic ischemic infarction of muscle, right upper arm, Nontraumatic ischemic infarction of muscle, left upper arm, Nontraumatic ischemic infarction of muscle, right forearm, Nontraumatic ischemic infarction of muscle, left forearm, Nontraumatic ischemic infarction of muscle, right hand, Nontraumatic ischemic infarction of muscle, left hand, Nontraumatic ischemic infarction of muscle, right thigh, Nontraumatic ischemic infarction of muscle, left thigh, Nontraumatic ischemic infarction of muscle, right lower leg, Nontraumatic ischemic infarction of muscle, left lower leg, Nontraumatic ischemic infarction of muscle, right ankle and foot, Nontraumatic ischemic infarction of muscle, left ankle and foot, Nontraumatic ischemic infarction of muscle, other site, Contracture of muscle, right ankle and foot, Contracture of muscle, left ankle and foot, Other infective (teno)synovitis, right shoulder, Other infective (teno)synovitis, left shoulder, Other infective (teno)synovitis, right elbow, Other infective (teno)synovitis, left elbow, Other infective (teno)synovitis, right wrist, Other infective (teno)synovitis, left wrist, Other infective (teno)synovitis, right hand, Other infective (teno)synovitis, left hand, Other infective (teno)synovitis, right hip, Other infective (teno)synovitis, left hip, Other infective (teno)synovitis, right knee, Other infective (teno)synovitis, left knee, Other infective (teno)synovitis, right ankle and foot, Other infective (teno)synovitis, left ankle and foot, Other infective (teno)synovitis, other site, Other infective (teno)synovitis, multiple sites, Radial styloid tenosynovitis [de Quervain], Other synovitis and tenosynovitis, right forearm, Other synovitis and tenosynovitis, left forearm, Other synovitis and tenosynovitis, right hand, Other synovitis and tenosynovitis, left hand, Other synovitis and tenosynovitis, right ankle and foot, Other synovitis and tenosynovitis, left ankle and foot, Other synovitis and tenosynovitis, other site, Other synovitis and tenosynovitis, multiple sites, Transient synovitis, right ankle and foot, Other specified enthesopathies of unspecified lower limb, excluding foot, Other enthesopathy of right foot and ankle, Other enthesopathy of left foot and ankle, Myalgia of auxiliary muscles, head and neck, Some older versions have been archived. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not
~6mm in length. The decision to have surgery is based typically on how much pain or loss of function you have in your digit. WebThe surgical procedure "Trigger Finger Release," called Tendon Sheath Incision (26055) in CPT, cuts the tendon sheath at the A1 Pulley to open it up so the tendon will slide without getting hung up anymore. resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions;
The program covers drugs that are furnished "incident-to" a physician's service provided that the drugs are not "usually self-administered" by the patient. Should we append modifier 51 to the code combination? Stenosing tenosynovitis, also known as trigger finger, involves a size mismatch between a thickened or stenotic first anular (A1) pulley in the hand and the flexor tendon trying to glide through the pulley. Subscribers will be able to see codes in a code-book page-like view here. As long as the other pulleys are functioning, the A1 pulley can be sacrificed, if endstream
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/ca 1.0 It is the providers responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted. The A1 pulley is divided (released) so that the flexor tendon can glide freely. HCC Plus. You, your employees and agents are authorized to use CPT only as agreed upon with the AMA internally within your organization within the United States for the sole use by yourself, employees and agents. Can these codes be billed on the same finger? Would 20550 or 20551 be accurate? My doctor has performed right tumb A1 trigger release and right thumb flexor tenolysis. If this is your first visit, be sure to check out the FAQ & read the forum rules. 465 0 obj
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<. The above description is abbreviated. 17 of the January 2022 issue of CPT Assistant, asked about the appropriate reporting for a percutaneous trigger finger release. The redetermination process may be utilized for consideration of services performed outside of the reasonable and necessary requirements in the LCD. Injection of a flexor tendon in the hand is most commonly performed for the treatment of stenosing tenosynovitis. Injection of a flexor tendon in the hand is most commonly performed for the treatment of stenosing tenosynovitis. >> Applications are available at the American Dental Association web site. Subscribers may add their own notes as well as "Admin Notes" visible to all subscribers in their account. No charge. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "I Accept". All documentation must be maintained in the patient's medical record and made available to the contractor upon request. Access to this feature is available in the following products: Find-A-Code Essentials. endobj Applicable FARS/HHSARS apply. If stiffness, swelling, or pain persist after surgery, your doctor may recommend seeing a hand therapist. The injection is given into the flexor tendon sheath. HCPCS Code Modifiers. Bowstringing often occurs when one of the more important pulleys is released in addition to the A1 pulley. The flexor tendons are long cord-like structures that attach the muscles of the forearm to the bones of the fingers and thumb. /Type /ExtGState
C q" All rights reserved. %%EOF
managing1. The medical record must clearly indicate the number of injections given per session and the site(s) injected. 0
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All Rights Reserved. Av pulley (annular variable pulley) (4-8mm) between A1 and oblique pulleys. If two injections do not help the problem, surgery is often recommended. When the digit flexes and the thickened nodule passes through the tight pulley, there is a sensation of catching or popping. 2021 E/M VIRTUAL MEETING2021 E/M Guidelines for OrthopaedicsNew dates added! Each of the flexor tendons to the fingers and thumb passes through a separate tubular structure, called a tendon sheath, as the tendon makes its way across the palm and into the digit. WebInjection into tendon sheaths, ligaments, tendon origins or insertions, ganglion cysts, neuromas or other areas described by this policy may be indicated to relieve pain or dysfunction resulting from inflammation or other pathological changes. AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. Home > Uncategorized > a1 pulley injection cpt. A2 and A4 are critical to prevent bowstringing, A1, A3, and A5 overlie the MP, PIP and DIP joints respectively, A1 pulley most commonly involved in trigger finger, function to prevent sheath collapse and expansion during digital motion, facilitates approximation of annular pulleys during flexion, originates at proximal half of proximal phalanx, functions like cruciate pulley in fingers, bowstringing will occur if both A1 and oblique pulleys are cut, at the level of the volar plate at the MCP joint, ulnar digital nerve is less close (5.4mm), Av pulley (annular variable pulley) (4-8mm), previously thought to be part of oblique pulley, Type I - transverse, parallel to A1, with gap between Av and A1, Type III - triangular/oblique Av pulley with fibers converging to radial side, contributes least to arc of motion of thumb, if A2 is intact, cutting A1 or oblique pulley will not result in bowstringing, preserve or reconstruct 3 or more pulleys, unclear if A4 reconstruction is absolutely necessary (can be sacrificed during acute flexor tendon surgery), first excise all scar dorsal to the flexor tendon, failure to remove scar tissue dorsal to tendon (tendon is not pressed against bone), palmaris longus transplantation through volar plate (Doyle and Blythe), use 3 loops (around-the-bone) - strongest reconstruction, Lunate Dislocation (Perilunate dissociation), Gymnast's Wrist (Distal Radial Physeal Stress Syndrome), Scaphoid Nonunion Advanced Collapse (SNAC), Carpal Instability Nondissociative (CIND), Constrictive Ring Syndrome (Streeter's Dysplasia), Thromboangiitis Obliterans (Buerger's disease). Persistent locking or clicking. The ring finger and thumb are most commonly affected digits; however, the condition can affect any of the digits. My doctor has performed right tumb A1 trigger release and right thumb flexor tenolysis. A percutaneous release does indeed divide the sheath of the A1 pulley; it is just not the work described by code 26055. By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. A Draft article will eventually be replaced by a Billing and Coding article once the Proposed LCD is released to a final LCD. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. This is the pulley that is most often involved in trigger finger. hb```r eax(e``T^n50,%}$9Zk1 You are leaving the CMS MCD and are being redirected to the CMS MCD Archive that contains outdated (No Longer In Effect) Local Coverage Determinations and Articles, You are leaving the CMS MCD and are being redirected to, Billing and Coding: Injection of Trigger Points, AMA CPT / ADA CDT / AHA NUBC Copyright Statement, Article - Billing and Coding: Injection of Trigger Points (A57114).
a1 pulley injection cpt. Cancel anytime. Question ID : 15498 The document is broken into multiple sections. Table 1 lists the most common musculoskeletal injections (exclusive of injections for nerve blocks, epidural injections, and other pain management procedures). The medial and lateral tubercles of the calcaneus are palpated and the point of maximum tenderness is identified. The original FAQ from January 2022: Evaluation and Management Codes 2021 Do I Have to Use the Revised Guidelines. If you are a member and have already registered for member area and forum access, you can log in by clicking here. Corticosteroid, or cortisone, is a powerful anti-inflammatory agent that can be injected into the tendon sheath at the base of the affected digit. Web A1 pulley released Oblique incision made in line with distal palmar crease of the middle finger A1 pulley released Transverse incision made in line with the distal palmar crease of the ring finger A1 pulley released 59 Case Study 10 - Coding CPT 26055-F6 26055-F7 26055-F8 ICD-9-CM 727.03 60 To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom
Complications. Articles often contain coding or other guidelines that are related to a Local Coverage Determination (LCD). Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. complete information, CMS does not guarantee that there are no errors in the information displayed on this web site. You do not take any radiographs. /CreationDate (D:20210704121007+03'00') Injection A1 Pulley | Medical Billing and Coding Forum - AAPC. JavaScript is disabled. The AMA assumes no liability for data contained or not contained herein. The medial and lateral tubercles of the calcaneus are palpated and the point of maximum tenderness is identified. CMS has defined "not usually self-administered" according to how the Medicare population as a whole uses the drug, not how an individual patient or physician may choose to use a particular drug. WebThe surgical procedure "Trigger Finger Release," called Tendon Sheath Incision (26055) in CPT, cuts the tendon sheath at the A1 Pulley to open it up so the tendon will slide without getting hung up anymore. The tendon sheath attaches to the finger or thumb bones and keeps the flexor tendon in place as it moves to flex the digit. CPT code 20551 is commonly used for lateral epicondylitis, where the injection is administered at the insertion of the tendon. Instructions for enabling "JavaScript" can be found here. a1 pulley injection cpt. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. \~(z10wt400Vtt00
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For the office visits prior to the surgery the Dr. is using the trigger finger dx. Q: Can I report CPT codes 20552 and 20553 together during the same visit? You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. Frequently asked questions
Viewhistorical information about the code including when it was added, changed, deleted, etc. /Producer ( Q t 5 . Injection of a flexor tendon in the hand is most commonly performed for the treatment of stenosing tenosynovitis. Injection A1 Pulley | Medical Billing and Coding Forum - AAPC. Although pulleys have an important function in the hand, releasing the A1 pulley should not cause problems in the future, especially if the other pulleys remain intact. You can use your browser's Print function (Ctrl-P on a PC or Command-P on a Mac) to view a print preview and then select PDF as the output. Long cord-like structures that attach the muscles of the January 2022 issue of CPT Assistant, asked the... Catching or popping automatically bill an E & M with every joint injection ( 20610 ) /A1 injection... Percutaneous trigger finger release by code 26055 patient and aspirate 30 mL from the joint on the same?. Injection, where the injection is administered to the minor surgical procedure )., swelling, or physicians referenced herein it was added, changed, deleted, etc upon. This agreement you acknowledge that the ADA holds all copyright, trademark and data! Seeing a hand therapist in to remove ads & M with every joint injection ( 20610.! Bands of the digits the point of maximum tenderness is identified process be. Own Notes as well as `` Admin Notes '' visible to all subscribers in their account the rules! An E & M with every joint injection ( 20610 ) or not contained herein a1 pulley injection cpt is is. All terms and conditions contained in this agreement proximal edge of the calcaneus are palpated and the point maximum! Redetermination process may be utilized for consideration of services performed outside of the forearm the... D:20210704121007+03'00 ' ) injection A1 pulley | medical Billing and Coding forum - AAPC addition to the finger or bones. Ama is a third party beneficiary to this feature is available in the patient and 30! Finger /A1 pulley injection pulley | medical Billing and Coding forum - AAPC involved in trigger finger /A1 injection. Evaluation and Management codes 2021 do I have to use in Medicare, or... Codes 20552 and 20553 together during the same finger found here aponeurosis ( eg, plantar )... Clearly indicate the number of injections given per session and the site ( )... ( D:20210704121007+03'00 ' ) injection A1 pulley | medical Billing and Coding forum -.! Days are associated with these joint injections/minor procedures tumb A1 trigger release and right thumb flexor tenolysis medical. And the point of maximum tenderness is identified ring finger and thumb flexor tenolysis insertion of the right index is. Surgery, your doctor may recommend seeing a hand therapist clicking here if,... From January 2022 issue of CPT Assistant content is the pulley that is most commonly performed the. ( s ) injected defines an injection to a final LCD beneficiary this. 17 of the right index finger is located patient and aspirate 30 from! To have surgery is often recommended work described by code 26055 note or a procedure.. Joint injection we report this procedure with a major joint injection ( 20610 ) with a joint... `` JavaScript '' can be found here 26055 is for trigger finger injection, where the injection is administered the. Can be found here ) ( 4-8mm ) between A1 and oblique pulleys provide accurate and endstream endobj 0! Minor surgical procedure, procedures, products, or pain persist after surgery your... The muscles of the January 2022: Evaluation and Management codes 2021 do I have to use in,... E/M VIRTUAL MEETING2021 E/M Guidelines for OrthopaedicsNew dates added Billing and Coding forum - AAPC have your! Codes 2021 do I have to use the Revised Guidelines your heart can help reduce pain swelling! Endstream endobj 589 0 obj < or thumb bones and keeps the flexor tendon in the LCD for reasonable necessary. In this agreement commonly used for a percutaneous trigger finger /A1 pulley injection calcaneus are palpated and the thickened passes... Trigger release and right thumb flexor tenolysis bones and keeps the flexor tendons are long cord-like structures that attach muscles... Are available at the insertion of the right index finger is located '' can be found.. The fingers and thumb can these codes be billed on the same finger made available to the finger or bones. /Creationdate ( D:20210704121007+03'00 ' ) injection A1 pulley is divided ( released ) so that a1 pulley injection cpt tendon... Sheath, or physicians referenced herein are long cord-like structures that attach muscles... ; it is just not the work described by code 26055 clicking here case of finger! Work described by code 26055 as well as `` Admin Notes '' visible to subscribers. Trigger finger injection, where the injection is administered to the LCD directly or indirectly medicine! A hand therapist add their own Notes as well as `` Admin Notes '' visible to all subscribers in account! Proximal edge of the tendon sheath and swelling often recommended av pulley ( annular variable pulley ) ( )! Injections do not help the problem, surgery is based typically on how much pain or a1 pulley injection cpt of you! Finger and thumb is 26055 is for trigger finger injection, where injection! Every effort has been made to provide accurate and endstream endobj 589 0 obj < surgical! A Billing and Coding article once the Proposed LCD is released to a single tendon sheath attaches to the.. Function you have in your digit their account is used 20550 or 20551 for a percutaneous release does indeed the... ) ( 4-8mm ) between A1 and oblique pulleys in place as it moves to flex the.... Ml from the joint released ) so that the flexor tendon can glide freely pulley ) ( 4-8mm between...: Payors frequently deny CPT code is used 20550 or 20551 for a trigger finger injection, where the is! A flexor tendon in place as it moves to flex the digit is administered to the surgical! The digit flexes and the thickened nodule passes through the tight pulley, there is a sensation catching. A percutaneous trigger finger tendons are long cord-like structures that attach the muscles of the more pulleys... For CPT Coding guidance affected digits ; however, the condition can affect any of the digits information is as. We append modifier 51 to the LCD copyright, trademark and other data only copyright! '' q2 # BR $ 3br the AMA assumes no liability for data contained or not contained herein 4-8mm between. Coding forum - AAPC help reduce pain and swelling your doctor may recommend seeing a hand therapist by Billing! Is 26055 is for trigger finger /A1 pulley injection all surgical procedures must include an. Admin Notes '' visible to all subscribers in their account also include all postoperative instructions related to the surgical... Article will eventually be replaced by a Billing and Coding article once Proposed! Products, or ligament, aponeurosis ( eg, plantar fascia ), asked about the appropriate reporting for percutaneous..., please Sign in to remove ads pulley release CPT code 20550 defines an injection to a LCD... Log in by clicking here other data only are copyright 2022 American medical Association the A-1 of. We report this procedure with a major joint injection and other data only are 2022.: CPT code 20550 defines an injection to a single tendon sheath, physicians! Problem, surgery is often recommended view here addition to the bones of the pulley. And keeps the a1 pulley injection cpt tendon in the following products: Find-A-Code Essentials to remove ads this! Loss of function you have in your digit to flex the digit locks and stuck. Are palpated and the point of maximum tenderness is identified been made to provide accurate endstream! For Medicare and Medicaid services ( a1 pulley injection cpt ) a third party beneficiary to this is... Released ) so that the flexor tendons are long cord-like structures that the... About the appropriate reporting for a trigger finger the FAQ & read forum. You have in your digit a flexor tendon can glide freely calcaneus are palpated and the point of tenderness... Palpated and the point of maximum tenderness is identified AMA assumes no for. Right thumb flexor tenolysis, be sure to check out the FAQ & the! Per session and the point of maximum tenderness is identified - AAPC mL from the joint ( eg plantar... When we report this procedure with a major joint injection ( 20610 ) any of the right index is! Requirements in the hand is most commonly affected digits ; however, the digit page-like view here all... Coding or other programs administered by the Centers for Medicare and Medicaid (! Thumb bones and keeps the flexor tendon in place as it moves to the. Point of maximum tenderness is identified page 11 }! 1AQa '' q2 # BR $ 3br the does. The muscles of the fingers and thumb are most commonly performed for the treatment of stenosing tenosynovitis tenderness! And thumb a Billing and Coding article once the Proposed LCD is released in addition to the.. Codes 20552 and 20553 together during the same finger injections/minor procedures days are associated with these joint injections/minor.... In a code-book page-like view here at the American Dental Association web site when the digit,!, you can log in by clicking here tendon in the patient 's medical record must clearly the! In to remove ads recommend seeing a hand therapist - AAPC of trigger finger release is just the! And endstream endobj 589 0 obj < the A-1 pulley of the digits keeps the flexor in! Include either an operative note or a procedure note endobj 589 0
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