607 W Evans St
Florence SC 29501
Medical School: University Of Pennsylvania School Of Medicine - 1982
Accepts Medicare: Yes
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: 13261
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Dr. Robert Hotchkiss is associated with these group practices
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|HCPCS Code:M0064||Description:Visit for drug monitoring||Average Price:$111.74||Average Price Allowed
|HCPCS Code:90862||Description:Medication management||Average Price:$119.94||Average Price Allowed
|HCPCS Code:90806||Description:Psytx off 45-50 min||Average Price:$123.30||Average Price Allowed
|HCPCS Code:90862||Description:Medication management||Average Price:$80.71||Average Price Allowed
|HCPCS Code:96372||Description:Ther/proph/diag inj sc/im||Average Price:$25.00||Average Price Allowed
HCPCS Code Definitions
- Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders
- Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
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Cardiovascular Disease (Cardiology)
Cardiovascular Disease (Cardiology)
*These referrals represent the top 10 that Dr. Hotchkiss has made to other doctors
Conservative management of elbow dislocations with an overhead motion protocol. - The Journal of hand surgery
To report the results of using an overhead motion protocol in 27 patients and to assess final range of motion and incidence of persistent instability in this cohort.A total of 27 patients were included who sustained a simple elbow dislocation and were treated nonsurgically with an overhead motion protocol designed to convert gravity from a distracting to a stabilizing force. Motion was initiated within 1 week of injury and average follow-up was 29 months. Final arc of motion and prevalence of instability were the primary outcomes measures.Final mean arc of extension to flexion was from 6Â° to 137Â°, and of pronation to supination was from 87Â° to 86Â°. No recurrent instability was observed in this cohort and all patients were fully functional and without limitations at latest follow-up.The overhead motion protocol was a reliable rehabilitation program after elbow dislocation that allowed for controlled early motion by placing the elbow in an inherently stable position. Prompt initiation of motion in a protected position can optimize final motion and satisfaction outcomes, and when done in a mechanically advantageous position it can potentially limit the risk of recurrent instability.Therapeutic IV.Copyright Â© 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Outcomes of anconeus interposition for proximal radioulnar synostosis. - Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]
Proximal radioulnar synostosis after elbow injuries can produce debilitating contractures. The estimated range of motion required to perform many activities of daily living is a 100Â° arc of forearm rotation. We hypothesized that excision of heterotopic bone and anconeus flap interposition could restore functional prono-supination in patients with proximal radioulnar synostosis.Patients with proximal radioulnar synostosis were subdivided into 2 groups on the basis of etiology: (1) as a complication after distal biceps tendon repair or (2) as a result of direct trauma to the proximal forearm/elbow. All patients underwent an excision of the synostosis with interposition of an anconeus flap and were observed clinically for a minimum of 6Â months.Twenty-three patients (16 men, 7 women) were included, with a mean age of 47Â years and mean clinical follow-up of 4.8Â years. Mean arc of forearm rotation improved from 21Â° to 132Â°, pronation increased from 12Â° to 70Â°, and supination increased from 9Â° to 62Â° (PÂ <Â .0001). Patients with biceps tendon repair etiology (nÂ =Â 7) displayed greater gains in pronation and a trend toward greater total forearm rotation than did those with a traumatic etiology (nÂ =Â 16).Anconeus interposition flap for management of proximal radioulnar synostosis produces significant and reliable clinical improvement in elbow prono-supination. Patients with biceps tendon repair etiology had a trend toward greater motion improvement than that of patients with a traumatic etiology. The degree of improvement seen would provide nearly full restoration of functional motion, resulting in minimal limitations in activities of daily living.Copyright Â© 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
Direct repair for managing acute and chronic lateral ulnar collateral ligament disruptions. - The Journal of hand surgery
Acute elbow injuries that disrupt the lateral ulnar collateral ligament and result in posterolateral rotatory instability usually require surgical treatment. The 2 technical options reported, direct repair and use of a palmaris longus tendon graft, have usually favored the use of the graft. To balance this emphasis, we report our experience with direct repair of the humeral origin in cases of trauma, whether acute, delayed, or recurrent. It was our hypothesis that because the humeral origin is the point of failure and separation, restoration of this attachment is sufficient to restore stability and durable function without the need for a graft.Patients with complete disruption of the posterolateral ligaments of the elbow, who were managed with direct repair to the humeral origin, were included. Patients were separated into an acute treatment group (< 30 d from injury to treatment) and a delayed treatment group (> 30 d). Mayo Elbow Performance Scores and postoperative range of motion were collected from patient records.A total of 34 patients were included with a mean follow-up of 42 months. No difference was seen in Mayo Elbow Performance Scores between acute (mean, 90) or delayed treatment (mean, 89) of the lateral ulnar collateral ligament tear. No difference was seen in final elbow flexion or extension. Two patients in the acute group had failure of the direct repair requiring intervention. In the delayed group, no patients had recurrent instability.No significant difference in clinical outcome or range of motion was observed after direct repair of traumatic tears of the lateral ulnar collateral ligament tear between acute and delayed treatment cohorts. Despite complete disruption of the posterolateral ligaments, direct repair of the torn ligament to its humeral origin was effective without supplemental tendon graft reconstruction irrespective of interval from injury to repair, mechanism of injury, or associated fractures.Therapeutic III.Copyright Â© 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Management of acute and chronic vascular conditions of the hand. - Current reviews in musculoskeletal medicine
Management of acute and chronic vascular disorders of the hand in patients with vasospastic and vaso-occlusive disorders is a complex problem and requires a multidisciplinary approach. The ischemia-related pain, skin ulcerations, and ultimately the threat of digital gangrene require a concerted effort to improve perfusion using a combination of medications and surgery. The purpose of this work is to review our experience over the past 2 decades with this cohort of patients including the variability of the clinical presentation, a method of classification, and a practical treatment philosophy.
Magnetic resonance imaging findings in acute elbow dislocation: insight into mechanism. - The Journal of hand surgery
To identify with magnetic resonance imaging the location and severity of ligamentous injury after acute elbow dislocations. Based on observations that many elbow dislocations arise from an initial acute valgus load, we hypothesized that all patients would have a high-grade medial injury but not all would demonstrate injury of the lateral ligaments.The medial collateral ligament was subdivided into anterior bands of the anterior bundle of the medial collateral ligament (MCL) and posterior bands of the anterior bundle of the MCL, whereas the lateral collateral ligament was divided into the lateral ulnar collateral ligament and the radial collateral ligament. Distinction on magnetic resonance imaging was made between normal morphology and low-grade partial tear (< 50% of the ligament fibers), high-grade partial tear (â‰¥ 50%), and full-thickness disruption. The site of disruption was also characterized.Acute magnetic resonance imaging studies for 16 patients were included. No low-grade tears or intact evaluations of either the anterior or posterior bands of the anterior bundle of the MCL were observed; most demonstrated complete tears. The lateral ulnar collateral ligament most frequently showed complete disruption but was occasionally intact. The radial collateral ligament infrequently showed full disruption. Complete tears involving either the anterior or posterior portions of the anterior band of the MCL were significantly more common than complete tears involving the ligaments on the lateral side.After elbow dislocation, complete ligamentous tears were more common on the medial versus the lateral side. Whereas the lateral ligaments were occasionally preserved, this was never observed on the medial side. These data suggest a sequence of failure starting on the medial side with subsequent variable energy dissipation laterally.Diagnostic IV.Copyright Â© 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Capitellum excision: Mechanical implications and clinical consequences. - Journal of orthopaedic research : official publication of the Orthopaedic Research Society
Controversy exists regarding the optimal treatment of isolated fractures of the capitellum that are not amenable to open reduction and internal fixation. Excision of the capitellum could result in instability of the elbow, though only limited the clinical or laboratory evidence exists to support this outcome. The aim of our study was to determine if capitellum excision leads to significant instability by measuring the relative change in varus-valgus displacement of the elbow. The varus-valgus displacement was recorded in 11 cadaveric elbows before and after isolated excision of the capitellum. Specimens were testing in varus-loaded and valgus-loaded positions with and without a 1â€‰kg weight on the forearm. The varus-valgus displacement at the elbow was measured using a 3D motion capture system. Capitellum excision did not significantly change varus-valgus displacements in either the adducted, varus, or valgus position of the elbow (pâ€‰=â€‰0.80, pâ€‰=â€‰0.28, pâ€‰=â€‰0.51). Furthermore, the addition of the 1â€‰kg external functional load to the forearm did not produce a significant change in the varus and valgus loaded positions (pâ€‰=â€‰0.16, pâ€‰=â€‰0.36). Our results demonstrate that excision of the capitellum in the setting of intact ligamentous structures does not result in significant instability in either the adducted varus loaded or valgus loaded positions of the elbow.Â© 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.
An online video investigation into the mechanism of elbow dislocation. - The Journal of hand surgery
Acute elbow instability leading to dislocation is thought to be a spectrum initiated by an injury to the lateral stabilizing structures of the elbow. Previous cadaveric studies have shown elbow dislocations to occur in flexion. The purpose of this study was to analyze videographic evidence of the deforming forces and upper extremity position during elbow dislocations. We sought to corroborate previous biomechanics studies with in vivo observations.We included 62 YouTube.com videos with a clear videographic view of an elbow dislocation. Three senior elbow surgeons independently evaluated arm position at the time of dislocation, along with the suspected deforming forces at the elbow based on these positions.Of the 62 visualized elbow dislocation events, the vast majority (92%) dislocated at or near full extension. The most common arm positions were forearm pronation (68%) with shoulder abduction (97%) and forward flexion (63%). The typical elbow deforming forces were a valgus moment (89%), an axial load (90%), and progressive supination (94%). We identified 4 discrete patterns of arm position and deforming forces.Acute elbow dislocations in vivo occur in relative extension irrespective of forearm position, a finding distinct from previous cadaveric studies. The most common mechanism appears to involve a valgus moment to an extended elbow, which suggests a requisite disruption of the medial collateral ligament, the known primary constraint to valgus force. These videographic findings suggest that some acute elbow dislocations may result from acute valgus instability and therefore are distinct in nature and mechanism from posterolateral rotatory instability. This information could lead to improved understanding of the sequence of structural failure, modification of rehabilitation protocols, and overall treatment.Copyright Â© 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
The influence of gravity on the unstable elbow. - Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]
Safely permitting early range of motion after a destabilizing injury to the elbow is believed to optimize return of function. However, the range-of-motion exercises must be balanced against the risk of re-dislocation or subluxation. The goal of this study was to describe the position of the upper limb that permitted the greatest motion while minimizing the risk of re-dislocation or subluxation.Seven cadaveric elbows were affixed with a 3-dimensional motion capture system. Ulnohumeral distraction was recorded at flexion angles from 10Â° to 90Â° for intact, approach only (sham procedure), and LCL-sectioned. Ulnohumeral separation was recorded in 3 distinct positions of the upper limb that are frequently used in a clinical setting: 1) trunk seated upright with arm at the side; 2) trunk seated upright with elbow in hinged-brace; and 3) trunk supine with shoulder flexed and internally rotated - "gravity-assisted overhead motion" protocol.A significant ulnohumeral distraction difference was found between the supine and the upright protocols. Upon direct comparison, 104% more displacement occurred across the ulnohumeral joint in the upright LCL-sectioned condition compared to the supine LCL-sectioned condition (P = .001). The greatest ulnohumeral distraction occurred in the seated upright range of motion with a hinged elbow brace (range, 2.5-5.6 mm).The overhead motion protocol is a safe protocol for unstable elbows. The supine position results in the least amount of ulnohumeral distraction across flexion angles from 10Â° to 90Â°. The upright protocols, especially with the hinged elbow brace, exhibited ulnohumeral distraction that may result in dislocation.Copyright Â© 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.
The Use of MRI Modeling to Enhance Osteochondral Transfer in Segmental KienbÃ¶ck's Disease. - Cartilage
KienbÃ¶ck's disease, defined as avascular necrosis of the lunate, is a relatively rare condition with a poorly understood etiology. Conservative and invasive treatments for KienbÃ¶ck's disease exist, including wrist immobilization, surgical joint-leveling procedures, vascularized bone grafting, proximal row carpectomy, and total wrist arthrodesis. Staging KienbÃ¶ck's disease using radiography assumes near complete avascularity of the lunate. The staging distinguishes only the "state of collapse" in an ordinal classification scheme and does not allow localization or indicate partial involvement of the lunate, which the image contrast from MRI may provide. In this short communication, we report the treatment of a patient's KienbÃ¶ck's disease by combining MRI with mathematical modeling to optimize the congruency between the curvature of donor and recipient sites of an autologous osteoarticular plug transfer. Follow-up MRI and radiographs at 1 year postoperatively demonstrated gradual graft incorporation and bone healing. The purpose of this study was to describe the feasibility of a novel surgical technique. The results indicate that donor site selection for autologous osteoarticular transfer using a quantitative evaluation of articular surface curvature may be beneficial for optimizing the likelihood for restoring the radius of curvature and thus joint articulation following cartilage repair.
Indications and reoperation rates for total elbow arthroplasty: an analysis of trends in New York State. - The Journal of bone and joint surgery. American volume
Total elbow arthroplasty was originally used to treat patients with arthritis. As familiarity with total elbow arthroplasty evolved, the indications were expanded to include other disorders. There continues to be a low number of total elbow arthroplasties performed each year in comparison with hip, knee, and shoulder arthroplasties, and few large studies have examined the indications and associated complications of total elbow arthroplasty. The purposes of this study were to evaluate the changes with time in the indications for total elbow arthroplasty and to examine the complications of this procedure in a large database.The Statewide Planning and Research Cooperative System database from the New York State Department of Health, a census of all ambulatory and inpatient surgical procedures in the state of New York, was used to identify individuals who underwent primary total elbow arthroplasty during the time period of 1997 to 2006. These total elbow arthroplasties were evaluated for admitting diagnoses, sex and age of patient, readmission and complication data, and time to subsequent elbow surgery.From 1997 to 2006, there were 1155 total elbow arthroplasties performed in New York State. In 1997, 43% of the total elbow arthroplasties were associated with trauma and 48%, with inflammatory conditions. In 2006, this changed to 69% and 19%, respectively. Within ninety days after the primary total elbow arthroplasty, 12% of the patients were readmitted to the hospital with approximately one-half (5.6%) admitted for problems related to the total elbow arthroplasty. The overall revision rate was 6.4%. The revision rates for the traumatic, inflammatory arthritis, and osteoarthritis groups were 4.8%, 8.3%, and 14.7%, respectively. Of particular interest, 90.5% of the total elbow arthroplasties were performed by surgeons with no recorded experience in the database, which began collecting these data in 1986.This study provides useful information regarding patients undergoing total elbow arthroplasty in New York State. During the study period, the most common indication for total elbow arthroplasty changed from inflammatory arthritis to trauma. Although the number of total elbow arthroplasties being performed each year has increased, there continues to be a high complication and revision rate.
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607 W Evans St Florence, SC 29501
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