Cast to be removed 10-14 days post-operation; A thermoplastic splint to be fabricated by a hand therapist; Splint to continue full-time except for hygiene reasons and when exercising; Wound to be checked, dressing changed, and sutures removed as necessary; Safe to begin a dart throwers motion as well as active rotation exercises prescribed by a hand therapist which do not stress the repair; Some pain is normal and patients should be encouraged to continue to try and move the wrists;. No need to be fancy, just an overview. I am currently continuing at SunAgri as an R&D engineer. 0000002069 00000 n My thesis aimed to study dynamic agrivoltaic systems, in my case in arboriculture. A very common ligament injured in a sprained wrist is the scapholunate ligament. What is chronic scapholunate dissociation? People seeking specific medical advice or assistance should contact a board certified physician. . Miller MD, Howard RF, . SLAC usually results from trauma to the wrist, but may be caused by a degenerative process such as calcinosis or as a sequela of a prior injury. This is the American ICD-10-CM version of S63. The reconstruction could utilize either parts of a patients tendon, or synthetic ligament, or a combination of both. Therefore, all of these injuries require open reduction and internal fixation and repair of the scapholunate interosseous ligament. Thanks. 7.2) 3.The dorsal and volar radioulnar ligaments (each with a. Indentify the scapholunate interosseous ligament. How is scapholunate dissociation treated? Medicine (Baltimore). A radiograph is shown in Figure 21. The main advantage, versus conventional total wrist arthrodesis, is that some intercarpal and radiocarpal function is preserved. Joint replacement of major and nonmajor joints, ligament reconstruction, effective trauma care, correction of deformities in children, and successful surgical treatment of musculoskeletal oncologic conditions are just a few examples of how orthopaedics has become so exciting to practice on a daily basis. Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period The physician gives me 20604 but since this is part of the wrist would it not be 20606? stabilized by dorsal and volar radioulnar ligaments, the TFCC, and the joint capsule.The TFCC consists of ve parts: 1. A person is aphakic if the natural lens was extracted and no IOL was implanted. Scapholunate (SL) dissociation is part of a spectrum of traumatic carpal bone instabilities and is defined as disruption of the ligamentous complex holding the scaphoid and lunate together.1 The SL ligament complex consists of the volar, dorsal, and . A 3.5 mm DX SwiveLock SL anchor provides knotless fixation for the biologic tendon graft reconstruction augmented with SutureTape for immediate strength. . 83.4 Indications Commonly suggested wrist pain generators are the scapholunate (SL) and luntotriquetral (LT) ligaments as well as the TFCC. sharing sensitive information, make sure youre on a federal CPT 66999, Under Other Procedures of the Anterior Segment of Eye. Introduction. 25023-RT Decompression fasciotomy, forearm and/or wrist, flexor OR extensor compartment; with debridement of nonviable muscle and/or nerve Summarize the importance of improving care coordination among the interprofessional team to manage mild cases using wrist splints and anti-inflammatory drugs, which will improve outcomes for patients with scapholunate advanced collapse. 26 Abnormal movement of the scaphoid can result in a clicking or clunking sensation in the wrist. Recently published studies evaluating SNAC of the left wrist caused by a displaced fracture of the distal pole of the scaphoid is reported with ICD-10-CM code S62.012K Displaced fracture of distal pole of navicular (scaphoid) bone of left wrist, subsequent encounter for fracture with nonunion. 2008-2023 eORIF LLC. This condition is a sequela of a scaphoid fracture, and characterized as chronic non-union. When a ligament is injured, this is referred to as a sprain. We then specifically examined patients who had undergone CI reconstruction procedures as determined by CPT code 25320. Keep all dressings/bandages intact and dry until the first post-operative appointment with Kemble or a hand therapist. Diagnosis is made with PA wrist radiographs showing widening of the SL joint. A very common ligament injured in a sprained wrist is the scapholunate ligament. This article describes the surgical repair of scapholunate ligament injury using Mitek suture anchors. Financing options are available for LASIK patients based in the US and Canada. Ligament / Volar Plate CPT Codes Ligament / Volar Plate CPT Codes Late effect of dislocation (nonspecific) (905.6) Repair lateral collateral ligament, elbow, with local tissue (24343) Repair lateral collateral ligament, elbow, with tendon graft, including graft harvest (24344) Repair medial collateral ligament, elbow, with local tissue (24345) 1. Yes, the 29844 is bundled into the 29846. and ligamentous tears of the wrist. (SBQ07SM.38) Shibayama H, Matsui Y, Kawamura D, Momma D, Endo T, Iwasaki N. J Hand Surg Glob Online. Common examples of unbundling and miscoding errors include: Case 1: The patient is a 49-year-old woman who presents to the ER with an acute onset of pain in her right wrist after she was chased by a dog and fell onto an outstretched hand while running for her front door. CPTor the following procedures when specified as LASIK, SMILE, LASEK, PRK: This code is described as open wrist capsulorrhaphy or reconstruction for CI (eg, capsulodesis, ligament repair, tendon transfer or graft). Scapholunate Ligament Repair-Bruneli 25320 synonyms: Scapholunate Ligament Repair-Bruneli CPT 25320 Scapholunate Ligament Repair-Bruneli Anatomy Scapholunate Ligament Repair-Bruneli Indications Acute scapholunate instability Subacute scapholunate instability Scapholunate Ligament Repair -Bruneli Contraindications Radioscaphoid arthritis Hand weakness or stiffness, especially with regard to grip strength. 0000030646 00000 n . Although closed reduction is possible, maintaining an anatomical reduction is extremely difficult. I love to write and share science related Stuff Here on my Website. Scapholunate Ligament Disruption is an injury involving the ligaments attaching the scaphoid to the lunate. Dorsal intercalated segment instability (DISI) is a deformity of the wrist where the lunate angulates to the posterior side of the hand. Disclaimer: All information provided on this webpage should be considered as general guidelines. As such, articles are written and edited by countless contributing members over a period of time. government site. experimental studies have shown that (1) ligaments and joint capsular tissue can be modified significantly (shortened) by thermal energy at the temperature range of 70 to 80 c, (2) thermal energy causes immediate deleterious effects such as loss of the mechanical properties, collagen denaturation, and cell necrosis, (3) thermally treated tissue Long-arm splint in pronation for 4-6 weeks, with frequent follow-up xrays to assess reduction. It is the most common pattern of wrist instability. Etiology Pathoanatomy chronic SL ligament injury creates a DISI deformity scaphoid is flexed and lunate is extended as scapholunate ligament no longer restrains this articulation scapholunate angle > 70 degrees Material and methods. Diagnosis of DISI deformity can be made with lateral wrist radiographs showing a scapholunate angle. Although topiramate may worsen cognition in some patients mood disorder dsm 5 code aripiprazola 10 mg discount without prescription, it may be useful within the control of headache and weight achieve mood disorder journal pdf 15 mg aripiprazola discount overnight delivery. 29846-RT Arthroscopy, wrist, surgical; excision and/or repair of triangular fibrocartilage and/or joint debridement Post-operative rehabilitation (developed in conjunction with MelbourneHand Therapy). definitive management of scapholunate ligament injuries and role of cervical fusion vs. disc replacement in the competitive athletes. push up position), may be associated with wrist instability or weakness, may see swelling over the dorsal aspect of the wrist, tenderness in the anatomical snuffbox or over the, pain increased with extreme wrist extension and radial deviation, when deviating from ulnar to radial, pressure over volar aspect of scaphoid subluxates the scaphoid dorsally out of the scaphoid fossa of the distal radius, and a clunk is palpated when pressure is released as the scaphoid reduces back over the dorsal rim of the radius, a painful clunk during this maneuver may indicate insufficiency of scapholunate ligament, clenched fist (can exaggerate the diastasis), dorsal tilt of lunate leads to SL angle > 70, may be used as screening tool for arthroscopy, always assess the contralateral wrist for comparison, may demonstrate the presence of a tear but cannot determine the size of the tear, positive finding of a tear may indicate the need for wrist arthroscopy, often overused as a screening modality for SLIL tears, requires careful inspection of the SLIL by a dedicated radiologist to confirm diagnosis, Carpal instability nondissociative (CIND), splinting and close follow-up with repeat imaging and clinical response with acute injuries, most people feel casting alone is insufficient, acute scapholunate ligament injury without carpal malalignment, ligament pathoanatomy is ammenable to repair, if pathoanatomy of SL ligament injury is a scaphoid fx than repair with, small incision is made just distal to the radial styloid, care to avoid cutting the radial sensory nerve branches, often added to a ligament repair and remains a viable alternative for a chronic instability when ligament repair is not feasible, place two k-wires in parallel into the scaphoid bone, reduce the SL joint by levering the scaphoid into extension, supination and ulnar deviation and lunate into flexion and radial deviation, confirm reduction of the SL joint under fluoroscopy, FCR tendon transfer (direct SL joint reduction), ECRB tendonosis (indirect SL joint reduction), weave not recommended due to high incidence of late failure. Is Clostridium difficile Gram-positive or negative? FOIA ANKLE Achilles Tendon Repair Operative Technique. It occurs mainly after the disruption of the scapholunate ligament and is more often encountered than volar intercalated segment instability (VISI). The scapholunate ligament is a C shaped ligament that connects the scaphoid bone in the wrist to the lunate bone. In cases of severe arthritis of the wrist, surgical removal of the scaphoid, lunate and triquetrum bones or proximal row carpectomy (PRC) is a well-known procedure. Strength and ligament retraining exercises to continue and possibly be upgraded; The speed of healing and a return to sport timetable differs for every patient. Phakic refers to a person with an intact natural lens while a pseudophakic individual had a lens extracted and an IOL placed. D*Dljc#xFE!.wWe$gR?=aG#vcG/4/5#\ba,jw8aY=*bQns?3(^&$Kzt It can correct nearsightedness, farsightedness, and astigmatism, Robert L. How much does Laser Eye Surgery cost? The Current Procedural Terminology (CPT ) code 66999 as maintained by American Medical Association, is a medical procedural code under the range Other Procedures of the Anterior Segment of Eye. A finite element wrist model was designed using a three-dimensional reconstruction of computed tomographic images from the distal end of the radius and ulna to the proximal third of the metacarpals. (1,9) The scaphotrapeziotrapezoid (STT), scaphocapitate (SC), and triquetrohamatecapitate (THC) are the volar intrinsic ligaments that provide mid-carpal stability. August 1989, a 19-year-old male patient fell from a horse (high-energy incident) with minimal pain initially. Difficulty bearing weight across the wrist; Dorsal swelling or tenderness directly over the scapholunate ligament; A focal point of pain in the scapholunate region; and. 1 Where can I find sea-run cutthroat trout? How do you do a bill corneal foreign body removal?PT code 65222 is removal of foreign body, external eye corneal, with slit lamp. Tendon: A tough cord or band of dense fibrous tissue that connects a muscle to some part of a bone. The information on this website may not be complete or accurate. Both are relatively low-risk procedures when performed on suitable candidates, and both are capable of producing exceptional results. The distal aspect of each joint articulates with the midcarpal joint. 0000001593 00000 n Evaluate the dorsal intercarpal ligament for injury to its lunate of scaphoid insertions. Common conditions of the wrist and distal radius from chapters 13 and 19 (M and S codes) are: The triangular fibrocartilage complex (TFCC) is a band of cartilage that cushions the area in the wrist where the ulna, lunate, and triquetrum intersect. J Hand Surg Am. The most common revision procedure was an additional reconstruction operation whereas the most common salvage procedure was proximal row carpectomy. How does scapholunate dissociation happen? There are many ligaments in the wrist. Light functional tasks with the hand in a splint- such as eating, dressing and using a phone should commence. Graduated from ENSAT (national agronomic school of Toulouse) in plant sciences in 2018, I pursued a CIFRE doctorate under contract with SunAgri and INRAE in Avignon between 2019 and 2022. Electromyography and nerve conduction velocity studies, AP and lateral radiographs of the forearm, (SAE07SM.78) Wrist Ligament and TFCC Reconstruction Codes Wrist Ligament and TFCC Reconstruction Codes Distal Radioulnar Joint Sprain carpal (842.01) Midcarpal dislocation, closed (833.03) Late effect of dislocation (nonspecific) (905.6) Late effect of sprain/strain (nonspecific) (905.7) Capsulitis of wrist (726.4) Laxity of ligament (728.4) The scapholunate ligament (SLL) is one of the two proximal interosseous carpal ligaments of the wrist. A 40-year-old right-handed professional football player reports persistent right wrist pain after falling during a game 5 days ago. Preliminary or stop-gap treatment may include fitting to a short-arm splint or cast. 25210-RT x 2 The brocartilaginous disk and the meniscal homologue 2. 46K views 4 years ago The All-Dorsal Scapholunate Reconstruction with InternalBrace ligament augmentation allows for a knotless, high-strength fixation of an extensor carpi radialis brevis. It consists of dorsal, proximal and palmar segments that bridge the scaphoid and lunate. Diagnosis of DISI deformity can be made with lateral wrist radiographs showing a scapholunate angle > 70 degrees. CPT code 65222 is removal of foreign body, external eye; corneal, with slit lamp. The Best Writing Prompts For Poets The day a child was born. 0000004032 00000 n It is a crucial stabiliser of the wrist. He lost his grip on a powered sander while refinishing a table and suffered a crushing injury into the capitate and hamate of his right wrist. Description of Technique Our technique for scapholunate (SL) reconstruction involves ligament reconstruction utilizing a portion of the flexor carpi radialis tendon rerouted via transosseous tunnels across the scaphoid, lunate, and triquetrum (scapholunotriquetral tenodesis). Epub 2018 Sep 12. and transmitted securely. ICD-10-CM: hTPn0[dt4NwE1%$8 :7{ae#W`[Wt :GZ; S67.31XA Crushing injury of right wrist, initial encounter 99283-57 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity Decision for surgery 65222 is a bundled code. Although injury to additional ligaments is present in scapholunate dissociation, the SLIL is the major target of surgical reconstruction. A pillow can be used to prop-up the arm when seated or lying down; Finger movement should begin early and regularly and unaffected joints such as shoulder and elbow should also continue to be moved to avoid stiffness. A global group of dedicated editors oversee accuracy, consulting with expert advisers, and constantly reviewing additions. 3 patients with neglected injuries of the scapholunate ligament were operated from 8 weeks to 5 months after trauma. All Rights Reserved. How does scapholunate dissociation happen? xb```f``ie`c``oed@ AV(G*XYX}@FAYYQ!`{6fi{WfG]4+*h|,MFT:4C*Idn=]Vdy;LKtQ3U_A:@\6|{ln@ksklQ&3F RxoVr /0T&V@Aa qa0 The scaphoid is typically flexed and the lunate is typically extended. What is the CPT code for Scapholunate ligament repair? Simple Interest Formulas and Calculations: Use this simple interest calculator to find A, the Final Investment Value, using the simple interest formula: A = P(1 + Read more, Can you go to jail for not paying credit cards in India? In large and unstable ligament tears, a screw is used to repair the scaphoid and lunate bones together with a reconstruction of the ligament. The donor tendon is harvested from either the forearm or below the knee. Synovitis of the wrist is often a byproduct of a TFCC disease or injury, and is treated during the same operative session as a TFCC repair. This is situated at the base of the thumb. J Clin Med. The Current Procedural Terminology (CPT) code 66999 as maintained by American Medical Association, is a medical procedural code under the range Other Procedures of the Anterior Segment of Eye. Phakic, aphakic and pseudophakic are terms used to describe the status of an individuals lens. Procedure Procedimiento. A scapholunate interval of >2 mm is seen on the PA x-ray (Terry Thomas sign). Management should consist of. Monovision LASIK is a specialized technique in LASIK surgery to reduce or eliminate the need for reading glasses. Scapholunate Ligament RepairContraindications, Scapholunate Ligament RepairAlternatives, Scapholunate Ligament RepairPre-op Planning / Special Considerations, Scapholunate Ligament RepairComplications, Scapholunate Ligament RepairFollow-up care, Scapholunate Ligament RepairReview References, Site Terms | Copyright Information | ContactUs | Site Registration. "LFAAAB($L@FqV d s::HJj@L It is a crucial stabiliser of the wrist. [2] Contents 1 Anatomy 2 Instability 2.1 Diagnosis 2.2 Treatment 2.3 Complications Case 3: The patient is a 68-year-old gentleman who was woodworking in the basement workshop in his single-family home. He initially thought it was a sprain, but presents due to continued pain worsened by push-ups. Rupture of the scapholunate ligament is the first event in any sequence of perilunar ligament ruptures. This ligament is in the middle of the wrist between the scaphoid and lunate . Wrist Denervation. Three weeks later, there is no improvement in her pain. Scapholunate reconstruction Session 1A, 10-11:30 AM Friday, October 26th, 2012 . This procedure converts the wrist in a simple hinged joint but allows us to preserve a certain range of motion in the wrist. Scapholunate dissociation most commonly results from trauma. In what phylum and class are starfish found? Y92.018 Other place in single-family (private) house as the place of occurrence of the external cause In either of these examples, epilation or removal of foreign body, it would be perfectly appropriate to bill for visits on the days following the date of the procedure, beginning first day postoperatively. He also gives me 20604 when injecting the radial carpal joint, is this correct? That means in most situations, it is inappropriate to bill both an office visit (99000 or 92000) on the same day as you do a surgical code like a FB removal (CPT 65222). Cpt code scapholunate ligament tear repair. Required fields are marked *. She was seen in the emergency department at the time of injury and was told she had a sprain. The scapholunate joint is a small joint between two carpal bones at the wrist crease, namely the scaphoid and lunate bones. Surgical treatments including arthroscopic debridement and thermal shrinkage of the ligament have been used. The OrthoIllustrated animation for scapholunate ligament reconstruction is an educational tool to help patients better understand this treatment. 64772 The recommended code for these excisions is 64772. 0000004545 00000 n Write something about yourself. The contents has been created online for information purposes only. That means if you have two or more foreign bodies in the same tissue in the same eye, on the same day, you can only bill once for the multiple foreign bodies. !N*G gWu&vTPlR4e^U Wf%by. 0000005289 00000 n The scapholunate ligament (SLL) is one of the two proximal interosseous carpal ligaments of the wrist. The day you made a decision to give up something Read more. KEMBLE WANG - Upper Limb & Trauma Surgeon, Scapholunate ligament repair/reconstruction. The presenters will use a combination of evidence- based medicine and clinical . What is scapholunate dissociation? CPTor the following procedures when specified as LASIK, SMILE, LASEK, PRK: This code is described as open wrist capsulorrhaphy or reconstruction for CI (eg, capsulodesis, ligament repair, tendon transfer or graft). She was told to follow up in two to three weeks, or if the pain exacerbates. The 2022 edition of ICD-10-CM S63. Copyright 2023, AAPC Epub 2020 May 20. Diagnosis of scapholunate ligament injury SLL injuries often result in decreased grip strength, swelling, and tenderness over the dorsoradial aspect of the wrist. 0000070811 00000 n %%EOF For more severe TFCC-related cases, such as complex injuries or profound degeneration causing wrist instability, an open procedure may be necessary, such as a ligamentous reconstruction (25337 Reconstruction for stabilization of unstable distal ulna or distal radioulnar joint, secondary by soft tissue stabilization (eg, tendon transfer, tendon graft or weave, or tenodesis) with or without open reduction of distal radioulnar joint). Just proximal to the arcuate ligament is an area of capsular weakening known as the space of Poirer. I am thinking 25320 for the ligament repair, but I am stumped on the radial styloid screw fixation. Reporting a ganglion cyst excision (25111, Billing for initial application of a short-arm cast (29075. . Ligament: A band of fibrous, white tissue that connects two bones to stabilize a joint. In the posterior-anterior (PA) projection, the carpus is foreshortened. Please enable it to take advantage of the complete set of features! CPT: 25606-58-RT Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation - Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period ICD-10-CM: S52.532A Colles' fracture of left radius, initial encounter for closed fracture Can you bill for office visit and procedure?nswer: Unfortunately, no. Scapholunate dissociation results from an injury to the scapholunate interosseous ligament which joins the scaphoid and lunate wrist bones together. Bookshelf CPT 26480 will always bundle with 25447. This helps to reduce swelling. Select a chapter. 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). Y92.017 Garden or yard in single-family (private) house as the place of occurrence of the external cause Scapholunate Ligament Repair synonyms: Scapholunate Ligament Repair CPT 25320 Scapholunate Ligament Repair Anatomy Scapholunate Ligament Repair Indications Acute scapholunate instability Subacute scapholunate instability Scapholunate Ligament Repair Contraindications Radioscaphoid arthritis Capitolunate arthritis Chronic scapholunate instability 111 0 obj <>stream SK is similar to Phototherapeutic Keratectomy (PTK), but PTK removes deeper layers of tissue and is used to correct more severe corneal problems. The lunate is triangular instead of quadrangular in shape. Careful surgical candidate selection and thorough preoperative discussion can help guide patient expectations and outcome. Case 2: The patient is a 42-year-old man with the diagnosis of scapholunate advanced collapse on his right wrist, with synovitis. The code reflects the scenario that trauma or previous surgery resulted in surgically induced astigmatism. The typical presentation of an acute scapholunate dislocation is swelling, pain, and deformity following acute trauma to the wrist. eCollection 2022 May. What is scapholunate dissociation of scaphoid? A primary function of the TFCC is to facilitate forearm rotation with a flexible connection between the distal radius and ulna, stabilizing the distal radioulnar joint (DRUJ) and supporting the ulnocarpal structures. official website and that any information you provide is encrypted The day your faith was shaken. What is scapholunate ligament disruption? 0000007497 00000 n Left scapholunate ligament tear ICD-10-CM S63.512A is grouped within Diagnostic Related Group (s) (MS-DRG v40.0): 562 Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with mcc 563 Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without mcc 963 Other multiple significant trauma with mcc Outcome after repair of the scapholunate interosseous ligament and dorsal capsulodesis for dynamic scapholunate instability due to trauma. Osteoarthritis (OA): A deterioration of the weight bearing surface distinguished by destruction of the hyaline cartilage and narrowing at the joint space. Following surgery, a cast is normally worn for a number of weeks to allow the repaired tissues to heal. The other being the lunotriquetral interosseous ligament. Consider posterior interosseous nerve neurectomy. Coding Guides (27) outstretched arm injury9th class result 2022 lahore board by sms. MeSH The wrist is a complex joint which is composed of the end of the radius (the big bone in the forearm, on the thumb. What is the ICD 10 code for scapholunate dissociation? Reduce scapholunate joint anatomically. Signs and symptoms of SLAC include: A popular test to detect SLAC is the Watson scaphoid shift test, which evaluates four progressive stages of carpal arthritis. ICD-9 code: 844.2 Anterior cruciate ligament tear. - D}8Y-0ux}9q What are the differences between a male and a hermaphrodite C. elegans? Your email address will not be published. . It is typically avulsed from its scaphoid insertion. Immeging 4K . Scapholunate Ligament Injury is a source of dorsoradial wrist pain with chronic injuries leading to a form of wrist instability (DISI deformity). 2006 Oct;31(8):1380-6. doi: 10.1016/j.jhsa.2006.07.005. This procedure converts the wrist in a simple hinged joint but allows us to preserve a certain range of motion in the wrist. Rehabilitation exercises to be upgraded to full wrist range exercises, active and passive; Ligament retraining exercises prescribed to improve wrist function; Continue to avoid weight bearing activities. endstream endobj 87 0 obj <> endobj 88 0 obj <> endobj 89 0 obj <>stream SNAC manifests as sharp pain and profound weakness in the wrist, with restricted range of motion. Clipboard, Search History, and several other advanced features are temporarily unavailable. Nazshura 20 May 2020: want to see blue film pictures, Mokazahn 8 April 2020: free online movies websites yahoo answers, Your email address will not be published. . ICD-10-CM:
It Was The Best Of Shires, It Was The Worcestershire, Where Is The Safe In Pacific Allied Shipyard, Jagerwurst Vs Bratwurst, Look, Think, Act Action Research, Eileen Walsh Hyneman, Articles C