Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Arthropathy


Related Terms

  • Joint Disease
  • Neuropathic Arthropathy
  • Osteoarthropathy

Differential Diagnosis

Specialists

  • Hand Surgeon
  • Internal Medicine Physician
  • Occupational Therapist
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist

Comorbid Conditions

Factors Influencing Duration

Duration depends on cause and underlying diagnosis. Length of disability depends on the specific diagnosis of the condition causing symptoms and the individual's job requirements. Depending on the reasons for the condition, some individuals may not be able to return to work as quickly as others; disability depends on the type of duties involved and response to treatment.

Medical Codes

ICD-9-CM:
274.0 - Gouty Arthropathy (Gouty Arthritis)
274.00 - Gouty arthropathy, unspecified
274.01 - Acute gouty arthropathy
274.02 - Chronic gouty arthropathy without mention of tophus (tophi)
711 - Arthropathy Associated with Infections
711.00 - Arthropathy Associated with Infections, Pyogenic Arthritis; Arthritis or Polyarthritis (Due to): Coliform [Escherichia coli], Hemophilus Influenza [H. Influenza], Pneumococcal Pseudomonas, Staphylococcal; Streptococcal; Pyarthrosis, Site Unspecified
711.01 - Arthropathy Associated with Infections, Pyogenic Arthritis; Arthritis or Polyarthritis (Due to): Coliform [Escherichia coli], Hemophilus Influenza [H. Influenza], Pneumococcal Pseudomonas, Staphylococcal; Streptococcal; Pyarthrosis, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
711.02 - Arthropathy Associated with Infections, Pyogenic Arthritis; Arthritis or Polyarthritis (Due to): Coliform [Escherichia coli], Hemophilus Influenza [H. Influenza], Pneumococcal Pseudomonas, Staphylococcal; Streptococcal; Pyarthrosis, Upper Arm; Elbow Joint; Humerus
711.03 - Arthropathy Associated with Infections, Pyogenic Arthritis; Arthritis or Polyarthritis (Due to): Coliform [Escherichia coli], Hemophilus Influenza [H. Influenza], Pneumococcal Pseudomonas, Staphylococcal; Streptococcal; Pyarthrosis, Forearm; Radius; Ulna; Wrist Joint
711.04 - Arthropathy Associated with Infections, Pyogenic Arthritis; Arthritis or Polyarthritis (Due to): Coliform [Escherichia coli], Hemophilus Influenza [H. Influenza], Pneumococcal Pseudomonas, Staphylococcal; Streptococcal; Pyarthrosis, Hand; Carpus; Metacarpus; Phalanges [Fingers]
711.05 - Arthropathy Associated with Infections, Pyogenic Arthritis; Arthritis or Polyarthritis (Due To): Coliform [Escherichia coli], Hemophilus Influenza [H. Influenza], Pneumococcal Pseudomonas, Staphylococcal; Streptococcal; Pyarthrosis, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
711.06 - Arthropathy Associated with Infections, Pyogenic Arthritis; Arthritis or Polyarthritis (Due to): Coliform [Escherichia coli], Hemophilus Influenza [H. Influenza], Pneumococcal Pseudomonas, Staphylococcal; Streptococcal; Pyarthrosis, Lower Leg; Fibula; Knee Joint; Patella; Tibia
711.07 - Arthropathy Associated with Infections, Pyogenic Arthritis; Arthritis or Polyarthritis (Due to): Coliform [Escherichia coli], Hemophilus Influenza [H. Influenza], Pneumococcal Pseudomonas, Staphylococcal; Streptococcal; Pyarthrosis, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
711.08 - Arthropathy Associated with Infections, Pyogenic Arthritis; Arthritis or Polyarthritis (Due to): Coliform [Escherichia coli], Hemophilus Influenza [H. Influenza], Pneumococcal Pseudomonas, Staphylococcal; Streptococcal; Pyarthrosis, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
711.09 - Arthropathy Associated with Infections, Pyogenic Arthritis; Arthritis or Polyarthritis (Due to): Coliform [Escherichia coli], Hemophilus Influenza [H. Influenza], Pneumococcal Pseudomonas, Staphylococcal; Streptococcal; Pyarthrosis, Multiple Sites
711.10 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Site Unspecified
711.11 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
711.12 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Upper Arm; Elbow Joint; Humerus
711.13 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Forearm; Radius; Ulna; Wrist Joint
711.14 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Hand; Carpus; Metacarpus; Phalanges [Fingers]
711.15 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
711.16 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Lower Leg; Fibula; Knee Joint; Patella; Tibia
711.17 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
711.18 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
711.19 - Arthropathy Associated with Infections, Arthropathy Associated with Reiters Disease and Nonspecific Urethritis, Multiple Sites
711.20 - Arthropathy Associated with Infections, Arthropathy in Behcets Syndrome, Site Unspecified
711.21 - Arthropathy Associated with Infections, Arthropathy in Behcets Syndrome, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
711.22 - Arthropathy Associated with Infections, Arthropathy in Behcets Syndrome, Upper Arm; Elbow Joint; Humerus
711.23 - Arthropathy Associated with Infections, Arthropathy in Behcets Syndrome, Forearm; Radius; Ulna; Wrist Joint
711.24 - Arthropathy Associated with Infections, Arthropathy in Behcets Syndrome, Hand; Carpus; Metacarpus; Phalanges [Fingers]
711.25 - Arthropathy Associated with Infections, Arthropathy in Behcets Syndrome, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
711.26 - Arthropathy Associated with Infections, Arthropathy in Behcets Syndrome, Lower Leg; Fibula; Knee Joint; Patella; Tibia
711.27 - Arthropathy Associated with Infections, Arthropathy in Behcets Syndrome, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
711.28 - Arthropathy Associated with Infections, Arthropathy in Behcets Syndrome, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
711.29 - Arthropathy Associated with Infections, Arthropathy in Behcets Syndrome, Multiple Sites
711.30 - Arthropathy Associated with Infections, Postdysenteric Arthropathy, Site Unspecified
711.31 - Arthropathy Associated with Infections, Postdysenteric Arthropathy, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
711.32 - Arthropathy Associated with Infections, Postdysenteric Arthropathy, Upper Arm; Elbow Joint; Humerus
711.33 - Arthropathy Associated with Infections, Postdysenteric Arthropathy, Forearm; Radius; Ulna; Wrist Joint
711.34 - Arthropathy Associated with Infections, Postdysenteric Arthropathy, Hand; Carpus; Metacarpus; Phalanges [Fingers]
711.35 - Arthropathy Associated with Infections, Postdysenteric Arthropathy, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
711.36 - Arthropathy Associated with Infections, Postdysenteric Arthropathy, Lower Leg; Fibula; Knee Joint; Patella; Tibia
711.37 - Arthropathy Associated with Infections, Postdysenteric Arthropathy, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
711.38 - Arthropathy Associated with Infections, Postdysenteric Arthropathy, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
711.39 - Arthropathy Associated with Infections, Postdysenteric Arthropathy, Multiple Sites
711.40 - Arthropathy Associated with Infections, Arthropathy Associated with Other Bacterial Diseases, Site Unspecified
711.41 - Arthropathy Associated with Infections, Arthropathy Associated with Other Bacterial Diseases, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
711.42 - Arthropathy Associated with Infections, Arthropathy Associated with Other Bacterial Diseases, Upper Arm; Elbow Joint; Humerus
711.43 - Arthropathy Associated with Infections, Arthropathy Associated with Other Bacterial Diseases, Forearm; Radius; Ulna; Wrist Joint
711.44 - Arthropathy Associated with Infections, Arthropathy Associated with Other Bacterial Diseases, Hand; Carpus; Metacarpus; Phalanges [Fingers]
711.45 - Arthropathy Associated with Infections, Arthropathy Associated with Other Bacterial Diseases, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
711.46 - Arthropathy Associated with Infections, Arthropathy Associated with Other Bacterial Diseases, Lower Leg; Fibula; Knee Joint; Patella; Tibia
711.47 - Arthropathy Associated with Infections, Arthropathy Associated with Other Bacterial Diseases, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
711.48 - Arthropathy Associated with Infections, Arthropathy Associated with Other Bacterial Diseases, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
711.49 - Arthropathy Associated with Infections, Arthropathy Associated with Other Bacterial Diseases, Multiple Sites
711.50 - Arthropathy Associated with Other Viral Diseases, Site Unspecified
711.51 - Arthropathy Associated with Other Viral Diseases, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
711.52 - Arthropathy Associated with Other Viral Diseases, Upper Arm; Elbow Joint; Humerus
711.53 - Arthropathy Associated with Other Viral Diseases, Forearm; Radius; Ulna; Wrist Joint
711.54 - Arthropathy Associated with Other Viral Diseases, Hand; Carpus; Metacarpus; Phalanges [Fingers]
711.55 - Arthropathy Associated with Other Viral Diseases, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
711.56 - Arthropathy Associated with Other Viral Diseases, Lower Leg; Fibula; Knee Joint; Patella; Tibia
711.57 - Arthropathy Associated with Other Viral Diseases, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
711.58 - Arthropathy Associated with Other Viral Diseases, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
711.59 - Arthropathy Associated with Other Viral Diseases, Multiple Sites
711.60 - Arthropathy Associated with Mycoses, Site Unspecified
711.61 - Arthropathy Associated with Mycoses, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
711.62 - Arthropathy Associated with Mycoses, Upper Arm; Elbow Joint; Humerus
711.63 - Arthropathy Associated with Mycoses, Forearm; Radius; Ulna; Wrist Joint
711.64 - Arthropathy Associated with Mycoses, Hand; Carpus; Metacarpus; Phalanges [Fingers]
711.65 - Arthropathy Associated with Mycoses, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
711.66 - Arthropathy Associated with Mycoses, Lower Leg; Fibula; Knee Joint; Patella; Tibia
711.67 - Arthropathy Associated with Mycoses, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
711.68 - Arthropathy Associated with Mycoses, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
711.69 - Arthropathy Associated with Mycoses, Multiple Sites
711.70 - Arthropathy Associated with Helminthiasis, Site Unspecified
711.71 - Arthropathy Associated with Helminthiasis, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
711.72 - Arthropathy Associated with Helminthiasis, Upper Arm; Elbow Joint; Humerus
711.73 - Arthropathy Associated with Helminthiasis, Forearm; Radius; Ulna; Wrist Joint
711.74 - Arthropathy Associated with Helminthiasis, Hand; Carpus; Metacarpus; Phalanges [Fingers]
711.75 - Arthropathy Associated with Helminthiasis, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
711.76 - Arthropathy Associated with Helminthiasis, Lower Leg; Fibula; Knee Joint; Patella; Tibia
711.77 - Arthropathy Associated with Helminthiasis, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
711.78 - Arthropathy Associated with Helminthiasis, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
711.79 - Arthropathy Associated with Helminthiasis, Multiple Sites
711.80 - Arthropathy Associated with Other Infectious and Parasitic Diseases, Site Unspecified
711.81 - Arthropathy Associated with Other Infectious and Parasitic Diseases, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
711.82 - Arthropathy Associated with Other Infectious and Parasitic Diseases, Upper Arm; Elbow Joint; Humerus
711.83 - Arthropathy Associated with Other Infectious and Parasitic Diseases, Forearm; Radius; Ulna; Wrist Joint
711.84 - Arthropathy Associated with Other Infectious and Parasitic Diseases, Hand; Carpus; Metacarpus; Phalanges [Fingers]
711.85 - Arthropathy Associated with Other Infectious and Parasitic Diseases, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
711.86 - Arthropathy Associated with Other Infectious and Parasitic Diseases, Lower Leg; Fibula; Knee Joint; Patella; Tibia
711.87 - Arthropathy Associated with Other Infectious and Parasitic Diseases, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
711.88 - Arthropathy Associated with Other Infectious and Parasitic Diseases, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
711.89 - Arthropathy Associated with Other Infectious and Parasitic Diseases, Multiple Sites
711.90 - Arthropathy Associated with Infections, Unspecified Infective Arthritis, Site Unspecified
711.91 - Arthropathy Associated with Infections, Unspecified Infective Arthritis, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
711.92 - Arthropathy Associated with Infections, Unspecified Infective Arthritis, Upper Arm; Elbow Joint; Humerus
711.93 - Arthropathy Associated with Infections, Unspecified Infective Arthritis, Forearm; Radius; Ulna; Wrist Joint
711.94 - Arthropathy Associated with Infections, Unspecified Infective Arthritis, Hand; Carpus; Metacarpus; Phalanges [Fingers]
711.95 - Arthropathy Associated with Infections, Unspecified Infective Arthritis, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
711.96 - Arthropathy Associated with Infections, Unspecified Infective Arthritis, Lower Leg; Fibula; Knee Joint; Patella; Tibia
711.97 - Arthropathy Associated with Infections, Unspecified Infective Arthritis, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
711.98 - Arthropathy Associated with Infections, Unspecified Infective Arthritis, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
711.99 - Arthropathy Associated with Infections, Unspecified Infective Arthritis, Multiple Sites
712 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis
712.10 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due to Dicalcium Phosphate Crystals; Chondrocalcinosis Due to Dicalcium Phosphate Crystals (with Other Crystals), Site Unspecified
712.11 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due to Dicalcium Phosphate Crystals; Chondrocalcinosis Due to Dicalcium Phosphate Crystals (with Other Crystals), Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
712.12 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due to Dicalcium Phosphate Crystals; Chondrocalcinosis Due to Dicalcium Phosphate Crystals (with Other Crystals), Upper Arm; Elbow Joint; Humerus
712.13 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due to Dicalcium Phosphate Crystals; Chondrocalcinosis Due to Dicalcium Phosphate Crystals (with Other Crystals), Forearm; Radius; Ulna; Wrist Joint
712.14 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due to Dicalcium Phosphate Crystals; Chondrocalcinosis Due to Dicalcium Phosphate Crystals (with Other Crystals), Hand; Carpus; Metacarpus; Phalanges [Fingers]
712.15 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due to Dicalcium Phosphate Crystals; Chondrocalcinosis Due to Dicalcium Phosphate Crystals (with Other Crystals), Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
712.16 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due to Dicalcium Phosphate Crystals; Chondrocalcinosis Due to Dicalcium Phosphate Crystals (with Other Crystals), Lower Leg; Fibula; Knee Joint; Patella; Tibia
712.17 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due to Dicalcium Phosphate Crystals; Chondrocalcinosis Due to Dicalcium Phosphate Crystals (with Other Crystals), Foot; Tarsus; Other Joints in Foot
712.18 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due to Dicalcium Phosphate Crystals; Chondrocalcinosis Due to Dicalcium Phosphate Crystals (with Other Crystals), Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
712.19 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due to Dicalcium Phosphate Crystals; Chondrocalcinosis Due to Dicalcium Phosphate Crystals (with Other Crystals), Multiple Sites
712.20 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due to Pyrophosphate Crystals, Site Unspecified
712.21 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due to Pyrophosphate Crystals, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
712.22 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due To Pyrophosphate Crystals, Upper Arm; Elbow Joint; Humerus
712.23 - Crystal Arthropathies, includes Crystal-Induced Arthritis and Synovitis, Chondrocalcinosis due to Pyrophosphate Crystals, Forearm; Radius; Ulna; Wrist Joint
712.24 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due To Pyrophosphate Crystals, Hand; Carpus; Metacarpus; Phalanges [Fingers]
712.25 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due To Pyrophosphate Crystals, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
712.26 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due To Pyrophosphate Crystals, Lower Leg; Fibula; Knee Joint; Patella; Tibia
712.27 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due To Pyrophosphate Crystals, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
712.28 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due To Pyrophosphate Crystals, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
712.29 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis Due to Pyrophosphate Crystals, Multiple Sites
712.30 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis, Unspecified, Site Unspecified
712.31 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis, Unspecified, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
712.32 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis, Unspecified, Upper Arm; Elbow Joint; Humerus
712.33 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis, Unspecified, Forearm; Radius; Ulna; Wrist Joint
712.34 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis, Unspecified, Hand; Carpus; Metacarpus; Phalanges [Fingers]
712.35 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis, Unspecified, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
712.36 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis, Unspecified, Lower Leg; Fibula; Knee Joint; Patella; Tibia
712.37 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis, Unspecified, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
712.38 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis, Unspecified, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
712.39 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Chondrocalcinosis, Unspecified, Unspecified, Multiple Sites
712.80 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Other Specified Crystal Arthropathies, Site Unspecified
712.81 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Other Specified Crystal Arthropathies, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
712.82 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Other Specified Crystal Arthropathies, Upper Arm; Elbow Joint; Humerus
712.83 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Other Specified Crystal Arthropathies, Forearm; Radius; Ulna; Wrist Joint
712.84 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Other Specified Crystal Arthropathies, Hand; Carpus; Metacarpus; Phalanges [Fingers]
712.85 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Other Specified Crystal Arthropathies, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
712.86 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Other Specified Crystal Arthropathies, Lower Leg; Fibula; Knee Joint; Patella; Tibia
712.87 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Other Specified Crystal Arthropathies, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
712.88 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Other Specified Crystal Arthropathies, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
712.89 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Other Specified Crystal Arthropathies, Multiple Sites
712.90 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Unspecified Crystal Arthropathy, Site Unspecified
712.91 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Unspecified Crystal Arthropathy, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
712.92 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Unspecified Crystal Arthropathy, Upper Arm; Elbow Joint; Humerus
712.93 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Unspecified Crystal Arthropathy, Forearm; Radius; Ulna; Wrist Joint
712.94 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Unspecified Crystal Arthropathy, Hand; Carpus; Metacarpus; Phalanges [Fingers]
712.95 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Unspecified Crystal Arthropathy, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
712.96 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Unspecified Crystal Arthropathy, Lower Leg; Fibula; Knee Joint; Patella; Tibia
712.97 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Unspecified Crystal Arthropathy, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
712.98 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Unspecified Crystal Arthropathy, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
712.99 - Crystal Arthropathies, Includes Crystal-induced Arthritis and Synovitis, Unspecified Crystal Arthropathy, Multiple Sites
713 - Arthropathy Associated with Other Disorders Classified Elsewhere
713.0 - Arthropathy Associated with Other Endocrine and Metabolic Disorders
713.1 - Arthropathy Associated with Gastrointestinal Conditions Other than Infections
713.2 - Arthropathy Associated with Hematological Disorders
713.3 - Arthropathy Associated with Dermatological Disorders
713.4 - Arthropathy Associated with Respiratory Disorders
713.5 - Arthropathy Associated with Neurological Disorders; Charcots Arthropathy Associated with Diseases Classifiable Elsewhere; Neuropathic Arthritis Associated with Diseases Classifiable Elsewhere
713.6 - Arthropathy Associated with Hypersensitivity Reaction
713.7 - Other General Diseases with Articular Involvement
713.8 - Arthropathy Associated with Other Conditions Classifiable Elsewhere
716 - Other and Unspecified Arthropathies
716.1 - Traumatic Arthropathy
716.10 - Traumatic Arthropathy, Site Unspecified
716.11 - Traumatic Arthropathy, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
716.14 - Traumatic Arthropathy, Hand; Carpus; Metacarpus; Phalanges [Fingers]
716.15 - Traumatic Arthropathy, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
716.16 - Traumatic Arthropathy, Lower Leg; Fibula; Knee Joint; Patella; Tibia
716.17 - Traumatic Arthropathy, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
716.18 - Traumatic Arthropathy, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
716.4 - Transient Arthropathy
716.40 - Transient Arthropathy, Site Unspecified
716.41 - Transient Arthropathy, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
716.42 - Transient Arthropathy, Upper Arm; Elbow Joint; Humerus
716.43 - Transient Arthropathy, Forearm; Radius; Ulna; Wrist Joint
716.44 - Transient Arthropathy, Hand; Carpus; Metacarpus; Phalanges [Fingers]
716.45 - Transient Arthropathy, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
716.46 - Transient Arthropathy, Lower Leg; Fibula; Knee Joint; Patella; Tibia
716.47 - Transient Arthropathy, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
716.48 - Transient Arthropathy, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
716.49 - Transient Arthropathy, Multiple Sites
716.5 - Unspecified Polyarthropathy or Polyarthritis
716.50 - Unspecified Polyarthropathy or Polyarthritis, Site Unspecified
716.51 - Unspecified Polyarthropathy or Polyarthritis, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
716.52 - Unspecified Polyarthropathy or Polyarthritis, Upper Arm; Elbow Joint; Humerus
716.53 - Unspecified Polyarthropathy or Polyarthritis, Forearm; Radius; Ulna; Wrist Joint
716.54 - Unspecified Polyarthropathy or Polyarthritis, Hand; Carpus; Metacarpus; Phalanges [Fingers]
716.55 - Unspecified Polyarthropathy or Polyarthritis, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
716.56 - Unspecified Polyarthropathy or Polyarthritis, Lower Leg; Fibula; Knee Joint; Patella; Tibia
716.57 - Unspecified Polyarthropathy or Polyarthritis, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
716.58 - Unspecified Polyarthropathy or Polyarthritis, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
716.59 - Unspecified Polyarthropathy or Polyarthritis, Multiple Sites
716.8 - Other Specified Arthropathy
716.80 - Other Specified Arthropathy, Site Unspecified
716.81 - Other Specified Arthropathy, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
716.82 - Other Specified Arthropathy, Upper Arm; Elbow Joint; Humerus
716.83 - Other Specified Arthropathy, Forearm; Radius; Ulna; Wrist Joint
716.84 - Other Specified Arthropathy, Hand; Carpus; Metacarpus; Phalanges [Fingers]
716.85 - Other Specified Arthropathy, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
716.86 - Other Specified Arthropathy, Lower Leg; Fibula; Knee Joint; Patella; Tibia
716.87 - Other Specified Arthropathy, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
716.88 - Other Specified Arthropathy, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
716.89 - Other Specified Arthropathy, Multiple Sites
716.9 - Arthropathy, Unspecified; Arthritis (Acute) (Chronic) (Subacute); Articular Rheumatism (Chronic); Inflammation of Joint, NOS
716.91 - Arthropathy, Unspecified; Arthritis (Acute) (Chronic) (Subacute); Articular Rheumatism (Chronic); Inflammation of Joint, NOS, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
716.96 - Arthropathy, Unspecified; Arthritis (Acute) (Chronic) (Subacute); Articular Rheumatism (Chronic); Inflammation of Joint, NOS, Lower Leg; Fibula; Knee Joint; Patella; Tibia
716.97 - Arthropathy, Unspecified; Arthritis (Acute) (Chronic) (Subacute); Articular Rheumatism (Chronic); Inflammation of Joint, NOS, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot

Overview

Arthropathy is a collective term for any disease of the joints. The disease may be localized to one joint, as with post-traumatic arthritis, or may affect multiple joints, as with osteoarthritis or rheumatoid arthritis. It may also be due to an underlying condition such as a bacterial infection (infectious, pyogenic, or septic arthritis). Neuropathic arthropathy refers to bone and joint changes that develop secondary to loss of sensation associated with various disorders, including diabetes, trauma, infection, pernicious anemia, spina bifida, or amyloidosis. Arthropathy is frequently associated with articular trauma, joint slippage (subluxation) and instability, or degenerative changes of the joint. The most common form of arthropathy is osteoarthritis, in which there is progressive loss of articular joint cartilage with reactive changes at the joint margins and subchondral bone, resulting in joint degeneration.

In fully developed arthropathy, joint degeneration is accompanied by enlargement of the joint from swelling caused by synovial fluid joint effusion, and the development of bony overgrowth at the joint margins (osteophyte formation). Eventually, joint deformity increases as microfractures, ligamentous looseness (laxity), and decreased muscular support occur. Increased joint laxity and periarticular fractures may also result in small pieces of bone or cartilage (loose bodies) that fragment into the joint. This may result in a grating or grinding noise when the joint is moved (crepitus), although crepitus also may be secondary to other causes.

Arthropathy may be the result of degenerative joint diseases such as facet joint arthropathy or knee osteoarthritis; bleeding into a joint (intra-articular hemorrhage) from trauma or hemophilia; neuropathic arthropathy secondary to diabetes (Charcot joint) or to Charcot-Marie-Tooth disease; inflammatory joint disorders such as rheumatoid arthritis, ankylosing spondylitis and polymyalgia rheumatica; inflammatory bowel disease (IBD) such as ulcerative colitis or Crohn's disease; autoimmune disorders such as systemic lupus erythematosus; septic disorders such as osteomyelitis and septic arthritis caused by bacterial or fungal infections; and crystal-depositing disorders such as gout or pseudogout.

Degenerative arthropathy may occur as the result of a single trauma to the joint, such as an acute shoulder dislocation or as the result of a healed fracture that occurred in or around the joint (intra-articular or periarticular fracture), in which case it is called post-traumatic arthritis. Degenerative arthropathy can also occur secondary to malunion of a nearby fracture that results in altered biomechanics of the joint.

Neuropathic arthropathy is the rapid degeneration of joints due to a loss of sensation associated with certain diseases, resulting in impaired position sense and pain perception. Although the exact pathophysiology of neuropathic arthropathy is not known, joint degeneration appears to develop when the individual who has lost deep sensation is unable to feel multiple small episodes of joint trauma that occur with certain conditions, and because of inadequate fine motor control which creates abnormal pressures on joints. Among conditions that are most likely to result in neuropathic arthropathy are diabetes mellitus with diabetic neuropathy, syringomyelia, spinal cord and peripheral nerve tumors, and Charcot-Marie Tooth disease. Almost any joint may be affected by neuropathic arthropathy, depending upon the underlying disease, but the knee joint is involved most frequently. Usually one to three joints are affected, normally in an asymmetrical distribution.

Gout and other crystal-associated arthropathies are caused by the deposition of monosodium urate (MSU), calcium pyrophosphate dehydrate (CPPD), calcium apatite, or calcium oxalate crystals, inducing acute or chronic osteoarthritis or periarthritis. MSU (gout) and CPPD (pseudogout) crystal deposition may also lead to degenerative arthropathy via repeated, intermittent attacks of acute arthritis. This frequently occurs in large, peripheral joints, particularly in the lower extremity.

Joint damage resulting in arthropathy may occur from the inflammatory reaction of infectious arthritis. The joint may become infected via surgery, injection, animal or even insect bite, trauma, abscess, osteomyelitis, or sepsis.

Individuals with diabetes or any underlying degenerative joint conditions are more likely to develop arthropathy.

Incidence and Prevalence: The exact incidence of multiple arthropathies is not known because occurrence of arthropathy is so often secondary to an underlying disease. Osteoarthritis affects over 20 million individuals in the US and is the most common articular disease worldwide (Lozada). The incidence of rheumatoid arthritis is 1% in US and global populations (Smith). The overall incidence of neuropathic arthropathy is not known, but neuropathic arthropathy associated with diabetes is estimated at 15% of diabetic patients in the US and worldwide (Khan).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Osteoarthritis, the most common type of arthropathy, is more common in those over age 40 years and is a leading cause of disability in individuals over age 65 years (Moses). Between the ages of 40 and 70, women are more troubled with osteoarthritis than men; after age 70, the rates are the same (Brandt; Porter).

Source: Medical Disability Advisor



Diagnosis

History: The individual may report recent trauma or acute onset of joint pain, or pain may be more gradual and chronic in nature. Individuals may describe symptoms occurring at any joint in the body, with type of pain ranging from dull to sharp, aching to throbbing. The joint may be stiff and painful with movement or weight bearing. Red, hot, and swollen joints may be reported. The individual may feel feverish if infectious arthritis is present; fever, malaise, and weight loss may also accompany severe rheumatoid arthritis. To help identify possible underlying causes, the individual should be asked to describe whether symptom onset was gradual or sudden and whether symptoms are constant or intermittent. A history of current and previous illnesses and injury will be obtained.

Physical exam: Stiffness or decreased joint range of motion may be evident in the individual's posture or gait pattern. The joint may be reddened and may be warm and sensitive to the touch (palpation). Accumulation of fluid (joint effusion) may be present. When joint range of motion is tested, there may be palpable crepitus, and there usually is at least some reduction in joint motion. A full physical examination will be conducted to assess health status and identify signs and symptoms of an underlying disease.

Tests: Blood tests can detect inflammation and rule out some underlying conditions. Tests may include a complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). A blood chemistry panel and various tests to detect the presence of specific antibodies in the blood may be needed to identify underlying diseases. Aspiration of joint synovial fluid may be necessary to culture for infective organisms responsible for systemic disease, and to examine for the presence of MSU or CPPD crystals. Polarizing light microscopy and other crystallographic techniques may be used to identify microcrystals in joint fluid.

The single finding present in all arthropathy is the loss of some (or in severe cases, all) of the joint articular cartilage, which is easily seen on x-ray. X-rays may show a swollen, deformed joint that may be subluxed. There may be significant formation of new bone (osteophytes) at the joint margins; at the spinal joints, these may be "parrot beaked" in shape. Articular cartilage calcification may be observed. In the spine, diagnostic nerve blocks may be indicated to determine the location of the arthropathy. Magnetic resonance imaging (MRI) and/or computed tomography (CT) scans can help diagnose unidentifiable, persistent pain. A bone scan may help rule out occult fracture, stress fracture, or neoplasm. On bone scan, arthritic joints usually show at least mild increased isotope uptake.

Source: Medical Disability Advisor



Treatment

Treatment depends upon the specific diagnosis and the underlying cause of joint pain or inflammation. Nonsteroidal anti-inflammatory oral drugs are used in early and in late stage arthropathy; these drugs have both analgesic and anti-inflammatory effects. In some diseases (e.g., rheumatoid arthritis), potent anti-inflammatory medications may be used to reduce the degenerative inflammatory process, and immunosuppressive drugs, disease modifying antirheumatic drugs (DMARDS), or biologic therapies may be used to slow the progression of the disease. In other diseases such as osteoarthritis, medication may control symptoms but does not change the progression of the disease. Short-term immobilization using a resting splint or special immobilizing boot may help decrease the speed of joint degeneration in a peripheral joint. Arthropathy may be treated with physical and/or occupational therapy to instruct the individual in stretching and strengthening exercises, as well as in joint protection strategies. Antibiotics may be required to treat arthropathy secondary to underlying infectious arthritis.

Painful spinal joints can be selectively injected with a local anesthetic and an anti-inflammatory corticosteroid to reduce back pain. Similarly, joints in the upper and lower limbs may be injected with an anti-inflammatory corticosteroid, or with hyaluronic acid derivatives to improve joint lubrication. The pain relief from injections is temporary. If effective, the injections can be repeated.

Surgery may be required in cases of severe arthropathy. In the spine, hypertrophic facet arthropathy may require partial facetectomy, decompressive laminectomy, or spinal fusion if spinal nerves are being compressed by new bone formation. Spinal fusion may also be necessary if spinal instability is present. If a joint is unstable, arthrodesis may be necessary using stabilizing hardware (internal fixation) or bone grafting to stabilize the joint and reduce pain. Total joint replacement may be necessary (e.g., total knee or hip replacement) if joint surfaces have been destroyed.

Surgery for total joint replacement has continued to improve. Total hip or knee replacement is common. Total shoulder or elbow replacement is evolving. Total wrist or ankle replacement is less common. Joint replacement of the fingers is common.

Source: Medical Disability Advisor



ACOEM

ACOEM's Practice Guidelines, the gold standard in effective medical treatment of occupational injuries and illnesses, are provided in this section to complement the disability duration guidelines.*
 
Chronic Pain
 
* The relationship between the MDGuidelines (MDA) content and ACOEM's guidelines is approximate and does not always link identical diagnoses. The user should consult the diagnostic codes in both guidelines, as well as the clinical descriptions, before assuming an equivalence.

Source: ACOEM Practice Guidelines



Prognosis

Since arthropathy is usually a symptom of an underlying condition, the expected outcome depends on the specific diagnosis. Pain from arthropathy accompanying widespread (systemic) infection usually resolves along with the underlying condition. However, if ongoing (chronic) disease such as osteoarthritis, rheumatoid arthritis, or psoriatic arthritis is the underlying cause, symptoms may continue indefinitely.

Source: Medical Disability Advisor



Rehabilitation

Rehabilitation therapy for arthropathy depends on the underlying cause and location of the affected joint. The goal of treatment is to decrease pain and inflammation, increase function, and teach patients how to manage their symptoms. Some conditions associated with arthropathy are progressively debilitating and may eventually cause permanent joint damage. Physical therapy for these individuals may be intermittent and aims to maintain joint mobility and strength as the condition progresses. Since arthropathy is often progressively degenerative, other therapeutic interventions such as pain management, occupational therapy, or counseling may be part of the rehabilitation plan.

Initially, pain-relieving modalities such as ice or heat to reduce swelling and pain may be used in combination with stabilization or immobilization of the painful joint. Physical and/or occupational therapy treatment should then focus on improving joint range of motion, strength, and proprioception. The specific treatment protocol will depend on the underlying diagnosis. During an acute stage of joint pain, the individual is instructed to rest and possibly use a splint or protective boot on the affected joint. Individuals may be instructed to perform isometric exercises (contraction of a muscle without joint movement) during this stage, and should be educated on how to protect the affected joint.

Once the acute stage subsides, it is important to get the joint active through its full range of motion while balancing rest and exercise. Active assisted range of motion exercises are implemented as tolerated, without overstretching the joint or increasing intra-articular pressure or joint temperature. Once the subacute phase has ended, the inflammatory response in the joints will have decreased enough that the individual may begin gentle stretching and more dynamic low-resistance isotonic exercises.

The physical therapists will instruct individuals in a progression of flexibility and strengthening exercises as tolerated. Therapists educate the patient on joint mechanics and loading so that the individual can moderate the exercises according to the pain level on a given day. The individual may be instructed in the use of an assistive device to improve ambulation and to decrease loading of the affected joint. Exercises to improve strength and stability of the joint will also be utilized.

Occupational therapists may re-evaluate the person's home environment to assess everyday living activities and recommend changes to help reduce joint stress. Therapists instruct individuals to make environmental changes, learn energy conservation techniques, and use adaptive equipment to protect the affected joint on a daily basis. The individual may be instructed to wear a night splint to help reduce excess motion and joint strain during sleep.

Rehabilitation visits are dependent on the condition being treated. See specific diagnosis sections for details.

Source: Medical Disability Advisor



Complications

No complications are expected from the conservative treatment of arthropathy. If surgery is required, complications such as wound infection or poor wound healing may occur. Following total joint replacement, the prosthesis may loosen or dislocate.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Limitations on physical activity may be necessary due to joint pain and stiffness, and the individual's ability to use his or her upper extremities, bear weight, or ambulate, depending on the joint or joints affected. The nature and duration of the limitations depend on the specific diagnosis, the severity of symptoms, and workplace duties. Workplace accommodations may include avoidance of tasks that require physical strength or that stress certain affected joints. Time off may be required for rest and recovery from underlying conditions such as an infection or disease, or if surgery is required. If the underlying condition causing the symptoms is ongoing (chronic), the individual may require permanent reassignment to less physically demanding activities.

Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function.

Accommodations: Accommodations are dependent on the condition causing the arthropathy. If physical limitations are present, then the employer's ability to accommodate is key to early return to work.

Source: Medical Disability Advisor



Maximum Medical Improvement

See specific diagnoses.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Is the underlying condition that is causing the arthropathy known?
  • Has individual had any recent trauma?
  • Does individual have diabetes?
  • Does individual have any bacterial, fungal, or parasitic illnesses?
  • Does individual have inflammatory joint disorders, autoimmune illnesses, or septic disorders?
  • Has individual received blood tests? X-rays? MRI or CT scan? Bone scan?

Regarding treatment:

  • Has underlying condition been determined? Is condition being treated?
  • Is primary disease acute or chronic?
  • Has physical or occupational therapy been prescribed?
  • Is individual compliant with rehabilitation regimen?
  • Does individual require a resting splint? Walking boot? Assistive device such as cane or walker?

Regarding prognosis:

  • Is condition chronic? Progressive?
  • Does individual have any conditions that could affect ability to recover?
  • Was irreversible joint damage confirmed by radiographic studies?
  • Did individual require surgery? Joint replacement? Fusion?
  • Is individual's employer able to accommodate any necessary restrictions?

Source: Medical Disability Advisor



References

Cited

Brandt, Kenneth D. "Osteoarthritis." Internal Medicine. Ed. Jay H. Stein. 5th ed. St. Louis: Mosby, Inc., 1998. 1264-1268.

Lozada, Carlos J., et al. "Osteoarthritis." eMedicine. Ed. Herbert S. Diamond. 12 Jul. 2013. Medscape. 2 Oct. 2013 <http://emedicine.medscape.com/article/330487-overview>.

Moses, Scott. "Osteoarthritis." Family Practice Notebook. 2 Nov. 2008. 2 Oct. 2013 <http://www.fpnotebook.com/Rheum/Osteoarthritis/Ostrthrts.htm>.

Porter, Robert S., et al., eds. "Osteoarthritis (OA)." Merck. Eds. Robert S. Porter, et al. Nov. 2013. Merck & Co., Inc. 2 Oct. 2013 <http://www.merck.com/mmpe/sec04/ch034/ch034e.html#sec04-ch034-ch034e-524>.

Smith, Howard R., and Katherine Temprano. "Rheumatoid Arthritis." eMedicine. 1 Oct. 2013. Medscape. 2 Oct. 2013 <http://emedicine.medscape.com/article/331715-overview>.

Source: Medical Disability Advisor






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