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.

Bone Spur


Related Terms

  • Enthesophyte
  • Osteophyte

Differential Diagnosis

  • Back or neck pain from injury or strenuous physical activity
  • Bursitis of heel or shoulder
  • Cervical or lumbar radiculopathy
  • Compression of posterior tibial nerve (tarsal tunnel syndrome)
  • Degenerated and / or herniated disc
  • Fracture of heel bone (calcaneus)
  • Gout
  • Impingement syndrome
  • Inflammation of ligaments (e.g., plantar fasciitis)
  • Outward rotation of heel and inward rotation of ankle (pronation)
  • Sciatica

Specialists

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

Comorbid Conditions

Factors Influencing Duration

Factors influencing length of disability include the severity of pain associated with the bone spur, the method of treatment (conservative or surgical), the individual's response to treatment and adherence to recommendations, and the individual's job requirements and leisure activities.

Medical Codes

ICD-9-CM:
721.8 - Other Allied Disorders of Spine
726.30 - Enthesopathy of Elbow, Unspecified
726.5 - Enthesopathy of Hip Region; Bursitis of Hip; Gluteal Tendinitis; Iliac Crest Spur; Psoas Tendinitis; Trochanteric Tendinitis
726.60 - Enthesopathy of knee, Unspecified; Bursitis of Knee NOS
726.70 - Enthesopathy of Ankle and Tarsus, Unspecified; Metatarsalgia, NOS
726.73 - Heel Spur; Calcaneal Spur
726.91 - Exostosis of Unspecified Site; Bone Spur

Overview

Bone spurs, also called osteophytes, are bony projections (bone growths) that develop along the edges of bones, around injured joints or joints that are frequently used, or in an injured bone. Bone spurs should be distinguished from enthesophytes, which are bony projections that form at the site of attachment of a tendon or ligament, as in the heel spur. Osteophytes are common signs of osteoarthritis and can be seen in the end joints (distal interphalangeal [DIP] joints) of the fingers as Heberden's nodes or in the middle joints (proximal interphalangeal [PIP] joints) of the fingers as Bouchard's nodes; spine; elbow; and feet, to name the most common areas. The main cause of bone spurs (osteophytes) is the wear-and-tear damage associated with osteoarthritis.

Unlike the rounded ends of bones in normal joints, bone spurs do not develop a layer of protective cartilage. The growth can enlarge and eventually block range of motion of the joint. The bony spur can sometimes rub against other bony surfaces, nerves, tendons, or blood vessels, causing pain and inflammation.

At the shoulder joint, bone spurs may form over time as tendons that are part of the rotator cuff complex move within the subacromial space between the bone of the shoulder blade (acromion) and the top of the shoulder joint (glenohumeral joint). It is thought that the repeated friction of the rotator cuff tendons against the bone causes inflammation and contributes to reactive bone spur formation (Ramsey).

In the case of the spine, the discs between vertebrae tend to toughen and shrink with age. Meanwhile, the tough, elastic cartilage at the ends of the bones progressively hardens and thins. As the space between the vertebrae narrows, ligaments become slack, allowing extra movement to occur in the spine (microscopic instability). Movement stresses stimulate the ligaments to thicken in an attempt to stabilize the spine, which causes the bone to react, growing the knobby enlargements known as bone spurs.

Bone spurs may also be found on the back of the heel where tight shoes rub, causing inflammation and reactive bone formation ("pump bump"). While these bone spurs on the back of the heel bone can be seen on x-rays, they do not usually cause pain.

Enthesophytes such as heel spurs located on the bottom of the foot are thought to be caused by excessive pulling on the heel bone (calcaneus or os calcis) by the small muscles of the foot (intrinsic muscles) and by the plantar fascia, a ligament-like structure on the bottom of the foot (Green). Because the abnormal pulling of the fascia irritates the calcaneus, the body responds by producing extra bone as a protective mechanism.

Incidence and Prevalence: The incidence of bone spurs increases with age. In persons over age 60, bone spurs of the spine are quite common (Schneider). Not all bone spurs require treatment. Most are found on x-rays that are obtained for other reasons.

Although the majority of heel spurs (enthesophytes) are asymptomatic, they are observed in up to 21% of individuals with plantar fasciitis (Green).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors for bone spurs include advancing age and previous trauma to a joint.

Source: Medical Disability Advisor



Diagnosis

History: Individuals will often present to a physician with nonspecific pain or pain related to specific trauma. X-rays are obtained of the area and bone spurs will be observed. Often the area of pain is not correlated to the location of the bone spur. This is considered an incidental finding and the patient should be so educated.

Occasionally, the area of pain will be located at the bone spur. Although the pain may be in the joint, currently it is unknown if the bone spur is the cause of the pain. Removal of osteophytes around joints does not always result in pain reduction.
In general, most bone spurs are discovered incidentally when the individual seeks medical attention for an adjacent disorder.

Physical exam: When the physician touches (palpates) the affected area, the individual with a bone spur may experience discomfort or pain. However, most spurs are asymptomatic on examination, as many are too deep to locate with external touch. Shoulder range of motion testing may reveal limitations and / or pain when a bone spur is present and impinging on rotator cuff tendons.

Tests: The usual test to identify bone spurs is an x-ray of the affected area, but x-ray results should be viewed with caution. First, x-rays do not always detect very small bone spurs, and second, many individuals with a bone spur on their x-rays never develop symptoms. Magnetic resonance imaging (MRI), computed tomography (CT), or electromyography (EMG) may be used if symptoms suggest impairment of nerves or muscles.

Source: Medical Disability Advisor



Treatment

Treatment is directed at the cause of the patient's pain and varies depending on the structures involved.

Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce pain and inflammation of tissues irritated by a bone spur. Heat, ice, and exercises may also be helpful.

Although controversial, some physicians believe that spinal osteophytes that cause symptoms by impinging on the nerve roots or the spinal cord may require surgical treatment. Another example of controversy is whether acromioclavicular osteophytes that may impinge on the rotator cuff should require arthroscopic or open surgery (débridement) (Ames).

Source: Medical Disability Advisor



Prognosis

In general, the predicted outcome for bone spurs is good in that the symptoms associated with many bone spurs can be resolved with conservative treatment. However, even though symptoms usually resolve, the spur persists and may gradually enlarge. The results of surgical removal of bone spurs are unpredictable. Occasionally, pain persists even after surgery, and surgical relief may be temporary because bone spurs can and do grow back.

Source: Medical Disability Advisor



Rehabilitation

Rehabilitation for bone spurs depends on the location of the bone spur as well as the extent of the condition. Individuals with bone spurs may require outpatient physical therapy to address pain and swelling, whether or not surgery is anticipated.

The primary focus of rehabilitation is to reduce the pain associated with the spur. This can be achieved by reducing pressure on the surrounding tissue and using modalities involving heat, cold, and ultrasound as appropriate. For symptomatic spinal osteophytes causing nerve root compression, the therapist will loosen (mobilize) stiff vertebral joints, educate individuals about improving posture and body mechanics, and initiate an exercise program to restore spinal flexibility and strength.

With shoulder bone spurs, the therapist focuses on improving the individual's biomechanics with reaching activities, performing joint mobilization to restore normal joint mechanics, and instructing the individual in a stretching and strengthening program to reduce muscular imbalances in the involved area.

With heel spurs (enthesophytes), the therapist will reduce the pressure on the spur through activity modification and / or use of orthotics, such as heel cushions. Night splints have not been shown to reduce the pain associated with enthesophytes on the heel, although they can be useful to maintain a stretch on tight plantar fascial tissues (Beyzadeoglu).

In addition to undergoing supervised rehabilitation, the individual should be instructed in a home exercise program to be practiced daily and continued independently under a physician's supervision after the completion of rehabilitation.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistBone Spur
Occupational or Physical TherapistUp to 6 visits within 6 weeks
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Complications

As spurs enlarge, in some locations they can cause symptoms by impinging on adjacent structures (spinal nerve roots or rotator cuff tendons). Heel spurs (enthesophytes) may cause pain when the individual bears weight on the affected area.

Individuals who require surgery to remove a symptomatic bone spur are subject to surgical complications, including poor wound closure, infection, and adverse reactions to anesthesia.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

The treatment and the condition itself may limit the individual's ability to return to previous work activities, temporarily in most cases. If a lower extremity (heel) is involved, use of an assistive device, such as a cane or walker, may be necessary to minimize weight and pressure on the area. If an upper extremity (shoulder) is involved, restrictions may include limited or no overhead lifting and heavy carrying. Use of prescribed medications for management of pain and inflammation may require review of drug policies. Safety issues may need to be evaluated.

Risk: With conservative treatment, the bone spur remains and may enlarge with time. The likelihood of pain returning to the same area is unknown. Most bony spurs are asymptomatic.

Capacity: Functional capacity if usually not limited by bone spurs, unless the osteophyte is blocking joint movement.

Tolerance: Pain will limit function.

Accommodations: Modification of activities during periods of pain will allow an individual to remain at work and work through the pain.

Source: Medical Disability Advisor



Maximum Medical Improvement

60 days.

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:

  • Where is the bone spur located?
  • Is pain present? Do numbness or pin-and-needles sensations occur? Does individual report sharp pain when putting weight on the foot? With overhead reaching?
  • On physical exam, was the area tender to palpation?
  • Was an x-ray done? MRI, CT, or EMG?
  • Were conditions with similar symptoms ruled out?

Regarding treatment:

  • Are NSAIDs being used for pain relief?
  • Does individual have appropriate orthopedic support?
  • Is individual receiving physical therapy?
  • Was surgery necessary?
  • Does individual have a recurrent bone spur?

Regarding prognosis:

  • Is individual active in rehabilitation?
  • Can individual's employer accommodate any necessary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Does individual report recurrent extremity numbness? Tingling?
  • Is individual able to grip objects? Is finger joint flexibility impaired?
  • Has individual developed spinal instability?
  • Has individual developed osteoarthritis or inferior calcaneal bursitis?
  • Is individual wearing appropriate footwear? Is heel cushion being used?
  • Does individual have rotator cuff dysfunction?

Source: Medical Disability Advisor



References

Cited

Ames, J. B. , et al. "Association between acromial index and outcomes following arthroscopic repair of full-thickness rotator cuff tears." Journal of Bone and Joint Surgery 94 (20) (2012): 1862-1869.

Beyzadeoglu, T. , H. Gokce, and H. Bekler. "The Effectiveness of Dorsiflexion Night Splint Added to Conservative Treatment for Plantar Fasciitis (translation of article in Turkish)." Acta Orthop Traumatol Turc 41 3 (2007): 220-224. PubMed. 2 May 2014 <PMID: 17876122>.

Green, D. , and P. S. Kim. "Plantar Calcaneal Spurs: Is Surgery Necessary?" PodiatryToday. 1 May. 2006. HMPCommunications. 2 May 2014 <http://www.podiatrytoday.com/article/5531>.

Hashiguchi, Hiroshi. "Glenohumeral joint now thought to cause subacromial impingement syndrome." ORTHOSupersite. 2009. 2 May 2014 <http://www.orthosupersite.com/view.asp?rID=39506>.

Ramsey, M. L. , C. L. Getz, and B. O. Parsons. "What's New In Shoulder and Elbow Surgery." Journal of Bone and Joint Surgery (American volume) 89 (2007): 220-230.

Schneider, John H. "Bone Spurs (Osteophytes) and Back Pain." Spine-health.com. 14 Dec. 2010. 2 May 2014 <http://www.spine-health.com/topics/cd/spurs/spurs01.html>.

Source: Medical Disability Advisor






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