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.

De Quervain's Release


Related Terms

  • De Quervain Tendinitis
  • De Quervain’s Disease
  • First Dorsal Compartment Stenosing Tendinitis

Specialists

Comorbid Conditions

Factors Influencing Duration

Factors include the extent of disease progression, the severity of symptoms, whether the dominant or nondominant hand is involved, development of complications, and individual's job requirements.

Medical Codes

ICD-9-CM:
82.01 - Exploration of Tendon Sheath of Hand; Incision of Tendon Sheath of Hand; Removal of Rice Bodies in Tendon Sheath of Hand

Overview

De Quervain's release is a surgical procedure to treat de Quervain's syndrome (stenosing radial tenosynovitis of the first doral compartment of the wrist), which has symptoms of pain with activities that require movement of the thumb. Although originally thought to be an inflammation of the covering (tendon sheath, retinaculum) of the tendons (abductor pollicis longus and extensor pollicis brevis) that control the thumb, biopsy does not usually show inflammation. These two tendons are in a fibrous, inelastic tunnel as they cross the radial side of the wrist.

In this condition, the tendon sheath probably becomes inflamed but over time changes to more of a fibrous thickening. Although symptoms can occur with repetitive motion of the thumb, this may not be the cause ("Disease and Injury Causation," page 164, table 9-11). Symptoms can develop after acute trauma, such as a direct blow to the wrist. In most cases, the involved tendons themselves are normal but the synovium around the tendons is thickened. Because space within the wrist is limited, any local "inflammation" results in swelling that reduces the space available for the tendon-pulley mechanism to function. Pain and increased inflammation result when the tendons in their swollen sheath are pulled through the tighter space. It becomes difficult for the tendons to glide normally, and consequently the tendons begin to catch and rub, producing jerky movements and causing more symptoms (pain, loss of strength, and limited motion).

In de Quervain's syndrome, the tenosynovitis affects two specific tendons of the wrist, the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). De Quervain's release surgery reduces disease progression by increasing the space for the tendons to slide and thereby altering conditions within the tendon tunnel that perpetuate the pain.

Source: Medical Disability Advisor



Reason for Procedure

De Quervain's release is used when conservative treatment has failed to relieve symptoms associated with the constriction (stenosing tenosynovitis) of the tendons controlling the thumb extension. Other conditions should be ruled out before considering de Quervain's release. The goal of de Quervain's release is to release the tendons trapped by compression under or in the tendon sheath (retinaculum). Incision through the tendon sheath and, in some cases, removal (excision) of a portion of the swollen tendon covering (synovium) decrease pressure on the tendons, allowing them to glide more easily.

Source: Medical Disability Advisor



How Procedure is Performed

De Quervain's release is a minor surgical procedure accomplished through a small incision exposing the tendon sheath (retinaculum) along the thumb (radial) side of the wrist. The sheath is cut (released) around the two tendons at the base of the thumb and portions of the sheath may be excised. The release is done under regional or local anesthesia in an in office or outpatient setting.

Source: Medical Disability Advisor



Prognosis

Relief of symptoms is usually permanent (Foye). In rare cases, when aggravating activities such as repetitive gripping and lifting are maintained, some symptoms may persist, but repeat surgery is rare.

Source: Medical Disability Advisor



Rehabilitation

Surgical release of de Quervain's syndrome is indicated when conservative management, injections, splinting, and ergonomic changes have failed. The rehabilitation specialist addresses the recovery from surgery and any underlying problems that may have led to the condition (Hegmann).

Traditionally after surgery, the hand was maintained in a soft bulky dressing for 48 hours. Once the postoperative dressing is removed, early movement was encouraged (Wright). However today most patients only require a light dressing and can start light activities the same day.

Following the surgical protocol and initial phase of healing, grip and pinch exercises are introduced between 1 to 2 weeks postoperatively, with more strenuous activities added according to tolerance. As therapy progresses, the exercises should be reflective of the work environment, which must be reassessed in preparation for the individual's safe return to work.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistDe Quervain's Release
Occupational / Hand / Physical TherapistUp to 4 visits within 6 weeks
Surgical
SpecialistDe Quervain's Release
Occupational / Hand / 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

Complications of a de Quervain's release may include infection, damage to blood vessels or nerves, and rarely complex regional pain syndrome (CRPS). In some cases, more severe constriction around the tendon sheath may have developed prior to surgery, complicating complete recovery. Inadequate decompression of the tendons or inadequate release of the EPB can lead to persistent symptoms. During surgery, care must be taken to avoid entrapping or cutting a sensory branch of the radial nerve because it will result in loss of feeling and may lead to growth of a disorganized mass of nerve fibers (neuroma) that is just as painful and debilitating as the original condition. Surgical scarring can also result.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals whose work requires that they maintain a grip while lifting or using their hands and wrists heavily may require temporary reassignment to less demanding work duties. Light, normal usage of the fingers is encouraged after surgical release. In cases of wrist tendon releases, normal hand usage is encouraged with limited wrist movement during the healing period. To prevent recurrence, adjustments may be needed in repetitive motion tasks that contributed to development of de Quervain's syndrome. Additional information concerning risk, capacity, and tolerance may be found in "Work Ability and Return to Work," pages 201-203.

Risk: The risk for reoccurrence is rare as is the risk for tendon rupture.

Capacity: Capacity is usually only limited by the tolerance for pain. Wrist motion is usually unaffected.

Tolerance: The decision to stay at work or return to work is primarily base on the symptoms (pain, range of motion loss, and grip weakness).

Accommodations: If activities at work and home can be modified, most individuals can return to normal activities the next day with light dressing over the incision site. Traditional wound care should be performed (keeping the wound clean and dry).

Source: Medical Disability Advisor



Maximum Medical Improvement

8 to 12 weeks post surgery

Continued improvement is possible over 18 months, but the amount of improvement is limited.

Source: Medical Disability Advisor



References

Cited

Foye, Patrick M., and Todd Stitik. "De Quervain Tenosynovitis." eMedicine. Eds. Robert L. Sheridan, et al. 21 Nov. 2006. Medscape. 10 Dec. 2008 <http://emedicine.medscape.com/article/327453-overview>.

Hegmann, Kurt T., et al., eds. "Chapter 11: Hand, Wrist and Forearm Disorders." Occupational Medicine Practice Guidelines: Evaluation and Management of Common Health Problems and Functional Recovery in Workers. 2008 Revision 2nd ed. ACOEM, 2008. 627-652.

Sampson, S. P., D. Wisch, and M. A. Badalamente. "Complications of Conservative and Surgical Treatment of de Quervain's Disease and Trigger Fingers." Hand Clinic 10 1 (1994): 73-82. National Center for Biotechnology Information. National Library of Medicine. 3 Dec. 2004 <PMID: 8188781>.

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011.

Wright, Phillip E. "Chapter 66 - Wrist Disorders." Campbell's Operative Orthopaedics. Eds. S. Terry Canale and James H. Beaty. 11th ed. Philadelphia: Mosby Elsevier, 2008.

General

Wheeless, Clifford. "DeQuervain's Disease." Wheeless' Textbook of Orthopaedics. Wheeless' Textbook of Orthopaedics. 13 Jun. 2010. Duke Orthopaedics. 6 Oct. 2010 <www.wheelessonline.com/ortho/dequervains_disease>.

Source: Medical Disability Advisor






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