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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.

Synovectomy


Text Only Home | Graphic-Rich Site | Overview | Reason for Procedure | How Procedure is Performed | Prognosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Maximum Medical Improvement | Medical Codes | References

Medical Codes

ICD-9-CM:
80.70 - Synovectomy, Unspecified Site
80.71 - Synovectomy, Shoulder
80.72 - Synovectomy, Elbow
80.73 - Synovectomy, Wrist
80.74 - Synovectomy, Hand and Finger
80.75 - Synovectomy, Hip
80.76 - Synovectomy, Knee
80.77 - Synovectomy, Ankle
80.78 - Synovectomy, Foot and Toe
80.79 - Synovectomy, Other Specified Site, Spine

Related Terms

  • Radionuclide Synovectomy
  • Synoviorthesis

Overview

A synovectomy is the surgical removal of the membrane lining a synovial joint (diarthrosis) capsule (synovium). The joint is opened (arthrotomy) and the synovium is cut away. This can be performed by means of arthroscopy, using small incisions around the joint, or may be done as an open procedure.

Synoviorthesis, or medical synovectomy, may be obtained with the intra-articular injection of several substances. There are two types of synoviorthesis: chemosynovectomy and radiosynovectomy.

Synovectomy or synoviorthesis can be performed for a variety of conditions. The benefits of removing the synovium and the length of time of improvement are dependent on the condition for which the synovectomy is being performed. For example, removal of the synovium of the wrist joint in an individual with rheumatoid arthritis (RA) will provide a temporary solution to problems of synovial inflammation (synovitis). Joint motion, pain, and swelling are usually improved and cartilage destruction diminished for about 2 years. After that time, further surgery may be required.

Individuals at risk of synovitis are the most likely candidates for this procedure. This includes those with RA, joint infection, joint trauma, exposure to toxins, arthritis secondary to hemophilia (hemophiliac arthritis), and pigmented villonodular synovitis (an idiopathic joint disorder resulting from brownish-colored nodular growth in the villi of the synovium).

Source: Medical Disability Advisor



Reason for Procedure

Removal of the synovium is done to reduce the symptoms of pain and swelling due to recurrent or persistent synovitis. This procedure usually is performed only if the condition is disabling or if the condition has not responded to other, more conservative methods of treatment, such as nonsteroidal anti-inflammatory drugs (NSAIDs), antirheumatic drugs (for RA), or the injection of corticosteroid drugs into the joint itself.

Source: Medical Disability Advisor



How Procedure is Performed

Local, regional, or general anesthesia is used depending on the location of the joint, amount of synovium to be removed, and the technique employed. The procedure can be performed in an outpatient or inpatient setting, depending on the technique.

More often for larger joints (i.e., knee, shoulder, hip), and increasingly for smaller joints, a synovectomy is performed arthroscopically. A thin, fiberoptic surgical and viewing instrument (arthroscope) is inserted into the joint space through a small skin incision to visualize the interior of the joint. Instruments are then inserted into the joint through 4 or 5 other tiny incisions (portals) to cut away the synovium. An irrigation solution is infused into the joint to help clear the area of debris created during the procedure. The arthroscopic approach is generally minimally invasive and requires only a few small incisions. Consequently, less tissue trauma may be associated with arthroscopic surgery than with open surgery. For larger joints this may result in a shorter hospital stay, reduced postoperative joint stiffness, and a more complete synovectomy. After the surgery, a pressure dressing is applied and the joint is kept mobile to inhibit scarring.

In an open procedure, the joint capsule is exposed through an incision over the affected joint (arthrotomy). The synovium is identified and removed by cutting. A soft pressure dressing is applied to control swelling. Early limited joint motion is encouraged to prevent scar tissue (adhesions) from forming in the joint that would limit range of motion.

Source: Medical Disability Advisor



Prognosis

Temporary relief of pain, swelling, and decreased range of motion is expected. Synovectomy does not remove the cause of synovitis, so relief of symptoms may not be permanent. Ongoing management of the underlying disease process will influence successful outcome.

Source: Medical Disability Advisor



Specialists

  • Hand Surgeon
  • Interventional Radiologist
  • Occupational Therapist
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Rheumatologist

Source: Medical Disability Advisor



Rehabilitation

The goal of rehabilitation after synovectomy is to decrease pain and to restore function. The intensity and duration of rehabilitation depend on the underlying condition, the involved body part, and the preoperative functional status of the individual.

Modalities such as heat and cold are used to control pain and swelling (Braddom). If the lower extremity is involved, assistive devices may be used to promote independent ambulation, although typically weight bearing is not limited. Individuals may be instructed in gentle range of motion and strengthening exercises to be continued independently in order to preserve joint mobility and function.

Limited supervised rehabilitation is indicated in most cases. Prior to discharge from therapy, individuals should be educated in ways to protect the involved joint and in self-care, including a home exercise program. If impaired function persists, modifications in lifestyle and the workplace may be recommended by an occupational therapist or ergonomist (Firestein).

FREQUENCY OF REHABILITATION VISITS
ClassificationSpecialistTopicVisit
SurgicalPhysical or Occupational TherapistSynovectomyUp to 6 visits within 8 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



Comorbid Conditions

  • Blood dyscrasias
  • Hepatic disease
  • Immune system disorders
  • Obesity
  • Rheumatic disorders

Source: Medical Disability Advisor



Complications

Possible complications include infection, bleeding into the joint (hemarthrosis), nerve and vessel damage, damage to bone surface (articular cartilage), and no relief of symptoms.

Radionuclide synovectomy is generally associated with fewer hemorrhagic episodes than the arthroscopic or open approaches. However, leakage (extravasation) of the radionuclide substance outside the joint space, causing localized tissue death (necrosis), has been reported as a rare complication of the procedure.

Source: Medical Disability Advisor



Factors Influencing Duration

The underlying condition, type and effectiveness of treatment, presence of complications, individual's response to treatment, and job requirements may influence duration of disability.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Limited loading of the affected joint is an appropriate work restriction. This may include no lifting, carrying, gripping, twisting, pushing or pulling, standing, squatting, or kneeling, depending on the joint(s) involved. Periods of rest and time for rehabilitation may be necessary.

Individuals may be required to use devices to assist with ambulation such as crutches, canes, or walkers. Worksite modification may be necessary to accommodate the use of these assistive devices safely.

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

Risk: The risk for recurrence is dependent on the original condition that caused the need for the synovectomy.

Capacity: Functional ability and capacity will be impacted by the joint(s) involved, the underlying disease, and the requirements of the job.

Tolerance: Large joint synovectomies are usually more painful than small joint synovectomies. The level of pain will vary by the individual's tolerance, the joints involved, and the underlying disease condition.

Accommodations: Employers willing to accommodate employee work restrictions can usually expect early return to work after synovectomy.

Source: Medical Disability Advisor



Maximum Medical Improvement

This is a broad category making MMI difficult to provide. Please see specific local and the diagnosis for which the synovectomy is being provided for details.

Source: Medical Disability Advisor



References

Cited

Braddom, Randolph L. Physical Medicine and Rehabilitation. 3rd Ed. ed. W.B. Saunders, 2006.

Firestein, G. S., et al. Kelley's Textbook of Rheumatology. 8th ed. Elsevier Saunders, 2008.

Source: Medical Disability Advisor