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.

Enthesopathy


Related Terms

  • Enthesitis

Specialists

  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Rheumatologist

Comorbid Conditions

Factors Influencing Duration

Severity of the underlying disease, the presence of complications, response to treatment, frequency of remission and recurrence, and physical job requirements will influence the length of disability.

Medical Codes

ICD-9-CM:
726.30 - Enthesopathy of Elbow, Unspecified
726.31 - Medial Epicondylitis
726.32 - Lateral Epicondylitis; Golfers Elbow; Tennis Elbow
726.33 - Olecranon Bursitis; Bursitis of Elbow
726.39 - Enthesopathy of Elbow Region, Other
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
726.64 - Patellar Tendinitis
726.69 - Enthesopathy of Knee, Other; Bursitis: Infrapatellar, Subpatellar
726.70 - Enthesopathy of Ankle and Tarsus, Unspecified; Metatarsalgia, NOS
726.79 - Enthesopathy of Ankle and Tarsus, Other; Peroneal Tendinitis
726.8 - Other Peripheral Enthesopathies
726.90 - Enthesopathy of Unspecified Site; Periarthritis NOS; Tendinitis NOS; Capsulitis NOS

Overview

Enthesopathy is a disorder at the site of the insertion of ligaments, tendons, fascia, or articular capsule into bone (enthesis) and is the result of an inflammatory rheumatic or non-rheumatic disease process. In enthesopathy, pain develops in the free nerve endings of entheses (enthesalgia), becoming a source of chronic musculoskeletal pain in some individuals. This process also may promote abnormal calcification or ossification of the tendon or ligament at the insertion into the bone.

Enthesopathy is a presenting part of many inflammatory conditions and is considered a process rather than a disease in itself. Conditions in which enthesopathy may develop include the spondyloarthropathies, septic arthritis, spinal arthritis, ankylosing spondylitis, reactive arthritis (reactive arthritis), psoriatic arthritis, enteropathic arthritis (accompanying ulcerative colitis and Crohn's disease), and such rare disorders as acne-associated arthritis, celiac disease, and Whipple disease. Enthesopathy is also seen as a complication of avulsion fractures and tendon tears (rarely).

When these inflammatory diseases develop, an enthesis can become irritated and painful, resulting in enthesopathy. The affected enthesis is found most commonly in peripheral joints such as foot joints, elbow and shoulder joints, or hip joints. Enthesopathy is not typically associated with traumatic injuries.

Incidence and Prevalence: Exact incidence cannot be estimated because of the broad range of inflammatory conditions that may result in enthesopathy and because the disorder may not be recorded as a separate diagnosis in patient records.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Enthesopathy is associated with the presence of inflammatory diseases and risk is highest in individuals diagnosed with rheumatic or non-rheumatic inflammatory conditions. Males and females are equally affected.

Source: Medical Disability Advisor



Diagnosis

History: Individuals may complain of pain and tenderness over joints, which may be aggravated with activity. Occasional swelling and warmth over joints may be reported, especially where affected structures are more superficial such as the patellar or Achilles tendons. There is usually no history of injury. A history of an underlying inflammatory disease may be reported if previously diagnosed.

Physical exam: Touch (palpation) will reveal tenderness over areas of tendon or ligament sites, along with redness and swelling of the joint (effusion) if the involved areas are superficial. Decreased range of motion may be noted in the involved joint. The remainder of the exam depends on the underlying condition being explored; a complete physical may be needed if an inflammatory diagnosis has not been made previously.

Tests: Diagnostic laboratory studies to identify the underlying inflammatory disease may include special tests such as fluorescent antinuclear antibodies (FANA), antinuclear antibody titers (ANA), rheumatoid factor, human leukocyte antigen B27 (HLA-B27); and routine tests, including erythrocyte sedimentation rate (ESR), uric acid, urinalysis, and complete blood count (CBC) with differential. Joint fluid aspiration may be needed to define diseases such as gout and the presence of infection. X-rays are used to define changes in the enthesis and bone. MRI and occasionally diagnostic ultrasound may help to determine the presence of thickening or swelling in the deeper soft tissues.

Source: Medical Disability Advisor



Treatment

Treatment of enthesopathy symptoms depends on the underlying inflammatory condition and how it is being managed. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used in managing some inflammatory conditions. In addition, exercise programs are often employed to maintain range of motion, strength, and mobility. Physical and/or occupational therapy may help decrease inflammation with modalities such as ultrasound, electrical stimulation, or ice. Resting the affected joint in acute periods will help calm the underlying inflammatory condition. Local injections of corticosteroids also may be used to relieve symptoms at peripheral sites. Tumor necrosis factor may be used as an experimental treatment to control inflammation of multi-level enthesopathies in the spine.

Source: Medical Disability Advisor



Prognosis

Recovery from enthesopathy depends on successful management of the underlying disease. Many inflammatory diseases are prone to periods of remission and recurrence and the enthesis can become irritated in acute periods.

Source: Medical Disability Advisor



Complications

Individuals with enthesopathy may have a severe and progressive chronic inflammatory disease resulting in incapacitating deformities. In addition, but rarely, individuals with ankylosing spondylitis and associated enthesopathy may develop secondary amyloidosis.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and special accommodations are determined on an individual basis and depend on the severity of symptoms, location of symptoms, response to treatment, and job requirements.

Accommodations might include decreased workload, limited weight-bearing activities, frequent rest periods, change in tasks, and ergonomic engineering thereby allowing for changes in body positions and movements, and repetitive activities. Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function.

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:

  • Does individual complain of pain over joints?
  • Is pain aggravated by activity?
  • Does individual have a history of arthritis? What type of arthritis has been diagnosed?
  • Has a spondyloarthropathy been previously diagnosed?
  • Has a non-rheumatic inflammatory disease been diagnosed (e.g., Crohn’s disease)?
  • Is the area over the affected tendon or ligament tender to the touch, reddened, or swollen?
  • Does individual have decreased range of motion in the involved joint?
  • Does individual have pain in response to strength testing?
  • Have blood tests for abnormalities related to arthritis-type conditions been obtained?
  • Was the diagnosis confirmed?
  • Have x-rays been done to identify changes in the bone? Were changes identified?

Regarding treatment:

  • Has the underlying inflammatory condition been identified correctly?
  • Has the underlying condition been treated and managed successfully?
  • Is individual taking NSAIDs and participating in an exercise program?
  • Does individual require supportive care such as physical or occupational therapy to decrease pain and improve functional strength?
  • Has individual been instructed in joint protection strategies?
  • Does the treatment appear to be relieving pain and improving mobility?

Regarding prognosis:

  • Is individual experiencing a recurrence of the underlying disease?
  • Has individual's underlying disease progressed?
  • Does enthesopathy return during periods of active disease?
  • Does individual have incapacitating joint deformities?
  • How do these deformities affect individual's activities of daily living?
  • Does individual require modification of work tasks or positions?
  • Is employer able to make these modifications and accommodations?

Source: Medical Disability Advisor



References

General

McGonagle, D. "Diagnosis and Treatment of Enthesitis." Rheumatic Disease Clinics of North America 29 3 (2003): 549-560.

Slobodin, G. "Varied Presentations of Enthesopathy." Seminars in Arthritis and Rheumatism 37 2 (2007): 119-126.

Source: Medical Disability Advisor






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