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.

Synovial Cyst


Related Terms

  • Baker’s Cyst
  • Ganglion
  • Ganglionic Cyst
  • Mucus Cyst
  • Myxoid Cyst
  • Popliteal Cyst

Differential Diagnosis

  • Arthritis conditions (especially rheumatoid arthritis)
  • Fracture
  • Tendon rupture
  • Tumor (benign or malignant)
  • Tumors nodules (especially rheumatoid nodules)

Specialists

  • General Surgeon
  • Orthopedic (Orthopaedic) Surgeon
  • Physical Therapist
  • Plastic Surgeon

Factors Influencing Duration

Duration depends on site and whether the dominant or nondominant limb is involved. If the spine is involved, the length of disability will depend on whether any neurological or surgical complications resulted from the cyst or cyst removal. There may be recurrent episodes of the ganglion cyst, and each episode may have different disabilities based on symptoms and treatment.

Medical Codes

ICD-9-CM:
727.40 - Synovial Cyst, Unspecified
727.41 - Ganglion of Joint
727.42 - Ganglion of Tendon Sheath
727.43 - Ganglion, Unspecified
727.51 - Synovial Cyst of Popliteal Space; Bakers Cyst (Knee)

Overview

© Reed Group
A synovial cyst is a small, fluid-filled sac or pouch that can develop over a tendon or joint, creating a mass under the skin. Synovial cysts are found most commonly in the knee and hip. Cysts also can form in the shoulder, elbow, wrist (flexor tendon sheath in the fingers), top of the foot (dorsum), ankle, and hand. A synovial cyst may or may not be painful, depending on their size and location.

Ganglionic cysts are the most common cysts found on the on the hands and feet. A mucus (myxoid) cyst is a synovial cyst of the last joint of a digit (distal interphalangeal [DIP] joint). Myxoid cysts are thought to be caused by leakage of synovial fluid from the DIP joint, with or without underlying degenerative joint disease.

Synovial cysts may also develop in a degenerated spine, most frequently between the fourth and fifth lumbar vertebrae (L4-L5) where there is the most movement and potential for chronic trauma and instability. This type of cyst may limit spinal joint movement and compress adjacent nerves and vascular structures.

A Baker's cyst (popliteal cyst) forms in the back of the knee when fluid from inside the knee joint becomes trapped outside the joint. It can be caused by any condition that causes knee swelling (e.g., osteoarthritis, rheumatoid arthritis, meniscal tear).

Many times the cause of a synovial cyst is unknown (idiopathic), although there is some evidence that trauma may be a factor. The size of the sac or cyst can change with activity and may disappear for some time, only to recur. The mass is often soft, but with time it may become firmer to the touch.

Incidence and Prevalence: Ganglion cysts of the wrist and hand comprise 50% to 70% of all masses found in the hand; 80% of such cysts are located on the back of the hand (dorsal surface) (Cassidy).

Popliteal cysts are found in up to 20% of asymptomatic knees (Tschirch).

Incidence of lumbar synovial cysts is less than 0.5% of individuals with back pain in the general population (Khan).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors for developing synovial cysts are osteoarthritis, rheumatoid arthritis, acute or chronic trauma, joint instability, and overuse injuries from repetitive movement. Risk is increased for individuals who participate in repetitive activities such as keyboarding or playing a musical instrument (Cassidy).

Ganglion cysts of the hand and wrist are most common in women aged 20 to 30 (Cassidy).

Painful lumbar synovial cysts occur slightly more often in females than in males and are typically found in individuals in their seventh decade (Epstein, Khan).

Source: Medical Disability Advisor



Diagnosis

History: Usually, the individual cannot pinpoint a significant incident that precipitated cyst formation; however, the individual will notice the cyst, whether painful or not, on the limbs, especially the ankle, wrist, fingers, or top of foot. Although pain may be present as the cyst forms, the pain usually goes away and the cyst becomes asymptomatic after a few months. The individual may report pain and swelling with activity, and the cyst may change in size with increased activity. Rarely, if a synovial cyst presses on a nerve, the individual may report feelings of tingling or numbness in the affected limb.

Physical exam: Palpation of the cyst reveals a soft to rigid mass near a joint or over a tendon. A ganglion cyst in the hand or wrist may reduce grip strength. With a myxoid cyst of the finger, the fingernail may appear deformed. With a popliteal cyst, the physician may palpate a thickening or soft tissue mass at the back of the affected knee. A synovial cyst that cannot be seen (occult) should be suspected for wrist pain without trauma. Although synovial cysts of the lumbar spine cannot be seen or palpated, they can result in muscle and sensory deficits and reflex changes.

Tests: Draining (aspirating) the cyst produces a thick, gelatinous liquid. X-rays may be ordered to rule out tumor or rheumatoid arthritis. Although not usually necessary, MRI is very useful in visualizing the cyst. In the case of occult synovial cysts of the lumbar spine, CT scan typically shows a soft tissue mass adjacent to a degenerative joint. A synovial cyst of the knee usually is not visible on plain x-rays, although x-rays can confirm the presence of osteoarthritis, which is associated with these cysts. An ultrasound or MRI is necessary to confirm the diagnosis of a popliteal cyst.

Source: Medical Disability Advisor



Treatment

Conservative treatment for synovial cysts may include ice packs applied directly to the affected region together with oral medication for pain (e.g., acetaminophen, ibuprofen). Another form of conservative treatment for synovial cysts consists of aspirating the fluid from the sac with a large-gauge needle. The sac is then injected with a corticosteroid drug to shrink or dissolve it. With lumbar synovial cysts, steroid injections into the affected facet joint may be indicated. In longstanding, painful, or recurrent cases, techniques including fluoroscopically guided removal of the cyst, surgery to remove the cyst (minimally invasive excision) and its attachment to the tendon or joint capsule (stalk), or surgery to enlarge the space around the affected nerve root (laminectomy or foraminectomy) may be necessary (Sehati). The cyst also may spontaneously rupture, providing relief.

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.*
 
Ganglion Cyst
 
* 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

Symptoms of untreated symptomatic cysts worsen with increased activity. Aspiration followed by corticosteroid injection results in relief of symptoms in 35% of cases, but it is not uncommon for the cyst to return. Following minimally invasive surgical excision for a lumbar synovial cyst, 95% of cases obtain full resolution of symptoms (Sehati). Surgical removal provides complete relief of symptoms in most cases, but about 10% of cysts recur after surgery. Surgical removal of a myxoid cyst is more successful in the fingers than in the toes, with a cure rate of 95% for fingers but only 33% after toe surgery (Lawrence). In rare cases in which a cyst is cancerous, the prognosis will depend on the type of cancer and whether it has spread (metastasized).

Source: Medical Disability Advisor



Complications

Synovial cysts on weight-bearing surfaces of the foot may make standing or walking painful. Synovial cysts on the palm of the hand or at the wrist may interfere with grasping. Synovial cysts on the top of the foot or ankle may be irritated by shoe pressure.

If the synovial cyst involves the spine, neurological deficits such as numbness and muscle weakness can significantly complicate the condition and recovery. If the individual requires surgical excision, there may be complications associated with surgery (e.g., anesthesia, poor wound healing, infection). In case of a lumbar cyst, rarely further surgery may be needed to stabilize an unstable spine (lumbar fusion).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

No restrictions are necessary for untreated synovial cysts, except in cases involving the dominant hand, a knee, or the back. Involvement of these areas of the body may require adjustments to the individual's job tasks. If surgery is necessary, time off from work may be needed until the affected limb/body part heals. 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:

  • Where is individual's cyst located? Is it painful? Is it soft or hard?
  • Has individual had any trauma to the affected area?
  • Does the size of the cyst change? Did it go away, only to return?
  • On physical exam, is there a soft to rigid mass near a joint or over a tendon?
  • Has individual had an x-ray of the affected area? MRI?
  • Have conditions with similar symptoms been ruled out?
  • Does individual have any neurological complications?

Regarding treatment:

  • Was individual's cyst aspirated?
  • Was the cyst injected with a corticosteroid?
  • Has cyst recurred?
  • Has surgical removal of the cyst become necessary?

Regarding prognosis:

  • Is individual exposed to repetitive trauma irritating the area of the cyst?
  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Does individual have any complications related to the location of the cyst (such as cysts on weight-bearing surfaces or the palm of the hand)?

Source: Medical Disability Advisor



References

Cited

Cassidy, C., and V. Chung. "Hand and Wrist Ganglia." Essentials of Physical Medicine and Rehabilitation. Eds. Walter R. Frontera, Julie K. Silver, and Thomas Rizzo. 2nd ed. Philadelphia: Saunders, Elsevier, 2008. 149-154.

Epstein, N. E. "Lumbar Synovial Cysts: A Review of Diagnosis, Surgical Management, and Outcome Assessment." Journal of Spine Disorders & Techniques 17 4 (2004): 321-325.

Kahn, A. M., and F. Girardi. "Spinal Lumbar Synovial Cysts. Diagnosis and Management Challenge." European Spine Journal 15 8 (2006): 1176-1182.

Lawrence, C. "Skin Excision and Osteophyte Removal is not Required in the Surgical Treatment of Digital Myxoid Cysts." Archives of Dermatology 141 (2005): 1560-1564. PubMed. <PMID 16365258>.

Sehati, N., L. T. Khoo, and L. T. Holly. "Treatment of Lumbar Synovial Discs." Medscape Today. 28 Jun. 2006. Medscape. 1 Aug. 2009 <http://www.medscape.com/viewarticle/536574>.

Tschirch, F. T. C., et al. "Prevalence and Size of Meniscal Cysts, Ganglionic Cysts, Synovial Cysts of the Popliteal Space, Fluid-filled Bursae, and Other Fluid Collections in Asymptomatic Knees o MR Imaging." American Journal of Roentgenology 180 (2003): 1431-1436.

General

Cone, Anita. "Section B Imaging Sports-Related Injuries of the Knee." DeLee and Drez's Orthopaedic Sports Medicine. Eds. Jesse DeLee and David Drez. 2nd ed. 2 vols. Philadelphia: W.B. Saunders, 2003. 1646-1648.

Source: Medical Disability Advisor






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