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.

Synovitis


Related Terms

  • Inflammation of the Joint
  • Joint Pain
  • Overuse Synovitis
  • Pigmented Villonodular Synovitis
  • Swollen Joint

Differential Diagnosis

Specialists

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

Comorbid Conditions

Factors Influencing Duration

Duration will depend on whether synovitis is acute or chronic, any underlying cause of inflammation, the number of joints involved, whether a joint on the dominant side is involved, job requirements, and response to treatment.

Medical Codes

ICD-9-CM:
727.00 - Synovitis and Tenosynovitis, Unspecified; Synovitis NOS; Tenosynovitis NOS
727.01 - Synovitis and Tenosynovitis in Diseases Classified Elsewhere
727.2 - Specific Bursitides Often of Occupational Origin; Beat: Elbow, Hand, Knee; Chronic Crepitant Synovitis of Wrist; Miners Elbow, Knee

Overview

© Reed Group
Synovitis is a condition that develops when a joint lining (synovial lining) becomes irritated and inflamed. Each joint is enclosed in a capsule lined with membrane tissue known as the synovium or synovial membrane. The synovium secretes a lubricating fluid (synovial fluid) and is able to adapt to different motions of a joint by expanding and contracting. When the synovium becomes irritated, it increases fluid production, resulting in warmth, tenderness, and swelling in and around the joint.

Synovitis has many causes, including infection (e.g., septic arthritis, tuberculosis), direct joint trauma, allergic reaction, gout, overuse syndromes, and systemic autoimmune inflammatory diseases (e.g., rheumatoid arthritis). Synovitis can occur as an acute episode limited to one joint, or it can involve multiple joints and be a chronic symptom of a general disease process.

A rare, slow-growing, benign tumor of the synovial membranes (pigmented villonodular synovitis [PVNS]) can cause pain and swelling in the knee synovium in 80% of cases and to a lesser extent may involve hip, ankle, or shoulder joints (Monu).

Synovitis is a common finding on arthroscopic exam of the temporomandibular (TM) joints, which are found where the lower jaw joins the skull.

Incidence and Prevalence: Prevalence of rheumatoid arthritis is 0.8% of the population (Venkateshan).

Incidence of septic arthritis is 6 to 10 cases per 100,000 population; following joint replacement surgery, incidence increases to 30 to 70 per 100,000 (Marquez).

Synovitis from bacterial infection caused by intra-articular steroid injections occurs in 10 per 100,000 procedures (Marquez).

Incidence of PVNS is 2 per 1 million population in the US (Monu).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals exposed to prolonged, repetitive motions of the hand, wrist, elbow, and shoulder, such as those who perform assembly line or keyboarding work, or those who participate in throwing sports are at risk for synovitis. This condition can affect joints of the lower extremities, placing at risk individuals performing repetitive movements of the hip, knee, foot, and ankle during activities such as running, climbing, and jumping.

Synovitis is not sex-specific, although rheumatoid arthritis, for which persistent inflammatory synovitis is a characteristic feature, is 3 times more common in women than in men (Venkateshan). Joint infection (septic arthritis) is observed primarily in individuals under age 15 and over age 55 and is most common in men (Marquez). PVNS usually occurs in individuals between the ages or 20 and 50 (Monu).

Uric acid overproduction, as seen in gout, places individuals at an increased risk for synovitis. People at risk of uric acid overproduction include those with a history of leukemia, lymphoma, psoriasis, and those receiving chemotherapy. Alcohol consumption, chronic renal failure, and hypertension can lead to a decreased excretion of uric acid, which in turn can lead to uric acid accumulation and an increased risk of gout and associated synovitis.

Source: Medical Disability Advisor



Diagnosis

History: Symptoms of synovitis often are activity-related, with the individual describing extended periods of repetitive movements or a history of physical forces sufficient to strain the involved joint(s). If the symptoms are not obviously activity-related, medical history of infection, allergic reaction, or inflammatory disease should be investigated, as this may provide clues to underlying conditions causing the synovitis. One joint or several may be involved. Individuals will complain of joint pain, swelling, warmth, and stiffness and may experience relief of symptoms with the use of heat or cold therapy.

Physical exam: Passive and active range of motion is observed for indications of pain, stiffness, and / or joint noise (crepitus). Muscles surrounding the joint are tested for weakness and pain to resistance. Joint-play movements are evaluated for mobility and irritability; they are typically limited and painful. However, if the synovitis is the result of a traumatic joint injury, joint-play may be excessive. Joints will appear swollen, red, and warm to touch, and may have a "boggy" feel to gentle probing with the fingers (palpation).

Tests: Laboratory tests include complete blood count (CBC), urinalysis, and erythrocyte sedimentation rate (ESR) to measure inflammation. If appropriate, a rheumatoid panel and / or joint fluid analysis (following joint aspiration) with Gram stain may be done. Routine x-rays may be indicated to evaluate the joint surface for erosion of the articular surface. Nuclear medicine scans also may provide valuable information, especially during earlier stages of inflammation.

Source: Medical Disability Advisor



Treatment

Synovitis is most often treated with anti-inflammatory drugs, cold or heat therapy, corticosteroid injections, and rest from aggravating activity. Medication for pain control may be needed, as well as splinting for part of the day or night to immobilize and support the joint. Once symptoms are stabilized, exercising the joint(s) is initiated to improve range of motion and restore strength to surrounding muscles.

In destructive synovitis, as found in conditions such as rheumatoid arthritis, surgical removal of the synovium may be required (synovectomy). Destruction of the synovium also can be accomplished with laser therapy/surgery and injections of selectively destructive chemicals (chemical ablation).

Source: Medical Disability Advisor



Prognosis

Acute, isolated episodes or synovitis usually respond well to conservative treatment. If the affected joint is rested properly, overuse synovitis can improve within a few days but may take up to 8 weeks to fully resolve (Ryan). In chronic synovitis, the course of the underlying disease will determine the outcome. Synovitis can recur if the synovium regrows after surgical removal of the inflamed synovium (synovectomy) or chemical or laser ablation if the underlying disease process causes inflammation of the synovium to recur.

Source: Medical Disability Advisor



Rehabilitation

The goal of rehabilitation for synovitis is to decrease inflammation and pain to the synovium and affected joint(s) and then to restore range of motion and strength to the joint(s). Early in the course of synovitis, the physical therapist may instruct the individual to elevate the affected joint to help reduce swelling. The therapist also will educate the individual on how to avoid pressure on the inflamed synovial tissues by applying an elastic bandage, sling, or soft foam pad to protect the involved area until the swelling decreases.

There are several possible treatments to control inflammation resulting from synovitis. At the initial flare-up, the physical therapist may use cold modalities (e.g., ice packs) to control swelling and pain for as long as the joint area is warm to the touch. Electrostimulation combined with a cold treatment may be used to relax muscles around the inflamed joint and help to decrease pain and inflammation.

When pain and inflammation of the acute stage of synovitis have lessened, heat modalities such as moist heat packs may be used to help relieve joint pain and stiffness and to increase blood flow to the synovium to promote healing. Ultrasound is another heat treatment used in physical therapy. It uses high frequency sound waves to produce heat that penetrates deep into the involved synovial membrane and surrounding joint. Iontophoresis, which uses a small electric current to drive anti-inflammatory medication into the inflamed tissues, may also be used.

Once pain and swelling have been greatly reduced, the physical therapist will perform passive stretching exercises to help restore full range motion to an affected joint. Exercise will be progressed to active stretching and strengthening as appropriate to restore function without recurrence of pain. Modifications may be made by the physical therapist depending on the location of the affected joint, the stage of the inflammation (i.e., acute flare-up or chronic pain), and whether surgery was required. However, this condition rarely requires surgical intervention.

Source: Medical Disability Advisor



Complications

When the synovitis is chronic, the synovium can grow over the articular surface of the joint (pannus) and destroy the cartilage.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Limited work (loading) of an affected joint may be a restriction that could require temporary reassignment to a job that puts less stress or repetition on the joint. Temporary use of adaptive equipment or assistive devices may be needed. Periods of rest and time off for physical therapy appointments may be necessary 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:

  • Did the individual present with pain, swelling, and redness of one or more joints?
  • Was range of motion restricted or painful? Was strength normal?
  • Were diagnostic x-rays and blood tests done to confirm the diagnosis?
  • Has cause of synovitis been identified?
  • Is more than one joint involved?
  • Would individual benefit from evaluation by a specialist (rheumatologist, sports medicine specialist)?

Regarding treatment:

  • Is the underlying cause being treated?
  • Has enough time passed for conservative measures to be effective?
  • Was physical therapy necessary?
  • Is individual compliant with recommendations to rest joint or participation in physical therapy?
  • If symptoms persist despite conservative treatment, is more aggressive intervention with laser, chemical, or surgical treatment warranted?

Regarding prognosis:

  • If an underlying condition of synovitis been identified, is it responding to treatment?
  • Has individual participated actively in a comprehensive rehabilitation program?
  • Does individual have any comorbid conditions (e.g., chronic inflammatory disease, allergies, diabetes, infection, over-use syndromes, tendinitis, bursitis) that could affect recovery?
  • What accommodations would allow individual to return to work? Can employer make those accommodations?

Source: Medical Disability Advisor



References

Cited

Marquez, J., L. Candia, and L. R. Espinoza. "Chapter 28: Septic Arthritis ." Infectious Diseases: Emergency Department Diagnosis and Management. Eds. E. M. Slaven, S. C. Stone, and F. A. Lopez. McGraw-Hill, 2006. 284-287.

Monu, Johnny U. V. "Pigmented Villonodular Synovitis." eMedicine. Eds. Amilcare Gentili, et al. 21 Jun. 2007. Medscape. 14 Aug. 2009 <http://emedicine.medscape.com/article/394649-overview>.

Ryan, J., and J. P. Salvo. "Chapter 11: Elbow Injuries." Athletic Training and Sports Medicine. Eds. C. Starkey and G. Johnson. 4th ed. Jones and Bartlett , 2005. 364-366.

Venkateshan, S. P., et al. "Efficacy of Biologicals in the Treatment of Rheumatoid Arthritis. A Meta-analysis." Pharmacology 83 1 (2009): 1-9.

Source: Medical Disability Advisor






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