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.

Tendinitis


Related Terms

  • Calcific Tendinitis
  • Tendinopathy
  • Tendinosis
  • Tendonitis
  • Tendonopathy
  • Tenosynovitis

Differential Diagnosis

Specialists

  • Family Physician
  • Hand Surgeon
  • Internal Medicine Physician
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Rheumatologist
  • Sports Medicine Physician

Comorbid Conditions

Factors Influencing Duration

Location of the tendinitis, its severity, the individual’s ability to control aggravating activities, treatment required, and any complications can all potentially affect the duration of disability.

Medical Codes

ICD-9-CM:
726.10 - Disorders of Bursae and Tendons in Shoulder Region, Unspecified; Rotator Cuff Syndrome NOS; Supraspinatus Syndrome NOS
726.11 - Calcifying Tendinitis of Shoulder
726.5 - Enthesopathy of Hip Region; Bursitis of Hip; Gluteal Tendinitis; Iliac Crest Spur; Psoas Tendinitis; Trochanteric Tendinitis
726.61 - Pes Anserinus Tendinitis or Bursitis
726.64 - Patellar Tendinitis
726.71 - Achilles Bursitis or Tendinitis
726.72 - Tibialis (Anterior) (Posterior) Tendonitis
726.79 - Enthesopathy of Ankle and Tarsus, Other; Peroneal Tendinitis
726.9 - Unspecified Enthesopathy
726.90 - Enthesopathy of Unspecified Site; Periarthritis NOS; Tendinitis NOS; Capsulitis NOS
727.82 - Calcium Deposits in Tendon and Bursa; Calcification of Tendon NOS; Calcific Tendinitis NOS

Overview

© Reed Group
Tendinitis or tendonitis is defined as "inflammation" of a tendon. Interestingly when the tendon is examined by the microscope, there are often no inflammatory cells present. It is often unclear, then, what is wrong with a tendon having "tendinitis," and it is unclear how the tendon can cause pain. Furthermore, the pain of "tendinitis" is often different depending on the location, for example, de Quervain's disease (wrist), trigger finger (finger-hand), lateral epicondylitis (tennis elbow), shin splints (legs), or plantar fasciitis (foot). The diagnosis for tendinitis is therefore a matter of excluding other causes, and the treatment involves primarily modifications of aggravating activities.

Tendinitis of the wrist exemplifies the involvement of other disorders. Tendinitis can have an acute onset with painful "inflammation" of a tendon, the tough, fibrous tissue that connects muscle to bone. The irritative condition usually occurs as the result of overuse and is one of several tendinopathies. Related conditions that also may occur include tendinosis, which is a chronic degeneration of the tendon, and tenosynovitis, inflammation of the sheath that surrounds the tendon.

Tendinitis is a very common condition especially among individuals engaged in heavy labor or sports. Tendinitis can be caused by acute trauma, poor technique during activity or exercise, lack of strength and flexibility, age-related deterioration, or overload and overuse of the affected tendon. Common sites for tendinitis include the shoulder (rotator cuff tendinitis), elbow (lateral and medial epicondylitis), knee (patellar tendinitis, iliotibial band tendinitis), Achilles tendon at the heel, and the posterior tibial tendon in the leg.

Calcific tendinitis occurs when calcium deposits form in the tendons of the rotator cuff. The cause of calcific tendinitis is unknown, but it does not appear to be due to trauma and may instead be associated with systemic disease such as rheumatoid arthritis, diabetes, or gout. Calcific tendinitis often resolves spontaneously in 1 to 4 weeks (Cluett).

Chronic degeneration of the tendon (tendinosis) results from microtrauma or overuse of the tendon, with symptoms developing gradually over time. The overuse can be caused by excessive pressure or workload. While up to 4% elongation of a tendon is tolerated well, greater elongation (4% to 8%) may cause microtrauma, and elongation greater than 8% may cause macrotrauma with rupture of tendon fibers (Rettig). Repetitive tasks and excessive exercise also may cause tendinosis. Shearing stress on the tendon may occur where tendons pass in close proximity to the bone.

Incidence and Prevalence: Both because muscle aches and pains are common and because tendinitis may require short periods of modified activities and gradually get better, many cases of tendinitis are not reported or treated with the result that the precise incidence remains unknown. One study suggested the incidence of tendinitis as an occupational injury is 1.1 per 100,000 individuals who work full-time ("Incidence Rates").

Overuse tendinitis is most common in the wrist and hand, and comprises between 25% and 50% of all sports injuries (Rettig).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Tendinitis is more common in males, and Achilles tendon tears occur 4 to 7 times more frequently in males than females (Maffulli). Middle-aged individuals are more likely to develop tendinitis (Steele) since tendons deteriorate with age. Work-related factors that increase the risk for tendinitis and tendinosis include vibration, cold temperatures, intense and sustained exertion, and maintaining awkward postures.

The use of certain broad-spectrum antibiotics, known as fluoroquinolones, is associated with increased risk of tendinitis. Individuals who use steroids or have decreased kidney function (renal insufficiency) are at higher risk of developing fluoroquinolone-associated tendinitis. Fluoroquinolone-associated tendinitis often occurs bilaterally in the Achilles tendons and also has been reported in the shoulders and hands, whereas overuse tendinitis usually occurs on one side only.

Calcific tendinitis usually occurs in individuals between the ages of 30 to 40, and is more common in diabetics (Cluett).

Source: Medical Disability Advisor



Diagnosis

History: Obtaining a thorough history is important and should include the exact location of the pain, time of onset, associated activities at the time of onset, aggravating and alleviating factors, other medical conditions, current medications, and occupational and recreational history. The individual may complain of pain at a specific point in the area of a muscle origin or insertion. Pain may have begun gradually or may be sudden in onset and reproduced with activity of the muscle or muscle group. The individual may also report repetitive use of that particular muscle group; it is very important to identify what activity (or activities) is causing the tendinitis. An athlete may report use of different footwear or equipment, or a change in training or training surfaces.

Physical exam: A detailed physical examination is the key to diagnosis. Each body location will require a specific physical examination. In general, there is usually pain with palpation (gentle touch) of the muscle unit; the pain may be localized to the insertion or origin of the muscle. Swelling, warmth, stiffness, and redness may also be present. Creaking or popping (crepitus) may be palpated. Pain may limit the normal range of motion of the affected muscle or muscle group. A neurovascular exam will help to rule out compartment syndrome and nerve injury. If the tendinopathy is chronic, thickening of the tendon on the affected side may be noted when compared with the normal side. Extreme pain in a lower extremity may indicate acute compartment syndrome. Excessive swelling may be a sign of tendon rupture.

Tests: Testing is seldom needed to make the diagnosis of tendinitis. If arthritis is suspected, specialized blood tests such as a rheumatoid factor assay may be helpful in determining the type of arthritis. If there is a history of trauma, an x-ray may reveal skeletal abnormalities at the site of tendon origin/insertion or calcium deposits in the tendons of the rotator cuff. Ultrasound—quick, non-invasive, and less expensive than MRI—can measure tendon width and integrity of the collagen as well as calcifications.

Source: Medical Disability Advisor



Treatment

The goal of treatment is to reduce discomfort and restore function. Tendinitis caused by trauma, especially if it occurs suddenly (acute), is generally treated with rest, ice (cold therapy), compressive dressing, and elevation to control swelling (RICE). Heat rather than cold therapy may be used for acute forms of the condition, depending on patient response. Nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed for pain and swelling. When the acute episode has passed, rehabilitation for strengthening and evaluation of individual factors that led to tendinitis may be needed to prevent recurrence.

Ongoing (chronic) tendinitis is treated by stopping the aggravating activity, initiating RICE therapy, and using NSAIDs. With chronic tendinitis, heat may be more effective than cold in therapy. Muscle strengthening may be recommended to restore normal function.

In the past, corticosteroids were injected into the tendon sheath to relieve pain and swelling in cases where conservative treatment failed or proved insufficient. However, this treatment may be associated with tendon rupture and should only be used in special circumstances. In extreme cases, surgery (excision, tenosynovectomy) may be needed to remove inflamed tissue or calcium deposits.

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.*
 
Ankle and Foot Disorders
Knee Disorders
 
* 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

Recovery depends on the cause or mechanism of injury for the tendinitis. The prognosis is also very good in chronic cases in which the inciting circumstances can be identified and changed. Cases requiring surgery are rare, but individuals with significant tendon damage may experience at least partial loss of function.

Source: Medical Disability Advisor



Rehabilitation

The initial goals of rehabilitation for tendinitis are controlling pain and swelling, followed by regaining motion, flexibility, strength, and endurance of the tendon, muscle, and involved joint structures. An effort should be made to identify the underlying cause of the current symptoms, after which, when possible, modifications should be made to reduce the risk factors associated with the condition. Tendinitis is probably less common than other more chronic tendinopathies or tendinoses, which do not manifest inflammation but may be more degenerative in origin (Hegmann; Canale).

Self-application of cold and sometimes heat may be used throughout rehabilitation to control pain and swelling (Hegmann). With tendinitis, the use of therapeutic ultrasound is contraindicated over an inflamed tendon as it may worsen the injury (Malanga), although in some cases pain control may be helped with iontophoresis (Stretanski). If pain significantly limits motion, then temporarily splinting the involved part may also be necessary. When indicated, therapy should begin with range of motion exercises, progress to strengthening exercises as indicated, and continue by instructing individuals in a home exercise program to complement supervised rehabilitation. Individuals should be taught correct body mechanics and movement patterns to reduce the risk of re-injury in the affected limb. Orthotics may be used for some lower extremity cases (Cleveland).

The final goal is returning the individual to full function for work and recreational activities with minimal risk of re-injury. If work tasks expose the individual to risk factors for tendinitis, an ergonomic assessment may be indicated. If leisure activities are suspect, the individual should be educated in ways to modify the activity and decrease the likelihood of developing symptoms.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistTendinitis
Occupational / Hand / Physical TherapistUp to 4 visits within 8 weeks
Surgical
SpecialistTendinitis
Occupational / Hand / Physical TherapistUp 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



Complications

Complications are uncommon for most forms of tendinitis. Compartment syndrome and nerve injury may be caused by tissue swelling from trauma associated with tendinitis. Inflammation of the lining of the tendon sheath (tenosynovitis) often accompanies tendinitis. Chronic tendinitis can weaken the tendon and lead to subsequent tendon rupture. Inflammation in tendons of the hand may cause the thumb to extend (de Quervain's disease). Fingers and/or the thumb may be hampered in movement by swelling of the tendons, which creates crepitus or catching (trigger finger).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions include limiting activities associated with symptoms of the tendinitis. Depending on the tendon involved, restrictions may include avoidance of lifting, carrying, or twisting movements of the wrist or forearm, as well as any repetitive motions or overhead work. Use of protective or assistive devices such as splints, crutches, or slings may affect dexterity. Safety issues may need to be evaluated. Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function.

Return to work requiring physical activity may need monitoring, as many individuals attempt to resume "normal" activity too soon, often leading to a cycle of recurring injury.

Risk: Risk for reinjury is dependent on the initial cause or mechanism of injury for the tendinitis.

Capacity: Capacity is also dependent on the initial cause or mechanism of injury for the tendinitis.

Tolerance: Tolerance is linked to the initial cause or mechanism of injury for the tendinitis. The more pain the lower the tolerance and the longer the disability.

Source: Medical Disability Advisor



Maximum Medical Improvement

In the absence of fracture, dislocation, nerve injury, or spinal cord injury, the cervical sprain/strain is considered a “soft tissue injury.” Like other soft tissue injuries, the majority of the healing occurs in the first 3 months. Other than surgery, additional treatment after 3 months from the date of injury is not likely to result in dramatic improvement, so MMI is frequently achieved by 3 months after injury.

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:

  • Which tendon is involved?
  • Does individual have a history of injury, overload, or overuse of the tendon?
  • Does individual have a history of fluoroquinolone use?
  • Does individual's work or recreation involve repetitive tasks or excessive exercise?
  • Does individual report a gradual onset of pain during or after activity, swelling, stiffness, and crepitus with motion?
  • On exam, was swelling, warmth, tenderness, or crepitus evident?
  • Is there pain with movement or decreased range of motion?
  • Has individual undergone any imaging or other tests to rule out conditions with similar symptoms?

Regarding treatment:

  • Is individual with an acute injury being treated with rest, ice, compression, and elevation (RICE)?
  • Is heat being used rather than ice?
  • Is individual being treated with NSAIDs?
  • Has physical therapy been prescribed? Has individual stopped aggravating activity?

Regarding prognosis:

  • Is individual active in physical therapy?
  • Does individual have a home exercise program? Is individual complying with program?
  • Does individual have any conditions that may affect ability to recover?
  • Has individual developed any complications such as compartment syndrome, nerve injury tenosynovitis, tendon rupture, De Quervain’s disease, or a trigger finger?

Source: Medical Disability Advisor



References

Cited

"Incidence Rates for Nonfatal Occupational Injuries and Illnesses Involving Days Away from Work per 10,000 Full-time Workers for Selected Characteristics and Industry Division, United States, 2002." U.S. Department of Labor. 28 Apr. 2004. U.S. Department of Labor. 6 Jun. 2013 <http://www.bls.gov/opub/cwc/sh20040414tb06.htm>.

Biundo, J. J., R. W. Irwin, and E. Umpierre. "Sports and Other Soft Tissue Injuries Tendinitis, Bursitis, and Occupation-related Syndromes." Current Opinion in Rheumatology 13 2 (2001): 146-149. National Center for Biotechnology Information. National Library of Medicine. 6 Jun. 2013 <PMID: 11224739>.

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

Canale, S. Terry, and James H. Beaty, eds. "Chapter 72 - Dupuytren Contracture." Campbell's Operative Orthopaedics. 11th ed. Philadelphia: Mosby Elsevier, 2008.

Cleveland, Kevin B. "Chapter 24 – Nontraumatic Soft-Tissue Disorders." Campbell's Operative Orthopaedics. Eds. S. Terry Canale and James H. Beaty. 11th ed. Philadelphia: Mosby Elsevier, 2008.

Cluett, Jonathan. "Calcific Tendonitis." About.com. 12 Aug. 2012. 6 Jun. 2013 <http://orthopedics.about.com/od/rotatorcuff/a/calcific.htm>.

Hegmann, Kurt E., ed. "Chapter 24 – Nontraumatic Soft-Tissue Disorders." Occupational Medicine Practice Guidelines. 2nd ed. ACOEM, 573-625.

Maffulli, N., J. Wong, and L. C. Almekinders. "Types and Epidemiology of Tendinopathy." Clinics in Sports Medicine 22 4 (2003): 675-692. MD Consult. Elsevier, Inc. 6 Jun. 2013 <http://home.mdconsult.com/das/journal/view/40179602-4/N/14064018?sid=293465610&source=MI>.

Mafi, N., R. Lorentzon, and H. Alfredson. "Superior Short-term Results with Eccentric Calf Muscle Training Compared to Concentric Training in a Randomized Prospective Multicenter Study on Patients with Chronic Achilles Tendinosis." Knee Surgery, Sports Traumatology, Arthroscopy 9 1 (2001): 42-47. National Center for Biotechnology Information. National Library of Medicine. 6 Jun. 2013 <PMID: 11269583>.

Malanga, Gerard A. , Jay E. Bowen, and . "Chapter 15 - Rotator Cuff Tear." Essentials of Physical Medicine and Rehabilitation. Eds. Walter R. Frontera, Julie K. Silver, and Thomas Rizzo. 2nd ed. Philadelphia: Saunders, Elsevier, 2008.

Rettig, A. C. "Wrist and Hand Overuse Syndromes." Clinics in Sports Medicine 20 3 (2001): 591-611. MD Consult. Elsevier, Inc. 6 Jun. 2013 <http://home.mdconsult.com/das/journal/view/40179602-4/N/11908443?sid=293465610&source=MI>.

Steele, Mark. "Tendonitis." eMedicine. Eds. Richard S. Krause, et al. 18 Oct. 2012. Medscape. 6 Jun. 2013 <http://emedicine.com/emerg/topic570.htm>.

Stretanski, Michael F. "Chapter 12 - Biceps Tendon Rupture." Essentials of Physical Medicine and Rehabilitation. Eds. Walter R. Frontera, Julie K. Silver, and Thomas Rizzo. 2nd ed. Philadelphia: Saunders, Elsevier, 2008. MD Consult. Elsevier, Inc. 6 Jun. 2013 <http://www.mdconsult.com/das/book/body/173267058-3/0/1678/14.html?tocnode=55147596&fromURL=14.html#4-u1.0-B978-1-4160-4007-1..50013-4_159>.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.