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.

Tenotomy


Related Terms

  • Division of Tendon
  • Tendon Release
  • Tendotomy
  • Tenontotomy

Specialists

  • Hand Surgeon
  • Neurosurgeon
  • Occupational Therapist
  • Orthopedic (Orthopaedic) Surgeon
  • Physical Therapist
  • Plastic Surgeon

Factors Influencing Duration

Factors influencing length of disability include reason for the procedure, presence of any coexisting conditions, job demands, and complications.

Medical Codes

ICD-9-CM:
82.11 - Tenotomy of Hand; Division of Tendon of Hand
83.11 - Achillotenotomy
83.12 - Adductor Tenotomy of Hip
83.13 - Tenotomy, Other; Aponeurotomy; Division of Tendon; Tendon Release; Tendon Transection; Tenotomy for Thoracic Outlet Decompression

Overview

Tenotomy is a surgical procedure to cut through or disconnect a tendon. The procedure normally involves cutting the tendon and allowing the end to be pulled or retracted by the muscle proximal or away from the location of the cut. Any tendon could be treated with this procedure, although tendons in the eyes and the extremities are the ones most commonly treated.

A tenotomy is performed by identifying and surgically releasing (resecting) the tendon that is attached to the muscle that is producing the symptoms, while protecting the normal surrounding tissues and their attachments. Tenotomy may also involve removal of unhealthy surrounding soft tissues or bone (débridement) to promote improved healing.

Tenotomy is commonly done to relieve tightened or shortened muscles (contractures). Sometimes the tendon is re-routed (transposed) to maintain muscle function. Tenotomy may be used to correct lazy eye syndrome, allow relaxation of joints in individuals with cerebral palsy who develop contractures, or treat tennis elbow (lateral epicondylitis).

Although often described as a "tendon release," surgery performed for specific conditions such as de Quervain's tenosynovitis is a release of the tendon sheath surrounding the tendon and not a cut through the tendon. Also see tendon-sheath-incision.

Source: Medical Disability Advisor



Reason for Procedure

This procedure is used to correct shortening in a muscle-tendon unit. Tenotomy also treats pain, deformity, and related problems associated with muscle shortening. For example, Achilles tendinitis that does not respond to nonsurgical (conservative) treatment may be improved with tendon splitting, excision of the diseased portion of the tendon, or partial release of up to 50% of the tendon without risk of rupture (Williams). Lateral epicondylitis may be successfully treated by open release of the tendon's insertion, excision of degenerated tendon tissue, and repair of any tendon tears when conservative treatments fail.

Source: Medical Disability Advisor



How Procedure is Performed

Tenotomy is normally done under either regional or local anesthesia and as either an inpatient or outpatient procedure, depending upon the complexity of the surgery. Some surgeries may be performed arthroscopically, allowing a smaller incision while using a small camera (arthroscope) to guide the actions of the surgeon. Generally, an incision is made over the area of tendon attachment, and the tendon tissue is cut away from the bone, allowing the tendon to relax or pull back towards the muscle belly. It may not be necessary to release the entire tendon to decrease tension on the muscle-tendon unit. If the tendon is to be reattached (transposed) to another location, the incision is larger and the procedure more complicated. Very limited procedures, where the tendon is only lanced or pierced to relieve tension, may be done in a physician's office, under local anesthesia. The wound is closed and dressings applied. Extension splints may be used over joints to promote relaxation of the muscle-tendon unit, increasing range of motion.

Specific surgical techniques to release the tendons of hypertonic (spastic) muscles usually involve an intramuscular lengthening. For an intramuscular lengthening, the tendon is cut at the musculotendinous junction and allowed to slide distally which results in a "sliding lengthening." In other words, the muscle-tendon length is now longer and the contracted (shortened) muscle has a longer resting length which can allow for increased range of motion at the joint.

Source: Medical Disability Advisor



Prognosis

Outcome is dependent on the underlying condition that resulted in the shortened muscle that is limiting range of motion. Recovery usually results in improvement but not a return to full function. Strength loss is common. Compliance with rehabilitation is very important to maintain the surgical outcome.

Source: Medical Disability Advisor



Rehabilitation

The primary focus of rehabilitation following a tenotomy is to control pain and restore function. Several factors may contribute to the course of rehabilitation including the underlying etiology that led to the tenotomy, the length of time motion was limited pre-operatively, the length of postoperative immobilization, the functional impairment, and the surgical procedure performed.

It is common for individuals to be splinted immediately after surgery. In the upper extremity, motion of the joint is usually encouraged immediately postoperatively (Wright) and soft dressings are preferred to full splints (Hegmann). Cryotherapy may be used to decrease edema and pain (Hegmann). Unless contraindicated, therapists may instruct individuals in exercises for the adjacent joints to prevent associated loss of motion and strength. When indicated, gentle range of motion exercises can be initiated and progressed as tolerated. Next, therapists instruct individuals in strengthening exercises that also are progressed as tolerated. Emphasis may be placed on the muscles opposing the involved muscle, depending on the reason for the release. As soon as indicated, therapists teach a home exercise program to the individual to complement the supervised rehabilitation (Hegmann).

Exact progression of therapy is determined by the surgeon and the operative procedure. It is important to focus all rehabilitation on functional improvement. Prior to initiating treatment, the therapist should consult with the treating physician to identify whether or not a particular postoperative protocol is to be followed. Loading of the involved muscle may need to be modified until full healing occurs, and should be discussed with the individual's physician. An ergonomic assessment may be beneficial in order to identify workplace modifications that may be beneficial if functional limitations persist after recovery.

FREQUENCY OF REHABILITATION VISITS
Surgical
SpecialistTenotomy
Occupational/Hand/Physical TherapistUp to 15 visits within 12 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 from tenotomy include infection, nerve and vessel injury, and loss of muscle function. Strength is often impaired following tenotomy surgery.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions and accommodations depend on the underlying cause for a tenotomy. For example, individuals undergoing tenotomy for lateral epicondylitis may require temporary reassignment. Use of temporary protective or assistive devices such as splints, crutches, or slings may affect dexterity and require reevaluation of safety issues. Ergonomic evaluation of the work place should be performed to prevent recurrence. If necessary ergonomic adjustments cannot be made to accommodate use of work equipment, reassignment may be permanent. Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function.

For more information refer to "Work Ability and Return to Work," pages 189–193.

Risk: The risk for recurrence or rupture of the repair site is dependent on the original condition that caused the need for the tenotomy.

Capacity: Functional ability and capacity will be impacted by the joint(s) involved, the underlying disease, and the requirements of the job. Strength loss is common. Postoperative splinting is often required for “tendon slide” or muscle lengthening procedures, which will result in decreased capacity.

Tolerance: The level of pain will vary by individual’s tolerance, the joint(s) involved, and the underlying disease condition.

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

Source: Medical Disability Advisor



Maximum Medical Improvement

Non-surgical treatment 45 days, surgery 90 days.

Source: Medical Disability Advisor



References

Cited

Hegmann, Kurt E., and Matthew A. Hughes. "Chapter 11 - Hand, Wrist and Forearm Disorders." Occupational Medicine Practice Guidelines. Ed. Kurt E. Hegmann. 2nd ed. ACOEM, 1-156.

Williams, S. K., and M. Brage. "Heel Pain-Plantar Fasciitis and Achilles Enthesopathy." Clinics in Sports Medicine 23 1 (2004): 123-144. PubMed. 29 Jun. 2015 <http://www.ncbi.nlm.nih.gov/pubmed/15062587>.

Wright, Phillip E. "Chapter 73 - Carpal Tunnel, Ulna Tunnel and Stenosing Tenosynovitis." Campbell's Operative Orthopaedics. Eds. S. Terry Canale and James H. Beaty. 11th ed. Philadelphia: Mosby Elsevier, 2008.

Source: Medical Disability Advisor






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