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.

Tendon Sheath Incision


Related Terms

  • Carpal Tunnel Syndrome
  • Division of Tendon Sheath
  • Extirpation of Tendon Sheath
  • Inspection of Tendon Sheath
  • Stenosing Tenosynovitis
  • Tenolysis
  • Tenosynovitis

Specialists

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

Comorbid Conditions

Factors Influencing Duration

Factors include location, whether the dominant or nondominant hand is involved, underlying medical conditions, complications, type of surgery, and the individual's job requirements.

Medical Codes

ICD-9-CM:
82.01 - Exploration of Tendon Sheath of Hand; Incision of Tendon Sheath of Hand; Removal of Rice Bodies in Tendon Sheath of Hand
83.01 - Exploration of Tendon Sheath; Tendon Sheath Incision; Removal of Rice Bodies From Tendon Sheath

Overview

A tendon is a tough band of fibrous tissue that connects muscle to bone. Tendons are surrounded by specialized tissues (tendon sheath) that protect and help to nourish the tendons. Sometimes, the sheath can cause pressure on the tendon, limiting movement or causing pain.

Incision of a tendon sheath is a surgical procedure in which the tissue surrounding a tendon (tendon sheath or epitenon) is cut. Often, this is necessary to relieve pressure or constriction around a tendon. The tendon itself may be normal, but if the sheath around it is too tight, it can prevent the normal gliding function of the tendon. Incision of the sheath restores function by allowing the tendon to move more freely. Tenolysis is a surgical procedure that removes adhesions that impair normal tendon movement within the sheath.

For example, tendons that control movement of the fingers pass from the forearm to the wrist and into the hand through a series of "tunnels" that help hold the tendon close to the bone. These tunnels act just like the metal eyelets on a fishing rod that help to hold the fishing line in place. If adhesions develop, it can prevent free movement of the tendon, just like a knot in the fishing line.

A tendon sheath incision may be necessary in the treatment of inflammatory disorders, entrapment disorders, cumulative trauma disorders like lateral epicondylitis, changes resulting from fractures and dislocations, or other conditions that lead to formation of scar tissue along the tendon. Surgery may be indicated when conservative treatment has not led to improvement, or when decreased function and pain interfere with the activities of daily living (ADLs).

Incision of the tendon sheath can be required anywhere in the body a tendon is affected. In inflammatory disorders like rheumatoid arthritis, the procedure is most often done in the feet and hands. Entrapment disorders like carpal tunnel syndrome and stenosing tenosynovitis occur mostly in the hands and wrists.

Source: Medical Disability Advisor



Reason for Procedure

This procedure is used to restore tendon function and to relieve symptoms of loss of function and pain caused by entrapment or compression of the tendon.

Tendons that slide through tight compartments or tunnels are most prone to problems with the tendon sheath. Conditions that cause tenosynovitis, such as inflammatory diseases, cumulative trauma disorders, or changes resulting from fractures and dislocations, could result in the need for tendon release.

Source: Medical Disability Advisor



How Procedure is Performed

Local, regional, or general anesthesia may be required, depending on the location of the involved tendon. The surgery may be performed either endoscopically (using a special operating microscope and miniature instruments) or through an open incision. An incision is made over the tendon. The sheath and the tendon are explored, isolating and protecting nerve and blood vessel branches. The sheath is then either cut away (excised) entirely or loosened (released) by making a cut on one side along its length. Tendon function is evaluated with passive motion, and the wound is closed with sutures.

Source: Medical Disability Advisor



Prognosis

Successful outcome depends on the underlying reason for the procedure. Restoration of tendon function is usually possible, along with relief of pain and swelling. If there are no other complications (e.g., joint contractures, muscle or nerve damage), the procedure should restore normal function. There is the possibility of repeated procedures caused by recurrence of the underlying disease process.

Between 59% and 90% of individuals undergoing flexor tenolysis of the hand experience improvement in joint range of motion. From 5% to 33% of individuals undergoing this surgery find no improvement, and 8% of individuals experience worsening of symptoms. Tendon rupture occurs in 8% to 15% of individuals (Gorum).

Source: Medical Disability Advisor



Rehabilitation

Common clinical practice indicates that therapy after a tendon sheath incision includes exercises and activities specific for the location, degree of injury, and the functional limitations. In most cases, a full recovery can be expected (Hegmann).

Range of motion exercises should be started on the adjacent joints as soon as possible, unless contraindicated. Therapy focuses on controlling swelling using elevation, and following wound care and scar management protocols. Once the wound has healed, normal use of the affected joint is usually encouraged (Wright). Early movement and light activities of daily living may be initiated within 2 to 3 weeks, and strengthening exercises may be gradually added over the following 4 to 6 weeks and progressed according to the surgeon’s protocol (Wright). Therapy is directed towards restoring full hand function and achieving safe independence in activities of daily living.

Depending on the location and extent of injury, an ergonomist may be called upon to assess working conditions and possible modifications.

FREQUENCY OF REHABILITATION VISITS
Surgical
SpecialistTendon Sheath Incision
Occupational / Hand / Physical TherapistUp to 8 visits to teach and reinforce home range of motion exercises
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

Laceration could occur to the tendon, nerves, or blood vessels during surgery. Some authors suggest that there is a higher risk of nerve injury or symptom recurrence in endoscopic carpal tunnel tendon sheath incision (Fuller). Generally, endoscopic repairs have a much shorter healing time because the surgery is less invasive and there is less tissue damage. Infection, bleeding, worsening of symptoms, the formation of postoperative scar tissues including additional tendon adhesions, and the development of reflex sympathetic dystrophy are all potential complications.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations will depend on the tendon(s) involved and the underlying condition necessitating the procedure. Several days are required for the wounds to heal, during which time the area must be kept clean and dry. Initially, any activity that places tension or stress on the tendon will be limited. If there is risk of tendon rupture while any swelling or irritation resolves, use of the affected body part will be restricted for a few weeks. Temporary or permanent reassignment may be required to allow adequate healing and to prevent recurrence. Individuals who perform heavy or very heavy work may require additional lifting restrictions. Those whose duties require fine motor skills, especially in the wrists and hands, may benefit from implementation of ergonomic principles and work station adaptations (JAN).

Source: Medical Disability Advisor



References

Cited

Job Accommodation Network (JAN). U.S. Department of Health and Human Services. 29 Dec. 2008 <http://www.jan.wvu.edu/soar/motor/4_keyboarding.html>.

Fuller, David A. "Carpal Tunnel Syndrome." eMedicine. Eds. Michael S. Clarke, et al. 12 Aug. 2008. Medscape. 29 Dec. 2008 <http://emedicine.medscape.com/article/1243192-overview>.

Gerard, F., et al. "Immediate Active Mobilisation After Flexor Tendon Repairs in Verdan's Zones I and II. A Prospective Study of 20 Cases." Chirurgie de la Main 17 2 (1998): 127-132. National Center for Biotechnology Information. National Library of Medicine. 9 Dec. 2008 <PMID: 10855278>.

Gorum, Jay W., and Cato T. Laurencin. "Flexor Tenolysis." eMedicine. Eds. Michael S. Clarke, et al. 8 Apr. 2008. Medscape. 29 Dec. 2008 <http://emedicine.com/orthoped/topic96.htm>.

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.

Schneider, L. H., and S. B. Feldscher. "Tenolysis: Dynamic Approach to Surgery and Therapy." Rehabilitation of the Hand and Upper Extremity. Eds. E. J. Mackin, et al. 5th ed. Philadelphia: Mosby, Inc., 2002.

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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