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.

Tenosynovitis, Radial Styloid

tenosynovitis, radial styloid in 中文(中华人民共和国)

Related Terms

  • De Quervain's Disease
  • De Quervain's Tenosynovitis
  • Stenosing Tenosynovitis of First Extensor Compartment

Specialists

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

Comorbid Conditions

Factors Influencing Duration

Dominant hand use, job requirements, ability to avoid aggravating activity, tolerance to immobilizing devices (splints), and complications of treatment would all affect length of disability.

Medical Codes

ICD-9-CM:
727.04 - Radial Styloid Tenosynovitis; de Quervains Disease

Overview

© Reed Group
Radial styloid tenosynovitis occurs when the tendons that move the thumb up or outward (away from the index finger) become painful and swollen (tenosynovitis). Symptoms are most commonly reported with repetitive gripping and twisting motions.

Two commonly affected tendons are those of the extensor pollicis brevis and abductor pollicis longus muscles. These tendons pass over the end of the radius (radial styloid) at the wrist. Normally, they slide through a canal (extensor retinaculum) without difficulty (first dorsal compartment). Motion of the thumb and wrist become painful and difficult when the tendons become thickened and do not slide smoothly.

The cause of tenosynovitis is unknown (idiopathic), but symptoms can be associated with repetitive grip, grasp, and vibration with the thumb positioned against the fingers while the wrist is moved toward the palm (flexed) and toward the little finger side of the hand (ulnarly deviated), as may occur when lifting or twisting. The concept is similar to that of trigger finger.

Incidence and Prevalence: The two most common entrapment tendinitis conditions in the hand and wrist are trigger finger and radial styloid tenosynovitis; however, trigger finger occurs 20 times more often (Meals).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The specific cause for pain over the first dorsal compartment is unknown, and multiple factors have been proposed.

Occupational risk factors for de Quervain's disease for which there is some evidence include highly repetitive work alone or in combination with other factors such as forceful work and awkward postures. Proposed occupational risk factors for which there is insufficient evidence include vibration, keyboard activities, cold environment, length of employment (trend to increased incidence if on the job less than 3 years), and dominant hand use.

Proposed nonoccupational risk factors for de Quervain's disease for which there is insufficient evidence are: advancing age (de Quervain's disease peaks in individuals younger than age 40), body mass index (BMI), gender (although some researchers have postulated that height differences between men and women at stationary workstations lead to differences in postures), biopsychosocial factors, and diabetes.

For more information refer to "Disease and Injury Causation," pages 162–166.

Source: Medical Disability Advisor



Diagnosis

History: Individuals complain of pain at the base of the thumb with wrist or thumb motion. There may be visible swelling or a lump on the thumb side of the wrist, and at times a catching or snapping sensation. Individuals may complain of inability to grip.

Physical exam: The exam reveals swelling and tenderness along the thumb side of the wrist (tip of radial styloid over the first dorsal compartment that contains the tendons of the extensor pollicis brevis and the abductor pollicis longus muscles). Pain is made worse with simultaneous flexion of both of the interphalangeal joint and the metacarpal phalangeal joint of the thumb with simultaneous ulnar deviation of the wrist (Finkelstein test). Swelling or fullness may be felt over the tendons. Active contraction against resistance of the involved thumb extensor tendon increases pain.

Tests: No invasive tests are required and x-rays are usually normal. X-rays are useful, however, in ruling out arthritic changes in the thumb (carpometacarpal [CMC] joint) and wrist.

Source: Medical Disability Advisor



Treatment

Modifying the aggravating activity and using nonsteroidal anti-inflammatory drugs (NSAIDs) as analgesics are only effective in very mild cases. Occasionally an ergonomic assessment is useful to examine workplace modifications that may reduce the risk factors associated with this condition.

Common clinical practice for the conservative (nonoperative) management of radial styloid tenosynovitis begins after attempts at modified activities have been unsuccessful. The first goal is to decrease pain and swelling with a trial of exercises; continuous immobilization of the thumb with a protective spica splint or cast may be necessary to provide rest for the tendons, which decreases the pain. However, individuals frequently remove the splint because of the restriction it imposes, and there is some question about its benefits when used alone. This may be followed with a corticosteroid and anesthetic injection which provides relief in more difficult cases. The final goal is to restore mobility and strength, and educate the individual in ways to protect the wrist (Hegmann). There are few studies that prove the effectiveness of various treatment options, but steroid injection tends to offer the best relief outside of surgery, whereas rest and NSAIDs are more useful for individuals who refuse steroid injection therapy.

If conservative measures fail, surgery may be necessary to release the first dorsal compartment. Limited studies suggest also doing a tenosynovectomy.

Physical and occupational therapy modalities to decrease the pain and swelling and adaptive splints may be recommended.

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.*
 
Extensor Compartment Tenosynovitis (including DeQuervain’s Stenosing Tenosynovitis)
 
* 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

Most individuals will recover with injections or modification of activities. Pain may decrease, while swelling is slower to resolve. Those who require surgery (tenosynovectomy or decompression) can expect improvement from symptoms. Permanent impairment after surgery is rare unless nerve injury occurs (superficial radial nerve).

Source: Medical Disability Advisor



Rehabilitation

The duration of therapy depends on the severity of the symptoms and the response to treatment. If the initial pain and swelling subside and motion becomes pain free, the rehabilitation process may warrant less direct observation and guidance of the therapist, being continued independently through a home exercise program. If symptoms persist, iontophoresis with corticosteroids as well as topical or oral NSAIDs may be used (Hegmann). According to the individual’s response during rehabilitation, corticosteroid injections may also need to be repeated (Hegmann).

As pain subsides, stretching and strengthening exercises of specific wrist and elbow muscles are emphasized. If work tasks are suspected as contributing to the condition, ergonomic recommendations should be implemented to reduce the risk factors associated with the symptoms.

If radial styloid tenosynovitis requires surgical release, some restrictions may be placed on the progression of range of motion and strengthening exercises with certain movements during recovery. These restrictions vary according to the degree or type of surgery that was performed and will be guided by the treating physician.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistTenosynovitis, Radial Styloid
Occupational/Hand/Physical TherapistUp to 4 visits within 6 weeks with home exercise program
Surgical
SpecialistTenosynovitis, Radial Styloid
Occupational/Hand/Physical TherapistUp to 8 visits within 8 weeks with home exercise program
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

Previous injury that altered the anatomy of the wrist would make treatment more difficult. Corticosteroid injections may cause changes in skin color and cannot be repeated more than one or two times.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions include modified use of the affected thumb, with restricted lifting, gripping, and twisting during early stages of treatment. Individuals may need to wear protective splinting for aggravating activities or during expanded periods of very heavy work. It may be helpful to limit repetitive simultaneous wrist flexion and ulnar deviation.

For more information refer to "Work Ability and Return to Work," pages 201–203.

Risk: Recurrence is rare if therapeutic activities are started early. After complete release of the retinaculum, early use allows for the healing to maintain a larger tunnel, which is less likely to cause rubbing or interfere with tendon gliding. Tendon rupture is rare.

Capacity: Wrist range of motion and grip are usually unaffected. If tenosynovectomy was performed, traditional wound healing requirements are necessary during recovery.

Tolerance: Pain is the limiting factor for tolerance. Each individual is unique and has various pain tolerance levels. The tolerance level is also impacted by rewards available per the activity. Temporary work modifications may be necessary during recovery, but most individuals can return to previous employment levels. Surgical treatment is usually successful.

Accommodations: If the individual’s activities at work and home can be modified, most can return to normal activities the next day with light dressing over the incision site.

Source: Medical Disability Advisor



Maximum Medical Improvement

90 days.

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:

  • Does individual complain of pain at the base of the thumb with wrist or thumb motion?
  • Is there a visible swelling or a lump on the thumb side of the wrist, and a catching or snapping sensation?
  • Does individual complain of inability to grip?
  • Has diagnosis of radial styloid tenosynovitis been confirmed?

Regarding treatment:

  • Do symptoms persist despite avoidance of aggravating motion?
  • If conservative measures failed to provide symptom relief, is individual now a candidate for surgical intervention?
  • Has individual been involved in a comprehensive rehabilitation program?
  • Has individual and/or job requirements been evaluated by an occupational and/or physical therapist?
  • Is a splint or adaptive equipment warranted and available?

Regarding prognosis:

  • Has adequate time passed to allow conservative measures to resolve symptoms?
  • Has individual been involved in a comprehensive rehabilitation program?
  • Is individual now a candidate for surgical intervention?
  • Has protective splinting been provided?
  • Does individual have an underlying condition that may impact recovery?
  • Would individual benefit from reassignment or vocational retraining?

Source: Medical Disability Advisor



References

Cited

Hegmann, Kurt E., and Matthew A. Hughes. "Chapter 11 - Hand, Wrist and Forearm Disorders." Occupational Medicine Practice Guidelines Evaluation and Management of Common Health Problems and Functional Recovery of Workers. Eds. Kurt T. Hegmann, et al. 2nd Edition, 2008 Revision ed. OEM Press, 2008. 1-156.

Meals, Roy A. "De Quervain Tenosynovitis." eMedicine. 15 Aug. 2014. Medscape. 14 Jul. 2015 <http://emedicine.medscape.com/article/1243387-overview>.

General

Ilyas, Asif, et al. "de Quervain Tenosynovitis of the Wrist." Journal of the American Academy of Orthopaedic Surgeons 15 12 (2007): 757-764.

Source: Medical Disability Advisor






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