70 144 Definition Inflammation of the tendon and synovial membrane of the tendon sheath. Sites of greatest risk of tendinitis include shoulder (rotary cuff and biceps), wrist, and elbow. The most com- mon etiology is extreme or repeated trauma, irritation, friction, or excessive unaccustomed exercise or use of affected area. Lower/extremity tendinitis is not uncommon in runners. Characteristics Acute pain or dull ache (with or without radiation), burning sensation, swelling, weakness of the extremity, and limited range of motion. Muscle tension may cause impingement and affect circulation of the tendon. Posture and force are the main risk factors for shoulder tendonitis. Wrist tendinitis is more likely to be associated with high force and repetition. Predisposing conditions include sports activities (tennis, running, swimming, etc.), congeni- tal anomalies, fractures, recent trauma or repetitive activities, rheumatoid arthritis or os- teoarthritis, and physically demanding hobbies. If not treated, it can advance to adhesive capsulitis (frozen shoulder). Policy Evaluate employee in the occupational health unit. Objectives Clinical Assessments and Interventions Referral for Medical Action Tendinitis Pain and inflammation persisting 5 days. Decreased range of motion. Lack of response to conservative treatment (heat or cold, NSAIDs, exercise). Similar complaints from several workers in same job area. Follow-up Actions Educate regarding signs, symp- toms, and causes of tendinitis. Advise to return to occupational health unit if symptoms recur. Perform job analysis, evaluate home activities, and make appro- priate recommendations as feasi- ble. Instruct regarding proper tech- niques for individual job. Assess employee status. Provide symptom relief. Prevent further injury to area. Record history of complaint including loca- tion of problem and type and frequency of symptoms. Inquire about predisposing fac- tors, repetitive upper/extremity activities, and excessive use of force by extremities. Obtain job and hobby history. Assess affected area including range of motion and stiffness. Visually inspect area for edema, erythema, and ecchymosis and palpate for tenderness. Administer analgesic or non-steroidal anti- inflammatory drug (NSAID) per standing order. Apply ice for acute injury heat may be alternately applied thereafter, depending on benefit to employee. Always limit to 20 minutes every 2 hours. Assess job’s physical demands, particularly repetitive, forceful tasks and recommend changes or accommodations as needed. Guideline continues on next page
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