Hi Tracy,
I can see why this case maybe quite challenging. Do not think of this
as an ongoing problem. Review her as if she was new to you; go over the full
history again, find out about the various treatments and interventions at
the hospitals. find out about her role both the pre and post symptoms, any
hobbies/ sports. then you need to start to investigate the workspace. put
a plan together once all the issues have been highlighted, this case is
likely to have yellow, blue/black flags all over it. but we should dispel
few things first tenosynovitis is quite an old term and has been replaced by
the term tendonopathy. The reason this is important is tenosysnovitis
implies the pathological process is an inflammatory one. Research seems to
suggest that this is not strictly true and that the collagen in tendons gets
damaged by micro trauma and the area is re-injured before the process can be
fully healed. Treatment strategies need to provide pain relief but also
provide adequate rehabilitation to strengthen the area to allow the area to
recover but provide support so she can return eventually to normal duties.
De Quervain's syndrome is a painful condition that affects tendons where
they run through a tunnel on the thumb side of the wrist. If she has
bilateral De Quervain's and shoulder problems, i.e. multiple upper limb
disorders then the picture is not so clear cut. Physiotherapy wise the
cervical/ thoracic spine and upper limbs need to be evaluated. as others
have said you need to review the workplace. The aim to evaluate four key
collective risk factors: repetitiveness, high force, awkward postures and
movements, lack of proper recovery periods. Sorry if this does not tread the
best strung it together in-between treating patients. If you have any more
queries please do not hesitate to contact me off jisc at the following
emails. I have added a quick ULD risk assessment to start to get you and
this client thinking in the right direction with regard to work related
issues.
Phil Morrow
Occupational Health Physiotherapist
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-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]] On Behalf
Of Tracy Turner
Sent: 10 January 2012 08:56
To: [log in to unmask]
Subject: [OCC-HEALTH] quervains tenosynovitis
Good morning
Please can you help with this case which I am finding quite challenging. 32
yr lady working in sausage factory - repetative tasks required. Long history
of pain in both wrsits and shoulder. Given restricted role for almost 3
motnhs - no improvement. Given splints to wear at work but I advised she
would be best refraining from work as even a light duty role was not
allowing full recovery.
S/B rheumatology - diagnosed with quervains tenosynovitis most likely
brought on by her repetative work. off work for 6 weeks - light ache in
wrists but wants to RTW. discharged by physio. It has been recommended that
she RTW with altered duties so that she does not have to make repetative
movements for whole shift and to lift less weights. The specialist has said
that she is likely to continue to have the symptoms if she keeps injuring
her wrists. Has anyone every dealt with an employee with this diagnosis who
has sucessfully returned to their original role or would you recommend a
permanent transfer to an alternatve role. I dont think there is such a role
available in the factory. In my opinion she is unlikely to come under the
DDA as every day activities are not affected. Is it RIDDOR reportable??
Please also note that she is clearly not telling her specialist of the
support which she has recived just that her Occupational Health Nurse does
not want her to work with splints! Do you think it is appropriate to work in
a repetative role if she required splints ?? Or do you think that now the
injury is improving splints would prevent further exacerbation. Sorry to aks
so many questions but I know you are all a knowledgable lot and will help.
Thank you.
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