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Schedule B Item 12 Bursitis and Item 13 Tendinitis, tenosynovitis
99/11/19-03
THE WORKERS' COMPENSATION BOARD OF BRITISH COLUMBIA
RESOLUTION OF THE PANEL OF ADMINISTRATORS
Re: Schedule B Item 12 Bursitis and Item 13 Tendinitis, tenosynovitis
WHEREAS:
Pursuant to Section 82 of the Workers Compensation Act, RSBC 1996, Chapter 492 and amendments thereto (the "Act") the Panel of Administrators (the "Panel") must approve and superintend the policies and direction of the Workers’ Compensation Board (the "Board"), including policies respecting compensation, assessment, rehabilitation and occupational safety and health, and must review and approve the operating policies of the Board;
AND WHEREAS:
Pursuant to Section 6(4)(a) of the Act the Board may, on the terms and conditions and with the limitations which are deemed adequate and proper, amend Schedule B of the Act;
AND WHEREAS:
The Policy and Regulation Development Bureau has consulted with the Occupational Disease Advisory Committee on the need to amend Items 12 and 13 of Schedule B;
AND WHEREAS:
The Board’s current policy dealing with compensation for "Bursitis" is provided in Section 27.12 of the Rehabilitation Services and Claims Manual;
AND WHEREAS:
The Board’s current policy dealing with compensation for "Tendinitis, tenosynovitis" is provided in Section 27.11 of the Rehabilitation Services and Claims Manual;
THE PANEL OF ADMINISTRATORS RESOLVES THAT:
- Pursuant to Section 6(4)(a) of the Act, Items 12 and 13 of Schedule B of the Act are amended as shown in Appendix A and a corresponding Regulation is to be deposited with the Registrar of Regulations in such form as may be required by the Registrar.
- Section 27.12 of the Rehabilitation Services and Claims Manual is renumbered and amended as shown in Appendix B.
- Section 27.11 of the Rehabilitation Services and Claims Manual is renumbered and amended as shown in Appendix C.
- As consequential amendments, Sections 27.10, 27.20 and Items 12 and 13 of Appendix 2 of the Rehabilitation Services and Claims Manual are amended as shown in Appendices D, E and F respectively.
- The above amendments to Schedule B and to Sections 27.10, 27.11, 27.12, 27.20, and Appendix 2 of the Rehabilitation Services and Claims Manual shall be effective 30 days after publication of the above Regulation in the British Columbia Gazette. The amendments to Schedule B and to the above policies shall apply only to those claims where the initial application for compensation has been received by the Board on or after the effective date of such amendments.
DATED at Richmond, British Columbia, December 17, 1999.
| By the Workers' Compensation Board |
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| DON COTT, CHAIR PANEL OF ADMINISTRATORS |
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APPENDIX A — Revised Schedule B Language
(Additions in Bold, Deletions in Strikethrough)
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| Description of Disease | Description or Process or Industry |
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| 12 Bursitis: |
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Where there is repeated jarring impact against, or where there are significant periods of kneeling on, the affected knee. |
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Where there is frequently repeated or sustained abduction or flexion of the shoulder joint greater than sixty degrees and where such activity represents a significant component of the employment. |
| 13 Tenosynovitis, tendinitis.. |
Where unaccustomed and repetitive use of the affected arm, hand, leg or foot is required.
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| 13 Tendinitis, tenosynovitis: | |
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Where there is use of the affected tendon(s) to perform a task or series of tasks that involves any two of the following:
and where such activity represents a significant component of the employment.
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Where there is frequently repeated or sustained abduction or flexion of the shoulder joint greater than sixty degrees and where such activity represents a significant component of the employment. |
APPENDIX B
(Additions in Bold, Deletions in Strikethrough)
#27.12 #27.11 Bursitis
The process or industry listed opposite to bursitis in Schedule B is "Where there is excessive friction, rubbing or pressure on the bursa involved".
Schedule B lists "Knee bursitis (inflammation of the prepatellar, suprapatellar, or superficial infrapatellar bursa)" and "Shoulder bursitis (inflammation of the subacromial or subdeltoid bursa)" as occupational diseases.
A bursa is a sac-like cavity lined with a slippery synovial tissue. It is typically found at a site of potential friction between tendons and muscles and a bony prominences lying beneath them. The primary purpose of the bursa is to reduce friction between the tissues. By virtue of its physiological anatomical proximity to less flexible anatomical structures, a bursa can become inflamed if it is subjected to excessive friction, rubbing or pressure.
Bursae are found in the wrist, elbow, shoulder, hip, knee and ankle. Bursitis is inflammation of a bursa. It is most commonly found in the knee involving the prepatellar or superficial infrapatellar bursa. Bursitis involving the knee has been referred to as "carpet layer’s knee". Bursitis may also be caused by general inflammatory diseases (such as rheumatoid arthritis) or by bacterial infections typically following a puncture wound.
Friction, rubbing, or pressure on a bursa if of infrequent occurrence or of moderate magnitude is less likely to be harmful.
Use of the word "excessive" indicates that the amount of friction, rubbing or pressure on the bursa must be significantly more than what is normal with respect to that bursa. If there is evidence of something physically pressing on or rubbing against the inflamed bursa which is considered excessive, the requirements of the second column of Schedule B will be met.
A claim for bursitis attributed to a sudden trauma to the knee (such as kneeling on a protruding object), to a sudden trauma to the shoulder, or for an infection of the bursa due to a penetrating wound, will be treated as an injury and will be adjudicated in accordance with the policies set out in Chapter 3. A claim made by a worker diagnosed with bursitis where no specific trauma or penetrating wound has occurred, will be treated as a disease and will be adjudicated in accordance with the policies set out in Chapter 4.
The following guiding principles apply when interpreting terms in Schedule B in connection with shoulder bursitis (Schedule B item 12(b)) and shoulder tendinitis (Schedule B item 13(b) — also see #27.12).
Frequently repeated abduction or flexion of the shoulder joint
In determining whether a particular work task involves "frequently repeated…abduction or flexion of the shoulder joint" consideration is given to such matters as:
- the frequency of the work cycle for the tasks being performed (how often there is abduction or flexion of the shoulder joint greater than sixty degrees);
- the amount of time during a work cycle that the affected muscle/tendon groups of the shoulder are working compared to the amount of time such tissues have to return to a relaxed or resting state;
- the amount of time between work cycles that the affected muscle/tendon groups of the shoulder have to return to a relaxed or resting state;
- whether other activities are performed between work cycles that require motions or muscle contractions that affect the ability of the affected muscle/tendon groups of the shoulder to return to a relaxed or resting state, and if so whether such activities are repetitive in nature.
Generally, tasks that are considered to involve "frequently repeated… abduction or flexion of the shoulder joint" include:
- ones that involve abduction or flexion of the shoulder joint greater than sixty degrees at least once every thirty seconds; or
- ones that are repeated and where at least 50 percent of the work cycle involves abduction or flexion of the shoulder joint greater than sixty degrees and where the muscle/tendon groups of that shoulder have less than 50 percent of the work cycle to return to a relaxed or resting state.
Whether tasks that involve lower work cycle frequencies or greater periods of rest and recovery time than referred to above involve "frequently repeated…abduction or flexion of the shoulder joint", will require the exercise of judgment based on the circumstances of the individual claim.
Sustained abduction or flexion of the shoulder joint
"Sustained abduction or flexion of the shoulder joint" means that the shoulder joint is held in a static position of abduction or flexion greater than sixty degrees. The greatest pressure is placed on the shoulder bursa when there is between 60 and 120 degrees of abduction or flexion (0 degrees being when the arm is straight down by the side of the torso). The longer the shoulder joint is held in such a static position during the work cycle, and the less time the affected muscle/tendon groups of the shoulder have to return to a relaxed or resting state, the more one is able to conclude that the work involves "sustained abduction or flexion of the shoulder joint". Conversely, the less time the shoulder joint is held in such a static position during the work cycle, and the more time that the affected muscle/tendon groups of the shoulder have to return to a relaxed or resting state, the less one is able to conclude that the work involves "sustained abduction or flexion of the shoulder joint".
Significant component of the employment
Use in Schedule B items 12(b) and 13(b) of the words "where such activity represents a significant component of the employment" means that the worker has been performing work activities involving the described use of the shoulder joint for sufficiently long that it is biologically plausible that the inflammation affecting the shoulder has resulted from the work activities. Employment activities that have involved minimal or trivial use of the shoulder joint do not amount to "a significant component of the employment".
For claims that do not meet the descriptions contained in items 12(a), 12(b) or 13(b) of Schedule B, see #27.20.
APPENDIX C
(Additions in Bold, Deletions in Strikethrough)
#27.11 Tenosynovitis and Tendinitis
#27.12 Tendinitis and Tenosynovitis
The process or industry listed opposite to tenosynovitis and tendinitis in Schedule B is "Where unaccustomed and repetitive use of the affected arm, hand, leg or foot is required". If a worker diagnosed with either condition was at or immediately before being disabled thereby employed in work that involved unaccustomed and repetitive use of the extremity affected, the condition is deemed to have been due to the employment unless the contrary is proved.
Schedule B lists "Hand-wrist tendinitis, tenosynovitis (including deQuervain’s tenosynovitis)" and "Shoulder tendinitis" as occupational diseases.
The performance of work often involves positioning and exerting the upper extremities in order to carry out tasks. Tendons carry much of the strain in the performance of certain types of work. If the strain on the tendon is large enough or lasts long enough (resulting in insufficient recovery time), the tendinous tissue may be damaged, leading to an inflammatory response in the tendon or extending to the tendon sheath.
It is recognized that Inflammation of a tendon (tendinitis) and of its synovial sheath (tenosynovitis) may occur at the same time.
Common sites for these inflammations include:
- the shoulder — for example including rotator cuff tendinitis, (sometimes referred to as impingement syndrome), supraspinatus tendinitis (either of which may cause an impingement syndrome), and bicipital tendinitis. Any of these may occasionally leading lead to frozen shoulder (adhesive capsulitis);
- the hand and wrist including
— for example deQuervain’s
syndrome tenosynovitis (inflammation
affecting the abductor pollicis longus and the extensor pollicis
brevis tendons).
- the ankle, including achilles tendinitis.
The terms "unaccustomed" and "repetitive" are undefined terms that require the exercise of judgment in the circumstances of each claim.
"Unaccustomed" means not accustomed, not customary, unusual. To exercise judgment about whether a particular work task is unaccustomed, consideration is given to such matters as:
- the length of time the worker has been doing the work task implicated in causing the inflammation;
- whether there have been any interruptions in performing the work task such as vacations, illness, labour disputes or plant shutdowns;
- whether the work task has changed such as with the use of new tools, machinery or procedures;
- whether there has been an increase in hours worked at that task such as with overtime;
- whether the worker has new work partners; or,
- whether any other relevant changes have occurred.
A worker who is new to a particular work task will normally be considered unaccustomed to the work. The longer the worker has been doing the same work task or tasks without interruption, the less likely one is able to conclude the work is unaccustomed. A worker does not generally become unaccustomed to a particular work task due to short absences from that work. The longer the absence, the more likely one is able to conclude the work has become unaccustomed.
Hand-wrist tendinitis/tenosynovitis and shoulder tendinitis may result from sudden strain placed on the tendons (such as where the tendon is suddenly contracted or stretched with sufficient force to cause immediate damage). Such a claim will be treated as an injury and will be adjudicated in accordance with the policies set out in Chapter 3. A claim made by a worker diagnosed with hand-wrist tendinitis/tenosynovitis or with shoulder tendinitis where no specific event or trauma, or series of events or traumas, has occurred, will be treated as a disease and will be adjudicated in accordance with the policies set out in Chapter 4.
Hand-wrist tendinitis or tenosynovitis
The following guiding principles apply when interpreting terms in Schedule B in connection with hand-wrist tendinitis/tenosynovitis (Schedule B item 13(a)).
Frequently repeated
"Repetitive" means characterized by repetition, the act of being repeated. It refers to the same work elements being repeated many times. It means the cyclical use of the same body tissues either as a repeated motion or a repeated muscular effort without movement.
To exercise judgment about whether a particular work task is repetitive, consideration is given to such matters as:
- how often the same motion or muscular effort is performed within a certain period of time (described as time variation or frequency of the work cycle);
- the amount of time during or between a given work cycle that the affected muscle/tendon groups have to return to a neutral recovery state;
- whether other activities are done between successive repeated motions or muscular efforts, and whether those other activities are also repetitive in nature (varied work motions or muscular efforts may also be repetitive);
- the extent to which the repeated motions or muscular efforts involve utilization of the tissues that have become inflamed or damaged;
- the duration of the activity in question.
In determining whether a particular work task involves "frequently repeated" motions or muscle contractions, consideration is given to such matters as:
- the frequency of the work cycle for the tasks being performed (the number of times the same motion or muscle contraction is performed within a specified period);
- the amount of time during a work cycle that the affected muscle/tendon groups are working compared to the amount of time such tissues have to return to a relaxed or resting state;
- the amount of time between work cycles where the affected muscle/tendon groups are able to return to a relaxed or resting state;
- whether other activities are performed between work cycles that cause stresses to be placed on the affected muscle/tendon groups that affect the ability of those tissues to return to a relaxed or resting state, and if so whether such activities are repetitive in nature.
There is little doubt that a worker who is performing in robotic fashion the same motions or muscular activities again and again without interruption or rest between is performing repetitive work. The lower the frequency of the repeated motion and the more varied the work motions required to do the job, the less likely one is able to conclude that the work is repetitive.
The unaccustomed and repetitive activity must involve utilization of the affected tendinous tissue in order to meet the requirements of the second column of Schedule B.
A worker who is performing the same work task(s) again and again without interruption or rest between, is likely required to perform "frequently repeated motions or muscle contractions".
Generally, tasks (that place strain on the affected tendon(s)) that are considered to involve "frequently repeated motions or muscle contractions" include:
- ones that are repeated at least once every 30 seconds; or
- ones that are repeated and where at least 50 percent of the work cycle is spent performing the same motions or muscle contractions and where the affected muscle/tendon groups have less than 50 percent of the work cycle to return to a relaxed or resting state.
Whether tasks that involve lower work cycle frequencies or greater periods of rest and recovery time than referred to above involve "frequently repeated motions or muscle contractions", will require the exercise of judgment based on the circumstances of the individual claim.
Significant flexion, extension, ulnar deviation or radial deviation
"Significant flexion, extension, ulnar deviation or radial deviation of the affected hand or wrist" means:
- moving (or holding) the hand or wrist in greater than 25 degrees of flexion, or
- moving (or holding) the hand or wrist in greater than 25 degrees of extension, or
- moving (or holding) the hand or wrist in greater than 10 degrees of ulnar deviation, or
- moving (or holding) the hand or wrist in greater than 10 degrees of radial deviation.
Forceful exertion
"Forceful exertion" of the muscles utilized in handling or moving tools or other objects means that the muscles and tendons which are used are loaded to a significant proportion of the maximum mechanical limit of those tissues. This limit will vary depending on factors such as the size, strength, and fitness level of the individual performing the work.
In determining whether the worker has been engaged in "forceful exertion of the muscles utilized", consideration is given to such matters as:
- the weight of the tool or work object;
- the manner in which the tool or work object is moved (pushed, pulled, carried, lifted, lowered, gripped, pinched etc);
- the distance the tool or work object is moved;
- the speed at which the tool or work object is moved (extra force may be needed to start or stop moving objects);
- the amount of friction that exists between the tool or work object and the worker’s hand (slippery tools may require greater force to grip) or between the tool or work object and other surfaces (greater force may be required to overcome that friction);
- whether tools or work objects are handled using a pinch grip or a power grip (pinch grips exert more force on the tendons of the thumb and fingers);
- whether sustained force must be applied (after an initial force is applied);
- whether the tool or work object is vibrating (greater force may be required to control a vibrating object).
Other evidence may be relevant to determining whether there was "forceful exertion" in the circumstances of the individual claim.
Significant component of the employment
Use in Schedule B item 13(a) of the words "where such activity represents a significant component of the employment" means that the worker has been exposed to the processes described in paragraphs (1), (2), and/or (3) of item 13(a) for sufficiently long that it is biologically plausible that the hand-wrist tendinitis/tenosynovitis has resulted from the work activities. Employment activities that have involved minimal or trivial use of the hand-wrist as described in item 13(a) do not amount to "a significant component of the employment".
For claims that do not meet the descriptions contained in item 13(a) of Schedule B, see #27.20.
Shoulder tendinitis
The policies set out in #27.11 dealing with interpreting the terms "frequently repeated…abduction or flexion of the shoulder joint", "sustained abduction or flexion of the shoulder joint", and "significant component of the employment" apply in interpreting those terms used in Schedule B item 13(b).
APPENDIX D — REVISED RSCM #27.10
(Additions in Bold, Deletions in Strikethrough)
#27.10 ASTDs Recognized by Inclusion in Schedule B
Four such ASTDs are recognized as occupational diseases by inclusion in Schedule B; namely tenosynovitis, tendinitis (#27.11), bursitis (#27.12), (#27.11), tendinitis, tenosynovitis (#27.12), and hand-arm vibration syndrome (#27.13).
APPENDIX E- REVISED RSCM #27.20
(Additions in Bold, Deletions in Strikethrough)
#27.20 Worker with Schedule B Disease Not Employed in Described Process or Industry
#27.20 Tendinitis/Tenosynovitis and Bursitis Claims Where No
Presumption Applies
This Section deals with claims where the worker has tendinitis/tenosynovitis or bursitis, but was not at the relevant time "employed in a process or industry mentioned in the second column of Schedule B".
A claim for compensation will be accepted for a worker who suffers from a disease designated or recognized by the Board as an occupational disease which the evidence establishes as having resulted from employment covered by the Act. Where a worker suffers from an occupational disease listed in Schedule B but was not employed in the process or industry described opposite to the disease in the second column of Schedule B, that simply means that there is no presumption of work causation. In that event, the Adjudicator must still determine on the evidence whether the disease was due to the nature of the employment under Section 6(1) of the Act. (see #26.22).
The requirements of the second column of Schedule B are not preconditions or limitations to the acceptance of a claim. There may be other evidence supporting the conclusion that the disease is due to the nature of the worker’s employment. It also follows that the requirements of the second column of Schedule B are not the only matters to be considered for that disease in the adjudication of the claim. It is only where the presumption applies that it may be unnecessary to consider such other matters because work causation will already have been established. Additionally there may be situations where the nature of the work activity is such as would ordinarily raise a likelihood of work causation, but there exists other evidence, which suggests a contrary conclusion. For example, both wrists may be affected by the same condition but the worker only ever used one wrist in performing the work, or the worker may be suffering from an underlying disease which itself is capable of producing the condition for which the claim is made (such as rheumatoid arthritis producing a wrist tendinitis). The decision in such a case can only be a judgement one makes by weighing the evidence for and against work causation. An assessment of risk factors related to the employment will normally be the most important consideration in these types of claims. However, this is not the only consideration. Non-occupational risk factors may exist relative to the claim, which tend to refute the conclusion which might ordinarily be suggested by an assessment of the work activity. For a discussion of risk factors see #27.40.
There are cases where a strong likelihood of work causation will exist for workers diagnosed with tenosynovitis or tendinitis who are not employed in work that involves both unaccustomed and repetitive use of the affected arm or hand, and for workers diagnosed with bursitis who are not employed in work that involves excessive friction, rubbing or pressure on the bursa involved.
Where the worker is performing repetitive work that is reasonably capable of stressing the inflamed tissues for which the claim is being made, and there is an absence of evidence suggesting a non-occupational cause for the worker’s condition, the claim will normally be accepted:
- in the case of a worker diagnosed with tenosynovitis and/or tendinitis in the hand or wrist if the worker is occupationally performing frequent, repetitive and forceful movements of that wrist or hand or forceful and repetitive gripping with that hand (Schedule B would apply in such circumstances if the work activity is unaccustomed and repetitive); or
- in the case of a worker diagnosed with bursitis or tendinitis in the shoulder if the worker is occupationally performing frequent or prolonged use of the arm at or above the horizontal plane with forceful, frequent movements of the shoulder or prolonged holding of a load at the horizontal (Schedule B would apply in such circumstances if the work activity is unaccustomed and repetitive and the diagnosis is one of tendinitis, or if the work involves excessive friction, rubbing or pressure on the shoulder bursa and the diagnosis is one of bursitis).
There will be other situations where the nature of the work activity is such as would ordinarily raise a likelihood of work causation, but there exists other evidence which suggests a contrary conclusion. For example, both arms may be affected simultaneously even though the work activity in question only affected one arm, or the worker may have an underlying condition which is known to produce the condition for which the claim is made (for example rheumatoid arthritis in a worker with tendinitis), or there may be evidence of activities outside of work that could have caused the condition. The decision is such a case can only be a judgment one makes by weighing the evidence for and against work causation. The nature of the work activity will normally be the most important consideration in these types of claims. However, it is not the only consideration. Other risk factors may exist relative to the claim which tend to support or refute the conclusion which might ordinarily be suggested by the work activity. For a discussion of risk factors see #27.40.
In the investigation of a claim for tendinitis/tenosynovitis or bursitis (in circumstances where no presumption applies) it is incumbent on the Adjudicator to seek out evidence of both occupational and non-occupational exposure to risk factors relevant to the causation of the disorder (see #26.21 regarding the approach when a presumption applies). Non-occupational exposures may be present as a result of participating in sports, hobbies, or certain ordinary activities of daily living. The compensability of such a claim depends on whether or not the employment activities (the occupational exposure to risk factors) played a significant role in producing the inflammatory disorder. The occupational exposure need not be the sole or even the predominant cause; it simply needs to have been a significant cause.
Although the risk of developing tendinitis/tenosynovitis or bursitis may be significantly greater where, in the performance of work tasks, two or more risk factors are present at the same time, these inflammatory disorders may result from a particularly frequent, intense or prolonged exposure to a single risk factor. Even though work causation may not be established by virtue of applying the presumption set out in Section 6(3) of the Act, the Adjudicator may conclude that exposure to a single risk factor (whether described in the second column of Schedule B or not) played a significant role in producing the tendinitis/tenosynovitis or bursitis, and that accordingly the claim meets the requirements of Section 6(1) of the Act.
In assessing whether or not a tendinitis/tenosynovitis or bursitis condition is due to the nature of a worker’s employment, in circumstances where there is evidence of both occupational and non-occupational exposure to risk factors (relevant to the causation of these inflammatory disorders), consideration is given to such matters as:
- the relative frequency, intensity, and duration of exposure to risk factors encountered in connection with the worker’s employment compared to those encountered in non-occupational activities;
- whether the intensity of the forces placed on the affected tissues in connection with the worker’s employment activities are likely to produce injury (such as a sudden stretching of tendinous tissues) when compared to such likelihood arising from the intensity of forces encountered in connection with the worker’s non-occupational activities;
- the likelihood that the worker’s occupational and non-occupational activities may have acted together in the development of the inflammatory disorder in circumstances where the inflamed tissues have had insufficient time to return to a relaxed or resting state due to the combined effects of these activities;
- whether any changes took place in either the employment activities or the non-occupational activities prior to or at the time of onset of symptoms of the inflammatory disorder, noting that performing unaccustomed activities may significantly increase the risk (see reference to "unaccustomed activity" in #27.40);
- whether there is evidence of similar inflammatory disorders occurring in other workers who perform the same type of tasks as those performed by the worker, and whether there is evidence of such disorders occurring in the general population among those who are engaged in the same type of non-occupational activities as those in which the worker is engaged;
- the likelihood that the worker’s combined employment activities (where the worker has more than one employment) may have acted together in the development of the inflammatory disorder in circumstances where the inflamed tissues have had insufficient time to return to a relaxed or resting state due to the combined effects of those activities;
- whether the worker has previously suffered injuries, inflammation, or infections associated with the affected tissues, and if so the likely cause of these prior conditions;
- whether there is evidence of a disorder ( such as a degenerative tear or infection) at or near the site of the subject condition;
- whether the worker has suffered from any degenerative or systemic disorders (including but not limited to degenerative arthritis, rheumatoid arthritis, gout, systemic lupus erythematosus, connective tissue disease, or inflammatory rheumatological disorder), and if so whether such underlying disorder is the likely cause of the subject inflammatory disorder, or alternatively has had the effect of rendering the worker more susceptible such that shorter, or less frequent, or less intense exposure to risk factors may initiate the subject disorder;
- whether the worker is taking prescription medications, is undergoing any therapy or treatment for any other condition, or is pregnant, and if so whether this is a likely cause of the subject disorder or alternatively has had the effect of rendering the worker more susceptible.
APPENDIX F- REVISED RSCM APPENDIX 2
(Additions in Bold, Deletions in Strikethrough)
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Description of Disease
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Description of Process or Industry | |
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| 12 Bursitis: |
Where there is excessive friction, rubbing or pressure on the bursa involved.
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| 13 Tenosynovitis, tendinitis.. | Where unaccustomed and repetitive use of the affected arm, hand, leg or foot is required. | |
| 12 Bursitis: | ||
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Where there is repeated jarring impact against, or where there are significant periods of kneeling on, the affected knee. | |
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Where there is frequently repeated or sustained abduction or flexion of the shoulder joint greater than sixty degrees and where such activity represents a significant component of the employment. | |
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| 13 Tendinitis, tenosynovitis: | ||
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Where there is use of the affected tendon(s) to
perform a task or series of tasks that involves any two of the following:
Where there is use of the affected tendon(s) to perform a task or series of tasks that involves any two of the following:
and where such activity represents a significant component of the employment. |
|
|
Where there is frequently repeated or sustained abduction or flexion of the shoulder joint greater than sixty degrees and where such activity represents a significant component of the employment. | |