Tendonitis vs Tendinosis and WCB
You say tendonitis, I say tendinosis, same thing, right? Think again…and you’re not alone! Confusion about the two diagnoses is widespread throughout the medical community and beyond. In many instances, what is thought to be tendonitis is actually tendinosis and although they may seem similar, the actual treatment goals and timelines can be quite different.
The differences between the two conditions and how they are medically managed can have significant consequences especially if a workers’ compensation (WCB) claim is involved.
What’s the Difference?
Tendon pain can happen suddenly and intensely or it can come on gradually and progressively, building up over time. The onset of the discomfort is often an indicator of whether the cause is tendonitis or tendinosis.
Tendonitis is an acutely inflamed swollen tendon as a result of a strain or force on the tendon that is too heavy or too sudden. The tendon isn’t actually damaged and the underlying cause of pain is inflammation.
Tendinosis, on the other hand, is a chronically damaged tendon as a result of overuse over time. The tendon is damaged with a hard, thickened, scarred and rubbery appearance and the underlying cause of pain is degeneration.
Differing treatment goals and healing timelines are the biggest contrast between tendonitis and tendinosis.
Why does it matter?
The primary treatment goal for tendonitis is to reduce inflammation, a condition which is not present in tendinosis. Some of the treatments used to address tendonitis inflammation can actually impede the healing process necessary to reduce the symptoms and pain associated with tendinosis. An incorrect diagnosis can result in improper treatment modalities that cause delays in the healing process and possible further damage to the tendon.
As with any injury, a correct diagnosis followed by the appropriate associated treatment plan is key to achieving the best possible outcome in the least amount of time. Knowing whether the condition is inflammation, degeneration or both will impact the approach to treatment, recovery expectations and preventive measures to avoid recurrences.
How does it impact WCB claims?
The amount of time a worker requires away from their job duties, the types and amount of medical intervention involved and the duration of medical treatment all contribute to the overall costs on a WCB claim. While both tendonitis and tendinosis can be work-related, tendonitis is typically associated with a specific incident or accident and tendinosis usually develops gradually over a period of time from continued repetitive movements or overuse that do not allow the tendon to rest and heal properly.
The recovery period for tendonitis is generally short, in the range of several days to 6 weeks, depending on how quickly the diagnosis is made and treatment is initiated. The longer the tendon is inflamed before treatment starts, the longer the healing period. Often a simple approach of rest, avoidance of repetitive motions, short term use of over-the-counter anti-inflammatories and application of braces or straps for support is enough. For more persistent symptoms, an injection and/or a course of physiotherapy may be needed to resolve the condition but a full recovery and return to regular duties is anticipated.
Tendinosis is more complex because of the chronic and degenerative nature of the condition. Since tendinosis develops gradually and progressively, it takes longer to resolve. The appropriate treatment should eliminate or significantly decrease pain, increase range of motion, increase strength, and allow the return to pain-free, normal daily activities. If addressed early, recovery could be as little as 6 to 10 weeks; if the tendinosis is seen as chronic treatment it may take 3-6 months. For more severe cases, recovery can take up to 9 months or more of concentrated medical management to resolve or plateau the condition.
To complicate matters further, it is possible to have tendonitis as well as tendinosis in the same tendon or what is referred to as an acute-on-chronic condition. When a tendon with tendinosis is injured there can be a period of acute inflammation or tendonitis that requires immediate attention. Once the inflammation has resolved any ongoing symptoms are likely more attributable to the chronic tendinosis rather than acute tendonitis and the treatment plan needs to be altered accordingly. As a result, recovery of an acute-on-chronic condition can be much longer than either tendonitis or tendinosis individually.
These complex, complicated and sometimes overlapping conditions are why employers need to be concerned about absorbing costs that are unrelated to the actual injury or are not fully their responsibility.
What can employers do to mitigate costs?
There are two ways that employers can attempt to contain WCB claim costs; actively and administratively.
1. Active Approaches:
Active and early intervention in the claims process can help keep a claim on track and identify when issues start moving beyond the scope of an employer’s responsibility.
A diagnosis of tendonitis or tendinosis does not necessarily require time off work but it may require time away from specific job duties. It is important to keep in mind that WCB claims with no time loss, which have costs under the approved medical aid claim cost threshold may not be counted in WCB premium calculations.
Through Modified Work Programs workers are able to stay at work or at least return to work at the safest and earliest opportunity, which can contribute to a complete, speedy recovery. In many instances, simple modification of job duties or temporary reassignment to a different position that avoids aggravating the affected area is enough to achieve full healing.
If keeping an injured worker on full time modified duties is not possible,bringing them back on reduced hours with a graduated return to full duties and full hours can help limit costs.
When possible, having workers arrange doctors appointments, physiotherapy treatments and other medically recommended procedures outside of work hours or covering wages for time away from work can reduce or eliminate costs associated with wage loss benefits. Allowing a flexible work schedule to accommodate time off for medical treatment and appointments can also be beneficial.
Early intervention through ongoing current claims management can help redirect treatment plans when there has been a misdiagnosis or a change in diagnosis. Regularly reviewing medical documentation can help identify potential issues before they become problematic and can also assist in developing return to work plans as work restrictions are reassessed. This can help ensure that the cost of treatment is directly related to the injury or diagnosis.
2. Administrative Approaches:
Beyond the measures that can be used to manage active WCB claims, there are administrative avenues available to employers that can reduce the impact that WCB claims have on their premium calculations. These avenues are based on WCB policies and procedures that can be initiated while a claim is ongoing or after it is inactive. Opportunities include, but are not limited to, requests for:
- Initial entitlement decision review
- Cost relief
- Cost removal
- Cost sharing
While these cost saving measures can be effective, success often depends on a comprehensive understanding of the Workers’ Compensation Act, how it is applied, plus time, patience and perseverance. As such, it is important to know how to navigate the WCB system and how to identify which situations are most likely to result in a positive outcome before proceeding with any action.
As with so many aspects of workers’ compensation, the onus falls on the employer to protect themselves against escalating claims costs and rising premiums. Unfortunately, both active and administrative avenues of addressing claims costs often involve considerable knowledge, time and effort but the trade off of lower WCB premium payments can be worth it.
WCB claims consultants and/or employer representatives with extensive WCB experience can be an effective and efficient way to address these issues. If you would like more information regarding Current Claims Management, Modified Work Programs, how to reduce your WCB claims costs or help navigating the WCB system, you can connect with us on Facebook, Twitter , or LinkedIn or contact us directly at BCL.Calgary@bclconsulting.ca, BCL.Edmonton@bclconsulting.ca or at 1-844-377-9545.