Occupational Causation Assessment for Right Wrist Tendinopathy
The right wrist tendinopathy should be attributed primarily to the hospitality work as the occupational cause, given that symptoms began during the work shift, though yoga instruction represents a potential contributing factor that must be disclosed for complete medical-legal documentation. 1
Primary Occupational Attribution
The temporal relationship of symptom onset during the hospitality shift establishes the work activity as the primary causative factor. 2 The American Academy of Family Physicians recognizes that wrist and hand tendinopathies commonly occur in occupations requiring repetitive wrist flexion and extension, which characterizes most hospitality work involving food service, cleaning, or guest services activities. 2
Key Clinical Evidence Supporting Work-Related Causation:
Tendinopathies typically present with insidious onset of load-related localized pain that coincides with increased activity or new training demands, and the fact that symptoms manifested during the work shift directly implicates the occupational activities as the inciting event. 3
Overuse tendinopathies result from repetitive loading of tendons, and hospitality work characteristically involves sustained repetitive wrist movements throughout extended shifts. 2, 4, 5
The dominant wrist is affected in 75% of upper extremity tendinopathies related to occupational overuse, which aligns with repetitive work activities. 2
Yoga Instruction as Contributing Factor
While yoga instruction must be documented as a secondary activity, it represents a potential contributing factor rather than the primary cause based on the temporal sequence of symptom onset. 1, 6
Rationale for Disclosure:
Tendinopathy etiology is often multifactorial, and yoga instruction involving weight-bearing poses (downward dog, plank variations, arm balances) does place repetitive loading stress on wrist extensors and flexors. 2, 6
However, the critical distinction is that symptoms began during the hospitality shift, not during yoga teaching, establishing temporal primacy for the occupational exposure. 3
For work cover purposes, you must disclose all activities that could theoretically contribute to the condition, but the temporal relationship and symptom onset during work clearly establishes occupational causation. 1, 5
Documentation Strategy for Work Cover
Emphasize in your report that symptom onset occurred acutely during the hospitality work shift, which establishes the temporal and causal relationship to occupational activities. 3
Specific Documentation Points:
State explicitly: "Symptoms first manifested during the patient's hospitality work shift on [date], establishing temporal causation with occupational activities." 3
Document the specific repetitive movements required in the hospitality role (e.g., lifting trays, repetitive wiping/cleaning, food preparation tasks). 2, 4
Acknowledge yoga instruction as a secondary activity: "Patient also teaches yoga, which involves wrist loading activities. However, symptoms began during hospitality work, not during yoga instruction, establishing the occupational exposure as the primary causative factor." 6
Note that tendinopathy represents degenerative changes from cumulative repetitive loading rather than acute trauma, supporting the occupational overuse mechanism. 3, 7
Clinical Pitfalls to Avoid
Do not allow the discovery of yoga instruction to undermine the work-related causation claim when temporal evidence clearly supports occupational onset. 1, 3
The presence of multiple activities involving wrist loading does not negate occupational causation when symptoms began at work. 6
Tendinopathy develops from cumulative repetitive loading, and the hospitality work likely represents higher volume and intensity of repetitive movements compared to part-time yoga instruction. 2, 7
Work cover systems recognize that workers may have multiple physical activities, but causation is established by temporal relationship and predominant exposure. 5