Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Arthralgia


Related Terms

  • Joint Pain

Differential Diagnosis

Specialists

  • Hand Surgeon
  • Internal Medicine Physician
  • Occupational Therapist
  • Orthopedic (Orthopaedic) Surgeon
  • Pain Medicine Physician/Pain Specialist
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Rheumatologist

Factors Influencing Duration

The length of disability is determined by the underlying cause, severity of symptoms and findings, joint(s) involved, treatment used, response to treatment, results of therapy, and job demands.

Medical Codes

ICD-9-CM:
719.4 - Joint Pain; Arthralgia
719.40 - Joint Pain; Arthralgia, Site Unspecified
719.41 - Joint Pain; Arthralgia, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
719.42 - Joint Pain; Arthralgia, Upper Arm; Elbow Joint; Humerus
719.43 - Joint Pain; Arthralgia, Forearm; Radius; Ulna; Wrist Joint
719.44 - Joint Pain; Arthralgia, Hand; Carpus; Metacarpus; Phalanges [Fingers]
719.45 - Joint Pain; Arthralgia, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
719.46 - Joint Pain; Arthralgia, Lower Leg; Fibula; Knee Joint; Patella; Tibia
719.47 - Joint Pain; Arthralgia, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
719.49 - Joint Pain; Arthralgia, Multiple Sites

Overview

Arthralgia (from Greek arthro [joint] and algos [pain]) literally means joint pain; it is a symptom (subjective complaint), not a disease. The symptom may be used as a diagnosis, such as ICD-9-CM 729.5, "pain in limb," until the true cause of the joint pain is determined. Or the symptom may be used as a diagnosis indefinitely if examination and testing are inconclusive, but the pain persists. Joint pain is a symptom of many different conditions that can be either localized or involve the whole body (systemic). Underlying causes may be articular (in the joint) or non-articular (outside the joint) in origin. Arthralgia may affect just one joint (monoarthralgia) or multiple joints (polyarthralgia). In general, involvement of only one joint suggests localized disease (joint specific), and pain in multiple joints indicates systemic disease.

Localized causes of arthralgia include infectious arthritis (septic arthritis), inflammation of a bursa (bursitis), avascular necrosis, tumor, inflammation of a tendon (tendinitis) or tendon sheath (tenosynovitis), or trauma. Systemic causes of arthralgia include osteoarthritis, fibromyalgia, crystal-induced arthritis (gout or pseudogout), polymyalgia, systemic lupus erythematosus, rheumatic fever, sickle cell disease, or rheumatoid arthritis. Lyme disease, influenza, and many other systemic bacterial and viral infections also can cause joint pain. Non-articular causes of joint pain may include disorders of bones, nerves, or blood vessels such as osteomyelitis, radiculopathy, nerve entrapment, or vasculopathy.

Arthralgia can be the initial presenting symptom for other systemic diseases. For example arthralgia may accompany colitis, especially with pain in the knees, ankles, and wrists. It may warn of endocarditis or be a side effect of rubella vaccination. It gives notice to the often-difficult-to-diagnose intestinal infection called Whipple's disease or heralds certain defects of immune function called cryoglobulinemia. It may be a consequence of the parvovirus B19 or be associated with the heart tumor myxoma.

Incidence and Prevalence: The exact incidence is not known because, as a symptom, arthralgia accompanies a broad range of disparate conditions. The prevalence of arthralgia increases with age.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Arthralgia is a common symptom that affects virtually everyone at some point during life and occurs in women more often than men.

Source: Medical Disability Advisor



Diagnosis

History: The individual may complain of pain in one or multiple joints. Helpful information about the pain includes the time of day it occurs; what makes it worse or better; and the presence of any other symptoms such as fever, sore throat, fatigue, joint swelling, or a general feeling of poor health (malaise). A complete history of prior and current illnesses, injuries, and medications is needed to help diagnose the underlying condition.

Physical exam: The exam helps determine if the pain comes from the joint itself or is referred from nerve root impingement in the spine, nerve entrapment in the limb, or other pathology in the same extremity. For example, a hip problem may manifest as knee pain. If pain comes from the joint itself, there may be joint tenderness, warmth, swelling, or redness. Joint range of motion is measured, with attention to whether the movement is painful or not, whether the motion is normal or reduced, and whether it is smooth or accompanied by a crackling sound (crepitus) or catch. The individual may appear acutely or chronically ill. Overall health status will be evaluated with a complete physical examination.

Tests: Laboratory tests include erythrocyte sedimentation rate (ESR or sed rate), C-reactive Protein (CRP), a complete blood count (hemoglobin, hematocrit, red blood cell [RBC], and white blood cell [WBC] counts), and uric acid level. If the ESR and/or CRP is elevated, consistent with significant inflammation, then rheumatoid factor and antinuclear antibodies may also be tested. A complete blood chemistry panel may be done to evaluate health status. Joint fluid may be analyzed for the presence of crystals, bacteria, blood, and inflammatory cells. X-rays of affected joints may detect fracture, tumor, joint space narrowing (arthritis), osteoarthritis spurs, pockets of fluid in the bone just under the cartilage (subchondral cysts), joint surface erosions, soft tissue calcifications, or other abnormalities. MRI or CT scans, ultrasound, arthrography or arthroscopy, synovial biopsy, bone scanning, and bone biopsy may also be indicated. Electrodiagnostic testing such as electromyography or nerve conduction studies may be warranted if referred or nerve pain is suspected.

Source: Medical Disability Advisor



Treatment

Treatment depends on the underlying cause. Treatment will vary based on whether the underlying disease or condition is acute or chronic and whether it is inflammatory or non-inflammatory. While the specific cause of the arthralgia remains unknown, the individual may be given anti-inflammatory drugs, non-narcotic analgesics to relieve discomfort, activity modification, and/or exercises.

Source: Medical Disability Advisor



Prognosis

The outcome depends on the underlying cause, whether it is acute or chronic, and how the causative disease or condition is treated. Arthralgia as a symptom of rheumatoid arthritis, polymyalgia, lupus, or fibromyalgia may respond favorably to successful treatment of the underlying disease with anti-inflammatory, immunosuppressive, or disease-modifying medications. If a chronic condition is the cause of arthralgia, flare-ups and recurrence or persistence of arthralgia are likely. Surgery, if required to correct a specific joint problem such as joint damage from osteo- or rheumatoid arthritis, has a success rate contingent on the nature and severity of the condition and the procedure performed. Joint replacement can be very successful in treating arthralgia caused by severe arthritis of the hip and knee.

Source: Medical Disability Advisor



Rehabilitation

Rehabilitation for arthralgia aims to improve function (usually range of motion), decrease pain, and preserve joint integrity. Although the type of treatment depends on the underlying cause, rehabilitation often includes occupational and physical therapy. The therapist may need to modify treatment according to the cause and severity of the arthralgia, which joint is affected, and whether or not surgery on the joint was required.

Therapy will include a program that combines stretching and strengthening exercises. Stretching exercises will preserve and/or improve joint range of motion, and the strengthening program will train the muscles in order to improve the functional capacity of the involved joints. The individual can progress through stretching and strengthening exercise programs depending on pain tolerance and physical ability (Suomi). Pain control can be achieved by use of modalities including cold, heat, and electric stimulation. All exercises are aimed at restoring full function and reducing pain.

Orthotics may be useful in reducing the biomechanical stress on involved lower limb joints and must be evaluated individually. An occupational therapist may educate individuals in joint protection techniques to improve daily living performance as well as in the use of adaptive devices to promote independence and safety.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistArthralgia
Physical or Occupational TherapistUp to 16 visits within 8 weeks (depending on specific condition)
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Complications

Complications are specific to the disease or condition causing the arthralgia. Anti-inflammatory drugs can cause stomach, liver, or kidney problems.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations vary, depending on the location of the affected joint, severity of symptoms and signs, underlying cause, treatment required, and response to treatment.

Company policy on medication usage should be reviewed to determine if prescribed medication use is compatible with job safety and function.

Risk: Risk is dependent of the condition or diagnosis that is causing the arthralgia. Please view specific diagnoses for additional details regarding risk.

Capacity: Capacity will vary depending on the condition or diagnosis. For example, a shoulder with a rotator cuff tear after arthroscopic repair will require a period of limited hand over shoulder activities. Again, please view specific diagnoses for additional details regarding capacity.

Tolerance: Tolerance for joint pain is a frequent reason people choose to do, or not to do, specific activities, considering the rewards (such as salary or fun) versus the cost (such as pain or inconvenience).

Accommodations: Accommodations or modifications to activities will depend on the specific condition or diagnosis that is causing the arthralgia. For example, a bacterial infection of the knee may require limited weight bearing for 4 or 5 days after open arthrotomy of the joint.

Source: Medical Disability Advisor



Maximum Medical Improvement

Treatment can vary greatly between medicines and physical therapy. In general, MMI should be reached within 1-4 months.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual complain of pain in multiple joints or one joint?
  • Are there symptoms or physical exam findings that suggest a specific disease?
  • Has a specific diagnosis been established, or is the complaint pain in or near a joint(s) without objective findings?
  • Was range of motion restricted? Is there increased fluid in the joint (effusion).
  • Were complete blood count, erythrocyte sedimentation rate, rheumatoid factor, uric acid levels, and antinuclear factors done?
  • Was joint fluid analyzed for crystals, microbes, blood, and inflammatory cells?
  • Were x-rays, MRI, CT, bone scan, ultrasound, or arthroscopy performed? Are there significant objective findings? Do the results confirm a specific disease?
  • Were synovial biopsy, bone biopsy, or electromyography performed?
  • Is the disease or condition acute or chronic?

Regarding treatment:

  • Did individual receive appropriate treatment for a specific disease? Or, is there no objectively verifiable specific disease present?
  • Did treatment of the underlying disorder relieve the arthralgia?
  • Was surgery indicated?

Regarding prognosis:

  • Is individual active in rehabilitation?
  • Is individual's employer able to accommodate any necessary restrictions?
  • Is the underlying cause of the arthralgia a chronic condition requiring ongoing treatment?
  • Does individual have any other conditions (co-morbidity) that may affect the ability to recover?

Source: Medical Disability Advisor



References

Cited

Suomi, R., and D. Collier. "Effects of Arthritis Exercise Programs on Functional Fitness and Perceived Activities of Daily Living Measures in Older Adults with Arthritis." Archives of Physical and Medical Rehabilitation 84 11 (2003): 1589-1594. National Center for Biotechnology Information. National Library of Medicine. 5 Jan. 2009 <PMID: 14639556>.

Source: Medical Disability Advisor






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