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.

Arthrodesis


Related Terms

  • Artificial Ankylosis
  • Joint Fusion

Specialists

  • Hand Surgeon
  • Orthopedic (Orthopaedic) Surgeon
  • Plastic Surgeon
  • Spine Surgeon

Comorbid Conditions

Factors Influencing Duration

Factors that might influence the length of disability include the joint involved, the underlying disease process, the individual's tolerance of the resulting stiffness, and the individual's ability to modify work requirements after disability. The time to complete healing or fusion varies from 3 months to 9 months, and at least some degree of modified activities will be present until the bone fusion is solidly healed.

Medical Codes

ICD-9-CM:
81.11 - Ankle Arthrodesis; Tibiotalar Fusion
81.12 - Triple Arthrodesis; Talus to Calcaneus and Calcaneus to Cuboid and Navicular
81.13 - Subtalar Fusion
81.14 - Midtarsal Fusion
81.15 - Tarsometatarsal Fusion
81.16 - Metatarsophalangeal Fusion
81.17 - Fusion of Foot, Other
81.18 - Subtalar joint arthroereisis
81.20 - Arthrodesis of Unspecified Joint
81.21 - Hip Arthrodesis
81.22 - Knee Arthrodesis
81.23 - Shoulder Arthrodesis
81.24 - Arthrodesis of Elbow
81.25 - Carporadial Fusion
81.26 - Metacarpocarpal Fusion
81.27 - Metacarpophalangeal Fusion
81.28 - Interphalangeal Fusion
81.29 - Arthrodesis of Other Specified Joints

Overview

The term "arthrodesis" describes the surgical fusion of a joint so that it is no longer capable of movement. An artificially induced fusion of bones across a joint (ankylosis) performed to relieve pain or provide support in a diseased (such as in osteoarthritis) or injured joint, arthrodesis has been used to create bone fusions that ultimately relieve pain and provide stability in the ankle, wrist, knee, shoulder, hip, spine, and other joints. By the time afflicted individuals present for surgery, they usually have little motion left in their arthritic joints and have adapted to living without the motion. Most of them are, therefore, grateful for the reduction in pain that an arthrodesis can provide. As artificial joint replacements and implants improve, fewer arthrodesis procedures are performed.

Source: Medical Disability Advisor



Reason for Procedure

Arthrodesis is performed to control pain, to slow disease progression, to provide stability to a joint that has been damaged by arthritis or muscle weakness, and to correct deformity. Arthrodesis is also performed in individuals afflicted with poliomyelitis to reduce the number of joints the weakened or paralyzed muscles must control. It is also used to treat progressive spinal deformity that does not respond to nonoperative treatment. Relative to outcome, arthrodesis is performed to enable individuals to return to improved productivity.

Source: Medical Disability Advisor



How Procedure is Performed

The technique of the arthrodesis procedure varies according to its site (wrist, ankle, knee, hip, or shoulder joints), although in general, arthrodesis is performed with the individual under general or regional anesthesia and with the joint (two bones) placed in a position that is conducive to function. Two different techniques may be used to fuse the two ends of the bones that originally formed the joint. In both techniques, the surgeon makes an incision over the area to be treated and removes the joint surface (cartilage) on the bones on both sides of the joint, allowing for direct bone-to-bone contact, increasing the contact area and encouraging bone formation. With the first technique (intra-articular arthrodesis), the joint usually is held stiff in the position of function by a cast or metal hardware until the bone ends fuse together.

With the second technique (extra-articular arthrodesis), fusion is similar to the first technique but is supplemented by implanting bone grafts along the side of the joint. For both techniques, the joint must be kept immobile for a defined period of time to allow the fusion and healing to take place in and around the previous joint.

Spinal procedures involve various techniques. Anterior lumbar fusion in the spine involves removing the offending intervertebral disc and placing a bone graft between the vertebrae, which will then fuse together. In a posterolateral spinal fusion, the disc is not disturbed. The facet joints are excised, and bone graft is placed in the "gutter" on both the medial and lateral sides of the facet joints. In posterolateral interbody fusion (PLIF), discectomy is completed with placement of bone graft in the remaining disc space. A variation is transverse lumbar interbody fusion (TLIF), in which the approach is more lateral.

Source: Medical Disability Advisor



Prognosis

Most arthrodesis procedures will bring pain relief. However, in spite of more advanced surgical techniques and better appreciation of blood supply preservation, a certain number of individuals will require additional surgery. The majority of individuals adapt to joint fusion and accept stability, comfort, and improved appearance in exchange for limited range of motion. For example, following wrist surgery, the individual will generally be pleased with pain relief and deformity improvement but may have difficulty lifting objects that require awkward positions or awkward positioning of his or her hands for certain activities. For this reason, it is important to carefully select the appropriate patient.

After knee surgery, the knee has stability, but the lack of any motion in the knee makes activities such as entering a car difficult.

The results for lower back fusion (lumbar spine) are less promising if appropriate indications for patient selection are not followed. Approximately two-thirds of individuals who undergo lumbar fusion will remain disabled 2 years later. Following the procedure, over half of individuals report little or no change in their pain and ability to function ("Guidelines").

Source: Medical Disability Advisor



Rehabilitation

The hand (thumb and finger joints), wrist, and ankle are commonly seen for rehabilitation following an arthrodesis. It is important, however, to initially control postoperative pain and swelling for any joint fusion. This initial stage is followed by rehabilitating the individual to regain as much as possible the function of the body part involved. The physical therapist will use various methods to address postoperative symptoms.

Strengthening the muscles that move adjacent joints is important. For example, an individual who has undergone an arthrodesis of the hip would benefit from strengthening exercises for the muscles that move the back of the knee because these muscles must compensate for the loss of joint movement. This strengthening is important to improve an individual's gait. Instruction in the use of an assistive device such as crutches and afterwards a cane may be required shortly after surgery, while the individual progresses to independent walking. Strengthening exercises are equally important for any arthrodesis performed on the upper extremities.

Modifications may need to be made by the physical therapist for those who have arthritis or other conditions near the joint that underwent arthrodesis. Rehabilitation will also vary depending upon the body part and joint(s) involved.

Source: Medical Disability Advisor



Complications

Complications of any arthrodesis include a delay in the healing of the bone ends (delayed union), incomplete healing of the arthrodesis (nonunion), and/or healing in poor position (malunion), which may require revision surgery. Some surgeries may result in persistent localized swelling that generally resolves with time and benefits from elevation of the involved extremity. Postoperative infections and blood clots are potential complications of any arthrodesis procedure.

Complications specific to wrist arthrodesis include pain and tenderness around the plate that is often implanted during surgery, as well as tendon adhesions or ruptures (Walsh).

Individuals who have undergone shoulder arthrodesis may have loss of elbow motion, but this usually is temporary. Later postoperative complications include nonunion, malunion, painful hardware, and secondary onset of degenerative arthritis of the acromioclavicular joint.

Complications of hip arthrodesis include increases in stress in the lumbar spine, contralateral hip, and ipsilateral knee, all of which require greater energy expenditure for walking (ambulation). Premature onset osteoarthritis frequently develops in these joints due to the increased stresses or forces involved in activity such as walking. The extent of these complications is considerably greater for older, infirm individuals.

Complications following spinal fusion include nonunion, resulting in a false, frequently painful joint (pseudoarthrosis).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Accommodations and restrictions are intended to protect the site of arthrodesis until adequate healing has occurred. Restrictions and accommodations depend on the site of arthrodesis (i.e., ankle, wrist, knee, shoulder, hip, or back). Restrictions during recovery include limited or no use of the joint and extremity involved. Standing, walking, lifting, or carrying may need to be temporarily limited. Splints, short leg casts, postsurgical shoes, or braces may have to be worn; crutches and afterwards a cane may need to be used for a short time postoperatively. Frequent rest periods that include elevation of the involved extremity are conducive to earlier return to full-time work.

An important accommodation is a review of drug policies because the individual may be prescribed potentially sedating medication for pain control and inflammation.

Risk: Risk of delayed union, nonunion, and/or malunion will depend on the joint and the form of stabilization. Internal fixation with metal plate and screws would have a lower risk than stabilization with a cast or splint only.

Capacity: Capacity or ability to perform activities is also impacted by the joint, the form of stabilization, and the ability of the employer to provide modified activities.

Tolerance: Pain after fusion can limit the ability to return to work and perform activities. Each individual is unique regarding his or her ability to work through pain, as well as regarding the limitations caused by the arthrodesis.

Accommodations: Accommodations become the key to early return to work. For example, if the individual is offered desk jobs after knee fusion, the work can be performed from a wheelchair with a leg extension. However, if the job involves standing all day, the length of disability will be longer.

Source: Medical Disability Advisor



Maximum Medical Improvement

The length of time to fusion depends on the location and condition being treated. Fusion is usually supplemented with internal fixation allowing for early return to modified work. Fusion (bone to solid bone) may take 12 to 18 months.

Source: Medical Disability Advisor



References

Cited

"Guidelines for Lumbar Fusion (Arthrodesis)." Washington State Department of Labor and Industries. 1 Nov. 2009. 2 Oct. 2013 <http://www.lni.wa.gov/migration/ClaimsInsurance/Files/OMD/MedTreat/2002MTG31to39.pdf>.

Walsh, John J., and Mark Harper. "Wrist Arthrodesis." eMedicine. Eds. Lee Osterman, et al. 9 Apr. 2012. Medscape. 2 Oct. 2013 <http://emedicine.medscape.com/article/1241236-overview>.

General

Schroeder, Stephen A., et al. "Triple Arthrodesis." eMedicine. Eds. Heidi M. Stephens, et al. 16 Aug. 2011. Medscape. 2 Oct. 2013 <http://emedicine.com/orthoped/topic354.htm.>.

Source: Medical Disability Advisor






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