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.

Arthroplasty, Shoulder


Related Terms

  • Shoulder Arthroplasty
  • Total Shoulder Replacement

Specialists

  • Occupational Therapist
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist

Factors Influencing Duration

Factors influencing the length of disability include the underlying disease for which the procedure was performed, the development of complications, individual compliance with therapy and rehabilitation recommendations, the individual's job requirements, and whether the dominant or non-dominant arm was involved. Most individuals will be hospitalized for up to 3 to 5 days following surgery. Conditions that would impact ability to recover and further lengthen disability include rheumatoid arthritis, bursitis, and rotator cuff injury.

Medical Codes

ICD-9-CM:
81.8 - Arthroplasty and Repair of Shoulder and Elbow
81.80 - Other Total Shoulder Replacement
81.81 - Shoulder Replacement, Partial
81.82 - Repair of Recurrent Shoulder Dislocation
81.83 - Repair of Shoulder, Other

Overview

Most often, a shoulder arthroplasty is a surgical procedure designed to replace the damaged or diseased natural bone of the shoulder with a prosthesis made of metal and polyethylene. What is referred to as the shoulder joint is the connection between the humerus or upper arm bone and a cup-like depression in the scapula or shoulder blade called the glenoid. The glenohumeral joint is a ball-and-socket type joint, similar to that of the hip, that is capable of producing arm movement in virtually all directions. In a hemiarthroplasty, only the ball of the humeral head is replaced. In a total shoulder arthroplasty, both the ball of the humeral head and the socket of the glenoid are replaced.

Degenerative arthritis, such as osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis can cause irreparable bone erosion, particularly on the articular surface or area where the two bones are connected and move against one another. To date, arthroplasty is by far the most successful type of treatment for those individuals with arthritic involvement of the glenohumeral joint.

Source: Medical Disability Advisor



Reason for Procedure

While performed less often than hip or knee replacement, shoulder replacement can restore quality of life for individuals with limited shoulder function due to chronic pain or mechanical dysfunction.

Although the primary indications for this surgery are pain, joint instability, and limited range of motion, pain relief is the primary goal. The procedure is performed to relieve pain and stiffness associated with degenerative osteoarthritis, rheumatoid arthritis, or trauma-related arthritis that has failed to respond to medical treatment.

Arthroplasty of the shoulder is a useful treatment for individuals of all ages with unremitting pain and loss of mobility due to arthritic involvement of the shoulder joint; however, individual age and extent of disease may determine which procedure and prosthetic device is most appropriate. Regardless of age, the individual must be motivated to follow through with a substantial physical therapy commitment and must be a good surgical risk.

If a patient suffers from humeral head osteonecrosis where the blood supply to the humerus is compromised they may benefit from arthroplasty with reduction and bone grafting according to a new study.

Source: Medical Disability Advisor



How Procedure is Performed

Total Shoulder Replacement: Initially, either general or local anesthesia will be administered. An incision running across the front of the shoulder from the middle of the collarbone (clavicle) to the middle of the arm bone (humerus) will be made. Scar tissue, which may limit movement, is then removed. The upper end of the humerus is cut using a saw; some of the removed bone may be used as a bone graft to assist with the placement of the implant (prosthesis). The shoulder blade is then prepared for the placement of the artificial socket.

The humeral and the glenoid component compose the shoulder replacement which can be implanted with or without cement. The metal humeral component is the portion that takes the place of the ball on the upper end of the humerus, and the glenoid component is the portion that takes the place of the scapula's socket. The plastic glenoid component articulates with the ball of the humeral component.

Core Decompression and Bone Grafting: Core decompression is a procedure where an incision is made on front of the shoulder, blunt dissection is performed, and then a cannulated reamer is put into the proximal humerus using fluoroscopy. This drills a hole or tunnel in the bone into which bone graft can be inserted.

After the individual awakens from either surgery, a bulky dressing will be on the affected shoulder. A drainage tube may be in place to drain excess fluid from the operative site. For the first few postoperative days, a continuous passive motion (CPM) machine may be used to move the shoulder in order to decrease the possibility of stiffness. The average hospital stay is 3 to 5 days.

Source: Medical Disability Advisor



Prognosis

Approximately 89% of individuals experience a reduction in pain following a total shoulder arthroplasty procedure (Azar 495). While the joint usually functions better than the pre-surgery diseased joint, it may not function as well as a healthy normal joint.

Range of motion and strength may also be improved by this procedure, but functional improvement is less predictable than pain relief. Increase in motion is dependent on many factors, including how long the motion had been lost and whether the rotator cuff tendons are intact. Often abduction and flexion do not exceed 90° after shoulder replacement.

Most individuals are very satisfied with their postoperative result. However, if a patient does not recover from arthroplasty or suffers from recurrences of dislocation of the shoulder, arthrodesis or fusion of the joint with a screw is indicated. Unstable or dislocating shoulder replacement patients achieve stability and pain relief with arthrodesis, but the near total loss of shoulder that results creates significant handicaps. Individuals with osteonecrosis who have arthroscopic bone grafting are usually pain free and able to lift their upper extremity to 160° following recovery from surgery.

Source: Medical Disability Advisor



Rehabilitation

Ideally rehabilitation for individuals with a shoulder replacement begins before surgery by assessing the individual's medical and social condition in order to determine what they might require postoperatively for a successful outcome. The main goal of rehabilitation is to restore function by controlling pain and improving the range of motion and strength of the shoulder.

Individuals who undergo total shoulder arthroplasty require a specific rehabilitation process that begins in the hospital and continues in outpatient physical therapy, and which is always progressed to a home exercise program (Boardman). After surgery the shoulder is immobilized for approximately 5 days, during which time the individual maintains range of motion of the neck, elbow, wrist, and hand by actively moving these joints in all available directions (Azar). Occupational therapists can instruct in the use of special adaptive equipment for activities of daily living (ADLs) and mobility. Modalities such as ice may be used to reduce swelling and pain, and when indicated, heat may be used to promote muscle relaxation (Braddom).

An important goal of rehabilitation is to restore shoulder range of motion. After the initial period of immobilization, individuals wear a sling for 2 to 6 weeks, which may be removed for exercise (Azar; Williams). Aquatic therapy is used by many surgeons as part of the rehab program, and may be initiated as early as the first postoperative week with the surgical wound protected by a waterproof dressing (Williams). Therapists begin passive and active assisted exercises according to the protocol of the surgeon; these are typically performed at first with the individual lying down (supine) and then progressed to movements against gravity. Special attention must be paid during range of motion exercises to avoid dislocating the prosthesis and to protect the surrounding soft tissues. When indicated, the individual can start active exercises to achieve optimal range of motion and strength; resistance exercises are usually allowed after 12 weeks, with an emphasis on strengthening the anterior deltoid and rotator cuff muscles (Azar). The individual is instructed in a home exercise program throughout the rehabilitation process, which is continued well after discharge from supervised rehabilitation (Azar). Home exercises are frequently performed for 10 to 15 minutes, 3 to 4 times a day.

Individuals may need to continue both the stretching and strengthening exercises for 1 year after surgery to ensure the restoration of functional strength and range of motion.

FREQUENCY OF REHABILITATION VISITS
Surgical (recurrent dislocation)
SpecialistArthroplasty, Shoulder
Physical or Occupational TherapistUp to 24 visits within 12 weeks
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

As with all major surgical procedures, complications can occur. Complications associated with shoulder replacement include infection, loosening, dislocation, and nerve or blood vessel injury.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals whose jobs require heavy lifting or strenuous activities involving the arm will need permanent reassignment to sedentary duties. Also, the individual will require time off to attend regular physical therapy appointments.

Source: Medical Disability Advisor



References

Cited

Azar, Frederick M., and James H. Calandruccio. "Chapter 8 - Arthroplasty of the Shoulder and Elbow." Campbell's Operative Orthopaedics. Eds. S. Terry Canale and James H. Beaty. 11th ed. Philadelphia: Mosby Elsevier, 2008.

Boardman, N. D., et al. "Rehabilitation after Total Shoulder Arthroplasty." Journal of Arthroplasty 16 4 (2001): 483-486. PubMed. Jun. 2001. 25 Feb. 2005 <PMID: 11402412>.

Braddom, Randolph L. Physical Medicine and Rehabilitation. 3rd ed. Philadelphia: W.B. Saunders, 2006.

Dahni, Diane L., and Jay Smith. "Rehabilitation after Shoulder Arthroplasty." Joint Replacement Arthroplasty. Ed. Morrey Bernard. Philadelphia: Churchill Livingstone, Inc., 2003.

Williams, Matthew D., and T. Bradley Edwards. "Chapter 17, Section L – Glenohumeral Arthritis in the Atlhete." DeLee and Drez’s Orthopaedic Sports Medicine. Eds. Jesse C. DeLee, David Drez, and Mark D. Miller. 3rd ed. Saunders Elsevier, 2009.

Source: Medical Disability Advisor






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