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.

Bartholin's Gland Cyst


Differential Diagnosis

Specialists

  • General Surgeon
  • Gynecologist

Comorbid Conditions

Factors Influencing Duration

Surgical excision procedures can be performed in the office under local anesthesia and should not cause a long disability. If the cyst is painful and infected, then disability may be longer but should not exceed 2 weeks.

Medical Codes

ICD-9-CM:
616.2 - Inflammatory Disease of Cervix, Vagina, and Vulva, Cyst of Bartholins Gland; Bartholins Duct Cyst

Overview

© Reed Group
Bartholin's glands are two small glands located on both sides of the vaginal opening. A cyst can develop from one of the glands or the ducts. It can be chronically inflamed and painful.

Bartholin glands cysts develop from dilation of the duct following blockage of the duct opening. The glands are normally the size of a pea and drain into a duct that exits near a fold between the mucous membrane (hymen) and the outer lips of the vagina (labia). The gland's secretions provide some moisture for the vulva but are not needed for sexual lubrication. Therefore, removal of a Bartholin gland does not seem to compromise sexual function. Bartholin gland cysts tend to grow slowly and noninfected cysts are sterile.

Although small cysts are usually asymptomatic, they may become enlarged or infected and cause significant pain. If the cyst becomes infected, the abscess can grow rapidly and become increasingly painful.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Women aged 20 to 29 are most likely to develop Bartholin's glands cyst (Blumstein).

Source: Medical Disability Advisor



Diagnosis

History: Symptoms may include vulvar pain, painful intercourse (dyspareunia), inability to engage in sports, or pain during walking or sitting. The individual may also notice a bulge in the labium majus or be found during a routine gynecologic examination.

Physical exam: The exam reveals a small mass on either side of the vaginal opening. The Bartholin duct and surrounding tissue may be swollen due to the blocked duct. Infected cysts that develop abscesses show a large tender mass in the Bartholin gland area accompanied by a red, swollen, and inflamed vulva. There may be a fever. The abscess may rupture and drain 4 to 5 days after onset.

Tests: Aspiration of an infected cyst for bacterial culture may be done to identify the causative microorganism and specifically treat the infection.

Source: Medical Disability Advisor



Treatment

Asymptomatic Bartholin gland cysts in individuals under the age of 40 may not require treatment. Some physicians advocate removal (excision) of all Bartholin gland cysts in individuals over 40 due to the possibility of cancer. If the cyst ruptures spontaneously, all that may be required is for the individual to take hot baths and sit in a tub of water so the affected area is covered (sitz bath). If an infection develops, a broad-spectrum antibiotic is indicated until bacterial culture results are obtained and more specific antibiotics can be administered to treat the causative microorganism(s). Pain medications may also be used.

Incision and drainage should be avoided since many cysts and most abscesses can recur if treated only by incision. Definitive methods of treatment include placing a catheter (Word catheter) inside the cyst to provide drainage. The catheter is left in place for up to 4 weeks. The individual is asked to undergo pelvic rest until removal of the catheter and abstain from sexual intercourse. Over time, the resulting opening created by the catheter decreases in size and becomes unnoticeable. Another procedure (marsupialization) can be performed if the cyst recurs despite treatment with a Word catheter. In this procedure, an incision is made in the lining of the vulva and an oval of skin removed. This is followed by an incision in the cyst wall to drain the cyst or abscess. The new tract slowly shrinks over time and a new duct opening forms.

Lancing a Bartholin gland cyst may result in recurrence. More effective treatments such as use of the Word catheter and marsupialization are the preferred methods and the Word catheter can be inserted in the physician's office.

Other techniques such as a "window operation" involve making a larger incision where a large oval piece of the cyst wall is removed. The cyst wall is sewn to the skin as in marsupialization. Other techniques involve incision of Bartholin gland abscesses followed by curettage of the abscess cavity and application of silver nitrate to the cyst or abscess cavity. A carbon dioxide laser can also be used to excise the cyst. The laser does not offer any advantage over the less expensive and technically difficult procedures. Excision of the cyst may be required if it has recurred several times. Individuals with recurring cysts should be referred to a gynecologist experienced with excision procedures.

Source: Medical Disability Advisor



Prognosis

The recurrence rate after marsupialization is about 10%. The window operation is a variation of the marsupialization procedure and has no known treatment failures or complications. It is theorized that the larger opening prevents blockage of the newly formed opening and may make the window operation more advantageous than the marsupialization procedure. The carbon dioxide laser is also an effective method of excision but does not offer any advantage over the other procedures. Full recovery is expected if the symptomatic cyst is treated with one of these procedures and infection is treated with a course of oral broad-spectrum antibiotics.

Source: Medical Disability Advisor



Complications

If the cyst becomes infected and is not treated initially with a broad-spectrum antibiotic, an abscess may form on the gland. If the abscess is not treated early with sitz baths until the abscess comes to a point, incision and treatment may be more difficult. A secondary infection may develop called bartholinitis, which is an inflammatory condition of one or both Bartholin's glands caused by bacterial infection. Vaginal infections such as chlamydia or gonorrhea can cause the disability to lengthen since specific antibiotic treatment is indicated.

Recurrence rates, regardless of procedure, are reported to be less than 20%.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

If the Bartholin gland is infected or develops an abscess, it can be so painful that the individual becomes incapacitated. Difficulty walking or sitting for long periods of time may limit work capacity. Adequate breaks with the opportunity to move around should be allowed.

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:

  • If symptoms are present, does individual have vulvar pain, painful intercourse (dyspareunia), inability to engage in sports, and pain during walking or sitting? Does individual notice a bulge in the labium majus?
  • Did physical exam reveal a small mass on the side of the vaginal opening? Was the Bartholin duct and surrounding tissue swollen?
  • Was diagnosis confirmed through a gynecologic exam?
  • Were conditions with similar symptoms such as sebaceous cysts, dysontogenetic cysts, bruises (hematomas) of the vulva, benign solid tumors, or rare vulva masses ruled out?

Regarding treatment:

  • Given individual's age and diagnosis, was the treatment appropriate?
  • Was a culture and sensitivity done to identify the causative organisms and determine the most effective antibiotic?
  • Was surgery required?
  • If the cyst was recurrent, was placement of a Word catheter or marsupialization done? Window operation or carbon dioxide laser?

Regarding prognosis:

  • Does individual have any comorbid conditions that may impact ability to recover? If so, were these conditions addressed in the treatment plan?
  • Did individual suffer any secondary infection?
  • Did adequate time elapse for complete recovery?
  • Would individual benefit from consultation with a specialist (gynecologist)?

Source: Medical Disability Advisor



References

Cited

Blumstein, Howard. "Bartholin Gland Disease." eMedicine. Eds. Joseph J. Sachter, et al. 26 Jul. 2004. Medscape. 15 Dec. 2004 <http://emedicine.com/emerg/topic54.htm>.

Source: Medical Disability Advisor






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