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.

Burn of Wrist and Hand


Related Terms

  • Hand Burn
  • Wrist Burn

Specialists

  • General Surgeon
  • Hand Surgeon
  • Occupational Therapist
  • Orthopedic (Orthopaedic) Surgeon
  • Physical Therapist
  • Plastic Surgeon

Comorbid Conditions

Factors Influencing Duration

Severity and extent of the burn, type and site of the burn, response to treatment, associated injuries, age, and specific job duties may all affect duration of disability. Loss of digits or hand function also affects length of disability.

Medical Codes

ICD-9-CM:
944.00 - Burn of Hand, Unspecified Site, Unspecified Degree
944.01 - Burn of Single Digit (Finger, Nail) Other than Thumb, Unspecified Degree
944.02 - Burn of Thumb (Nail), Unspecified Degree
944.03 - Burn of Two or More Digits, Not Including Thumb, Unspecified Degree
944.04 - Burn of Two or More Digits Including Thumb, Unspecified Degree
944.05 - Burn of Palm, Unspecified Degree
944.06 - Burn of Back of Hand, Unspecified Degree
944.07 - Burn of Wrist, Unspecified Degree
944.08 - Burn of Wrist(s) and Hand(s), Unspecified Degree
944.10 - First-degree Burn (Erythema) of Hand, Unspecified Site
944.11 - First-degree Burn (Erythema) of Single Digit [Finger (Nail)] Other than Thumb
944.12 - First-degree Burn (Erythema) of Thumb (Nail)
944.13 - First-degree Burn (Erythema) of Two or More Digits, Not Including Thumb
944.14 - First-degree Burn (Erythema) of Two or More Digits Including Thumb
944.15 - First-degree Burn (Erythema) of Palm
944.16 - First-degree Burn (Erythema) of Back of Hand
944.17 - First-degree Burn (Erythema) of Wrist
944.18 - First-degree Burn (Erythema) of Multiple Sites of Wrist(s) and Hand(s)
944.20 - Second-degree Burn, Blisters with Epidermal Loss of Hand, Unspecified Site
944.21 - Second-degree Burn, Blisters with Epidermal Loss of Single Digit [Finger (Nail)] Other than Thumb
944.22 - Second-degree Burn, Blisters with Epidermal Loss of Thumb (Nail)
944.23 - Second-degree Burn, Blisters with Epidermal Loss of Two or More Digits, Not Including Thumb
944.24 - Second-degree Burn, Blisters with Epidermal Loss of Two or More Digits Including Thumb
944.25 - Second-degree Burn, Blisters with Epidermal Loss of Palm
944.26 - Second-degree Burn, Blisters with Epidermal Loss of Back of Hand
944.27 - Second-degree Burn, Blisters with Epidermal Loss of Wrist
944.28 - Second-degree Burn, Blisters with Epidermal Loss of Multiple Sites of Wrist(s) and Hand(s)
944.30 - Third-degree Burn, Full-thickness Skin Loss of Hand, Unspecified Site
944.31 - Third-degree Burn, Full-thickness Skin Loss of Single Digit [Finger (Nail)] Other than Thumb
944.32 - Third-degree Burn, Full-thickness Skin Loss of Thumb (Nail)
944.33 - Third-degree Burn, Full-thickness Skin Loss of Two or More Digits, Not Including Thumb
944.34 - Third-degree Burn, Full-thickness Skin Loss of Two or More Digits Including Thumb
944.35 - Third-degree Burn, Full-thickness Skin Loss of Palm
944.36 - Third-degree Burn, Full-thickness Skin Loss of Back of Hand
944.37 - Third-degree Burn, Full-thickness Skin Loss of Wrist
944.38 - Third-degree Burn, Full-thickness Skin Loss of Multiple Sites of Wrist(s) and Hand(s)
944.40 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Hand, Unspecified Site, without Mention of Loss of Body Part
944.41 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Single Digit [Finger (Nail)] Other than Thumb, without Mention of Loss of Body Part
944.42 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Thumb (Nail), without Mention of Loss of Body Part
944.43 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Two or More Digits, Not Including Thumb, without Mention of Loss of Body Part
944.44 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Two or More Digits Including Thumb, without Mention of Loss of Body Part
944.45 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Palm, without Mention of Loss of Body Part
944.46 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Back of Hand, without Mention of Loss of Body Part
944.47 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Wrist, without Mention of Loss of Body Part
944.48 - Deep Necrosis of Underlying Tissues (Deep Third-degree Burn) of Multiple Sites of Wrist(s) and Hand(s), without Mention of Loss of Body Part

Overview

A burn is an injury to body tissues from exposure to heat (i.e., flames, hot liquids or gases, steam), electricity, chemicals, or radiation. Burns impair the ability of the skin to prevent heat and water loss, and they eliminate the barrier the skin provides against infection. The area of skin surface injured, depth of the burn injury, and location of the injury determine the seriousness of a burn injury. Burns from exposure to heat (thermal burns) are the most common.

A burn to the hand involves only a small percentage of the total body surface area (TBSA); according the rule of nines, used to assess the percentage of the TBSA that has been burned, in adults one side of the hand and fingers is estimated as 1% of TBSA, and the entire hand is estimated as 2.5% of TBSA (Gómez). Nevertheless, any third-degree or fourth-degree burn of the hand is considered severe. With burns of the wrist, there is potential for impaired circulation, and in the hand, risk of disability arises from decreased function due to permanent shortening and stiffening of muscles or tendons (contractures).

Burns are described as first-, second-, third-, or fourth-degree based on the depth of tissue damage; burn injuries often result in a combination of burn depths. A first-degree burn affects only the topmost layer of the skin (epidermis) and causes redness without any blistering. Sunburn is an example of a common first-degree burn.

A second-degree burn, known as a partial-thickness burn, involves deeper layers of the skin and results in painful blisters. Superficial second-degree burns often result from scalds. These burns may be very painful, but they generally heal in 2 to 3 weeks without scarring. Deeper second-degree burns often result from contact with flames, or with hot oil or grease.

Third-degree burns are known as full-thickness burns. They affect the all layers of the skin and also the layer of tissue below the skin (subcutaneous tissue). Third-degree burns often are very pale and cause little pain at first, since all nerve endings have been destroyed. These burns may result from flames, scalds, chemical exposure, or electrical injuries. Individuals will develop significant scars and contractures of those joints involved in the injury.

Fourth-degree burns are extremely severe; these burns are third-degree burns that extend deeper into muscle and bone tissue. They sometimes cause the loss of fingers or hands.

Thermal burns are the most common burn of the wrist and hand. Thermal burns are due to exposure to hot materials such as liquids (scalds), flames (e.g., house fires), or steam (e.g., car radiators). Chemical burns occur as a result of exposure to acid or alkali chemicals or the deployment of automobile airbags.

Electrical burns are least common and occur when the body is exposed to an electric current. Injuries are sustained at points where the current enters, passes through, and exits the body. The most common sites of an electrical entrance wound are the hands and head. Fingers and hands may be destroyed by electrical injury. Electric current may arc from one object to another, such as from a wire to a hand tool, without entering the body. Such arcs produce flash burns, or thermal burns from brief high intensity heat.

Incidence and Prevalence: Each year, more than 2 million individuals sustain burns serious enough to seek medical care, with up to 100,000 requiring hospitalization and 25% resulting in significant disability (Demling).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals who are exposed to high temperatures or flames and those who must handle flammable liquids are at increased risk for burns of the hand and wrist. Burns are most frequently sustained at home (72%), whereas 5% occur in relation to motor vehicle accidents and 9% are work-related ("Burn Incidence"). The most common type of burn injury to the wrist and hand is a scald injury, usually from a hot water source, followed by flame burns, flash burns from explosion of flammable gases or liquids, and contact burns (Mann).

Men and individuals between the ages of 17 and 25 are at the highest risk for burn injuries (Demling); approximately 70% of individuals with burn injuries are male ("Burn Incidence"). For all burns, 59% of individuals burned are Caucasian, 20% are blacks, and 14% are Hispanic ("Burn Incidence").

Source: Medical Disability Advisor



Diagnosis

History: Burn injuries are usually obvious and clear history of exposure is provided. Pain is always present but the severity can vary depending the type and level of the burn. Large blisters may form at the burn area. The individual may report other injuries sustained at the time of the burn.

Physical exam: In a first-degree burn, redness without blistering may be seen. The skin is usually very dry and may look like a "bad" sunburn.

In a second-degree burn, redness around the edges of blisters may be seen and the skin may appear wet. Skin may blanch with pressure.

In a third-degree burn, the skin may appear red or white (very pale) and dry. Sensation may be present but is usually diminished to light touch. Blanching is sluggish or absent.

In a fourth-degree burn, injury extends into muscle or bone. The burn is open and the skin is often gone or missing in sections.

Any combination of burn depths may be noted in a single injury.

In an electrical injury, signs of injury may be present only at the entrance and exit wounds or may be seen along the entire length between the entrance and exit wounds. Electrical burns can be deceiving. The entrance and exit wounds may be small and show little damage, yet if the amperage was high, the muscles, nerves, and arteries between the two points may be dead. This will result in swelling, compartment syndrome, and skin and soft tissue loss.

Tests: Testing is generally not needed for diagnosis of burns to the hand or wrist.

Source: Medical Disability Advisor



Treatment

Because the majority of individuals with burns presenting to emergency departments are those with hand and wrist burns covering less than 1% of the TBSA, fluid replacement usually is not required due to the low risk for hypovolemic shock (Gómez). Pain medication (analgesics) or sedation anesthesia may be provided before treatment of the burn. The individual should receive immunization against tetanus. All jewelry must be removed from the fingers and wrists to prevent constriction that may occur as swelling (edema) increases following a burn.

Emergency treatment for first- and second-degree burns includes immersing the affected area in cool water for 10 minutes or more until the burning feeling subsides. If the victim is burnt through clothing, the clothing should be left on and immersed in water. Care must be taken when treating a chemical burn. In most circumstances, immediate and thorough flushing to remove any remaining chemical is appropriate. However, specific substances may require caution and lavage with substances other than water. Alkaline burns are more difficult to treat as the injury often progresses. Water lavage following exposure to lithium, potassium, phosphorus, and sodium may cause ignition. Exposure to hydrofluoric acid may cause progressive damage, and application of 2.5% calcium gluconate gel or injection of calcium gluconate or magnesium sulfate into the affected area may be beneficial. Individuals in contact with a live electrical source following an electrical burn should not be pulled away; the current should first be switched off, if possible, or the individual pushed away from the source with a wooden stick or other item that does not conduct electricity. Cardiopulmonary resuscitation (CPR) and emergency treatment are needed if the individual has stopped breathing.

Individuals with more than minor burns to the wrist and hand generally are admitted to specialized burn centers. Treatment of second-degree burns may include cleansing, removal of large blisters and dead skin (débridement), and application of an antimicrobial burn ointment. If the burn is expected to take longer than 3 weeks to heal, burned tissue (eschar) may be surgically removed (excised); skin taken from another area of the body is then placed (grafted) on the burn to speed healing and minimize scarring and infection.

Third-degree burns require extensive treatment. The burn area is cleansed and débrided. Repeated débridement may be necessary to fully determine the depth of the burn injury. Excision and grafting usually are done to minimize the frequency of débridement and to prevent scarring and infection. Non-adherent, semi-permeable membranes in the shape of a glove may be used for wound dressings. In some cases specialized dressings can act as a scaffolding layer to allow re-epithelialization of the burn wound; as the burn heals, the dressing separates from the wound. With fourth-degree burns, especially those on the back side of the hand and wrist (dorsal surface), exposed bones may need to be stabilized with pins and wires to prevent contractures until the skin graft has healed. The majority of serious burns to the hands and wrist are also treated with splinting to prevent contractures. Elevation of the injured hand(s) is essential to reduce edema.

If eschar impairs circulation to the hand or fingers or encircles the extremity (circumferential burn), an incision is made through the burn to relieve the tightness and allow adequate circulation (escharotomy). Amputation of the fingers or hand may be necessary for severe burn injuries where circulation is absent or when bone and tissue are destroyed.

Long-term treatment includes prevention of infection, excision and grafting, nutritional support, care of associated trauma and other medical conditions, and plastic surgery or orthopedic repair to improve functioning of the fingers and hands. Long-term rehabilitation may be needed.

Source: Medical Disability Advisor



Prognosis

More than 10,000 individuals die from burn injuries each year (Demling) with an overall survival rate of 94.4% (Rosen). Structural fires are responsible for up to 45% of deaths from burns; chemical and electrical burns account for 5% of deaths (Demling). The outcome varies depending on the severity of the burn. Amputation of fingers or the hand is a possibility. Full function of the fingers and hands may be permanently lost. If the thumb is involved, up to 50% of hand function may be lost.

First-degree burns begin to heal in a few days and are typically healed within 1 week with no scarring ("Burns"). Superficial second-degree burns without infection heal spontaneously in about 2 to 3 weeks without scarring or impairment of function ("Burns"). With deeper burns, healing may take several months if no infection occurs; however, scar formation is significant in deep burns. Significant third- or fourth-degree burns will not heal properly without skin grafting. Skin grafting improves the outcome by providing a permanent transplantation of skin from other parts of the body to replace skin lost in the burn injury. The appearance of grafted skin may vary. Sometimes the graft blends into nearby healthy skin very well, but other times there may be a distinct mark between normal skin and the grafted skin. Rehabilitation should be started as soon as the graft heals, ideally within 2 to 3 weeks after injury, to restore functional movement and minimize the risk for joint contractures ("Burns").

Source: Medical Disability Advisor



Rehabilitation

Hand and wrist rehabilitation after a burn depends on the severity of the burn. Superficial and some partial-thickness burns may not require any formal therapy. Deep burns may require a combined rehabilitative program of splinting, stretching, and exercise. Splinting the hand and wrist in a specific position prevents further loss of motion from damage to tendons, joints, or from skin grafts. Stretching and exercise for any depth of burn focuses on keeping the healing tissue supple to allow return to function. Without exercise, the individual will develop excessive scar tissue and muscular atrophy, which leads to permanent loss of function and possible disfigurement.

Early in rehabilitation, the individual typically experiences great pain when performing any exercise. Therefore, the therapist must clearly outline the exercise plan and make the individual fully aware of the consequences of not performing the prescribed exercises. In rare cases when pain is too great or the individual exhibits an excessive fear response toward exercise, the individual may undergo therapy under anesthesia.

Initially, therapists instruct alert and responsive individuals to perform active range of motion exercises. The therapist also teaches the individual breathing techniques to reduce anxiety from anticipation of pain, which may cause muscle guarding and stiffness. If the individual remains unconscious or unresponsive due to a severe injury or burn, the therapist may manipulate the fingers or wrist (passive range of motion). The number of repetitions and duration of the exercise session is determined by the individual's level of pain, as well as the depth of the burn. Therapists also must evaluate the potential for tendon rupture due to tissue weakness following a burn. If skin grafting has been done, caution must be used to avoid excessive stress from movement on the newly grafted tissue, which may cause graft separation.

Once complete range of motion of the wrist or fingers is restored, the individual may perform progressive resistive exercises while wearing a pressure glove that is used to reduce disfiguring scar tissue formation. The pressure glove should be worn 22 to 23 hours each day and removed only to bathe or massage the scar tissue. Other modalities, such as neuromuscular stimulation, may be used to help strengthen muscles and restore hand and wrist function in conjunction with active exercise.

By the end of the third month or when all wounds are closed, the individual may participate in a work conditioning program to identify any potential problems on re-entering the work force. An occupational therapist or certified hand therapist will evaluate the different hand motions needed for work activities and simulate them in rehabilitation therapy to restore the necessary strength and flexibility for return to work.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistBurn of Wrist and Hand
Physical or Occupational TherapistLess than 4 visits
1st and 2nd.

Source: Medical Disability Advisor



Complications

In the first 72 hours after the burn, fluid may accumulate in the compartments of the hand, with blood flow decrease and pressure increase (compartment syndrome); uncontrolled edema is a dangerous condition that may require an emergency fasciotomy in which incisions are made in the muscles of the hand to relieve pressure. Other complications are impaired blood circulation (ischemia), decreased movement, infection, and loss of fingers due to constriction by eschar.

Hand contractures are a major complication of a wrist and hand burn, with 23% of hospitalized individuals experiencing at least 1 contracture; on average, individuals with at least 1 contracture will sustain as many as 10 contractures throughout their recovery (Schneider). The wrist joint is the most frequently involved, representing 22% of hand contractures (Schneider).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations vary depending on the severity of the burn and job responsibilities. Restrictions are not usually required for minor burns of the hand and wrist. For severe burns, several months of time off for recovery and surgical procedures may be needed. Compressive dressings may need to be worn for several months to minimize scar formation. The fingers and hand may be weak or stiff, and full function of the fingers and hand may be permanently lost. If fingers or hand was amputated or if burns occurred to other parts of the body, job reassignment may be necessary. The individual may require frequent follow-up appointments. If pain medication is needed, company policy on medication use should be reviewed to determine if medication usage is compatible with job safety and function.

Before the individual returns to work, skin irritation problems caused by garment friction during repeated hand movements should be identified. Adaptive equipment to assist in gripping may be needed such as thicker or more built-up railings, handles, or arms of chairs.

Risk: Risk depends on the level of burn, type of burn, and treatment required. For a first-degree burn, the risk of injury to the skin on return to work is low. For a fourth-degree burn after surgery requiring reconstruction and skin grafting, the grafted area will require increased protection during the healing phase.

Capacity: Capacity is impacted by the level and type of burn, and treatment required.

Tolerance: Burns are painful. Pain is impacted by the level of burn, type of burn, and treatment required. Each individual is unique in how they respond to pain.

Accommodations: The ability to provide accommodations is the most important factor after tolerance. If the individual is willing to return to work but requires accommodations to allow for appropriate recovery, the employer holds the key to reducing the duration of disability.

Source: Medical Disability Advisor



Maximum Medical Improvement

120 days.

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:

  • Did the burn involve thermal, chemical, electrical, or radiation injury?
  • Was the burn first-, second-, third-, or fourth-degree?
  • What percentage of TBSA was burned?
  • Did individual complain of pain, redness, or blistering?
  • What other associated burns or injuries occurred?
  • Were pulses present in the fingers and wrist?

Regarding treatment:

  • For minor burns, was the skin exposed to cold running water for at least 10 minutes?
  • For more severe burns, was excision and grafting performed?
  • Did individual receive adequate analgesic medication during rehabilitation?
  • Was individual given immunization against tetanus?
  • Was individual compliant with elevation of the hand(s) to minimize edema?
  • Was repeated débridement of the burn area required?
  • Did eschar impair circulation? Was escharotomy necessary?
  • Was amputation of the fingers or hand needed?
  • Was a program of splinting and exercise prescribed to prevent contractures?
  • Is individual compliant with rehabilitation program?

Regarding prognosis:

  • How severely was individual burned?
  • Was individual's thumb involved?
  • Did infection develop? If so, was individual compliant with antibiotic treatment?
  • Are underlying conditions present that could prevent healing and prolong recovery?
  • How severe is scar formation or contracture?
  • Did individual lose the fingers or hand? If so, how will this affect the daily activities of individual?
  • Did individual sustain other injuries at the time of the burn that may delay return to work?
  • Will the individual need follow-up plastic or orthopedic surgery?
  • Would individual benefit from psychological and rehabilitation therapy?

Source: Medical Disability Advisor



References

Cited

"Burn Incidence Fact Sheet." American Burn Association. 2013. 6 May 2014 <http://www.ameriburn.org/resources_factsheet.php>.

"Burns." American Society for Surgery of the Hand. 2008. 6 May 2014 <http://www.assh.org/Public/HandConditions/Pages/Burns.aspx>.

Demling, Robert H., and Jonathan D. Gates. "Chapter 112: Medical Aspects of Trauma and Burn Care." Cecil Medicine. Eds. L. Goldman, et al. 24 ed. Elsevier Saunders, 2011.

Gomez, Ruben, and Leopoldo C. Cancio. "Management of Burn Wounds in the Emergency Department." Emergency Medicine Clinics of North America 25 1 (2007): 135-146.

Marx, John A., et al., eds. Rosen’s Emergency Medicine. 7th ed. Mosby Elsevier, 2009.

Schneider, Jeffrey C. , et al. "Contractures in Burn Injury II: Investigating Joints of the Hand." Journal of Burn Care Research 29 4 (2008): 606-613.

Schneider, Jeffrey C. , et al. "Reconstruction of the Burned Hand." Total Burn Care. Ed. David N. Herndon. 3rd ed. Saunders Elsevier, 2007. 687-700.

General

Mosier, Michael J. , and David M. Heimbach. "Chapter 13: Emergency Care of the Burned Victim." Wilderness Medicine. Ed. Paul S. Auerbach. 6th ed. Mosby Elsevier, 2011.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.