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.

Carbuncle


Related Terms

  • Abscesses
  • Skin Abscess
  • Skin Boils

Differential Diagnosis

  • Botfly infestation
  • Conglobate acne
  • Deep fungal infection
  • Hidradenitis suppurativa
  • Inflamed epidermal inclusion cyst
  • Tinea profunda

Specialists

  • Dermatologist
  • General Surgeon
  • Infectious Disease Internist

Comorbid Conditions

Factors Influencing Duration

The location and size of the carbuncle, severity of pain, spreading of the infection, and response to treatment may influence length of disability.

Medical Codes

ICD-9-CM:
680.1 - Carbuncle and Furuncle of Neck
680.2 - Carbuncle and Furuncle of Trunk; Abdominal Wall; Back [any part, except buttocks]; Breasts; Chest Wall; Flank; Groin; Pectoral Region; Perineum; Umbilicus
680.5 - Carbuncle and Furuncle of Buttock; Anus; Gluteal Region
680.9 - Carbuncle and Furuncle, Unspecified Site

Overview

A carbuncle is a cluster of boils (furuncles) that are interconnected under the skin. Boils are pus-filled hair follicles caused by a bacterial infection, usually Staphylococcus aureus. If a boil is neglected or mishandled (picked or squeezed), the infection can spread throughout the skin and cause a carbuncle.

Carbuncles commonly appear on the nape of the neck, upper back, armpits, buttocks, and thighs. Carbuncles are less common than single boils. They develop slowly and may not reach the skin's surface on their own to drain. The infecting bacteria can spread to other parts of the body, producing potentially serious condition.

Individuals who are at risk for developing carbuncles include those who have acne, dermatitis, Job's syndrome, diabetes mellitus, pernicious anemia, or a lowered resistance to infection (immunodeficiency).

Incidence and Prevalence: Although the exact incidence of carbuncles is unknown, they are not common.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Men are more prone than women to get carbuncles, as are those who are elderly, malnourished, obese, or use corticosteroids. Carbuncles are also more likely to occur under conditions of poor hygiene, friction by clothing, or moist skin (maceration).

Source: Medical Disability Advisor



Diagnosis

History: The individual may complain of a very large and extremely painful lump that may or may not be draining pus. The individual may report episodes of fever.

Physical exam: The diagnosis is usually made by visual inspection of the affected area. A carbuncle initially presents as a painful lump (nodule), at first covered by tight, reddened skin that later becomes thin and develops holes (perforates), discharging pus from several openings.

Tests: Occasionally, laboratory culture of the pus is necessary to identify the causative bacteria and determine antibiotic sensitivities. Routine blood tests may show an increase in the number of leukocytes in the blood (leukocytosis). Further tests of the blood and urine may be necessary if the physician suspects an underlying disorder (diabetes or immunodeficiency disease).

Source: Medical Disability Advisor



Treatment

Carbuncles may be treated with oral antibiotics if they persist, especially if they are located on the face or spine. Hot compresses (cotton soaked in hot salty water) or plasters may be used to cause the pus-filled heads to burst, relieving the pain. If drainage and healing does not occur, surgical drainage (with removal of the core of the carbuncle) and possibly packing may be necessary. Continued spread of the infection requires intravenous antibiotics.

Source: Medical Disability Advisor



Prognosis

Although complete recovery is likely, the outcome is dependent on the severity of the infection, response to treatment, and the individual's ability to fight infection. Any carbuncle that persists longer than 2 weeks might spread the infection to the bloodstream (septicemia) and internal organs. Internal Staphylococcal infections are life-threatening. Recurrence is possible and may affect individuals for months or years. A carbuncle can lead to permanent scarring.

Source: Medical Disability Advisor



Complications

Carbuncles can progress to cellulitis, septicemia, kidney (perinephric) abscess, bone inflammation (osteomyelitis), or leg vein inflammation associated with clot formation (thrombophlebitis). A carbuncle on or near the nose, cheeks, forehead, or spine can spread even more rapidly and form a brain or spinal abscess.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Depending on the location of the carbuncle, excessive sitting or walking may need to be restricted, and the use of personal protective equipment (respirator) may be affected.

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:

  • Was a boil neglected, picked, or squeezed?
  • Does individual have acne, dermatitis, Job's syndrome, diabetes mellitus, pernicious anemia, or immunodeficiency disorders?
  • Is individual elderly, malnourished, or obese?
  • Does individual have poor hygiene or maceration of the skin?
  • Does individual complain of a very large and extremely painful lump that may or may not be draining pus?
  • Does individual report episodes of fever?
  • Did the carbuncle initially present as a nodule, at first covered by tight, reddened skin that later perforates, discharging pus from several openings?
  • Was a culture and sensitivity of the pus done?
  • Were routine blood tests done?
  • Were further tests to rule out an underlying disorder?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has individual been treated with oral antibiotics?
  • Did individual respond favorably to hot compresses?
  • Was surgical drainage with removal of the core of the carbuncle necessary?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect the ability to recover?
  • Does individual have any complications such as cellulitis, perinephric abscess, osteomyelitis, or thrombophlebitis?
  • Was the carbuncle on or near the nose, cheeks, forehead, or spine?

Source: Medical Disability Advisor



References

General

Koay, Jeannine, and Sylvia Hsu. "Furuncle/Carbuncle." Merck Medicus. 23 Jul. 2002. Merck & Co., Inc. 19 May 2005 <http://merck.micromedex.com/index.asp?page=bpm_brief&article_id=BPM01DE16>.

Source: Medical Disability Advisor






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