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.

Carpal Tunnel Release


Related Terms

  • CTR

Specialists

Comorbid Conditions

Factors Influencing Duration

Factors that alter the duration of disability include the severity of the individual’s case and the duration of symptoms before CTR was performed. The longer and more severely the median nerve was compressed, the longer it may take for the nerve to improve. Recovery times are variable. Any postoperative complications will increase length of disability. The length of disability relates to tolerance and hand activity (repetitive motion, awkward posture, grip force used) and may not directly relate to the amount of weight lifted.

Older individuals, those with severe preoperative symptoms, and individuals involved in heavy manual labor, especially those working with vibrating tools, may have longer, slower recovery times from the procedure. For additional information on factors influencing recovery times, refer to "Work Ability and Return to Work," page 198, table 12-9.

For individuals who seem to be unimproved or worse after surgery, postoperative nerve conduction studies can be obtained and compared to pre-operative nerve conduction studies. This comparison can be helpful to educate the patient and to determine if entrapment still is present. The most common complication of surgery is incomplete release (Bland, Assmus). If the entire ligament was not cut, then pressure on the nerve may not have been released, and typically there will have been no improvement in the nerve conduction studies.

If carpal tunnel syndrome is present and sufficiently symptomatic bilaterally, then typically both sides are treated with surgery, but the second wrist is operated on 2 to 6 weeks after the first surgery. The timing of the disability duration in these cases should start on the date of the second surgery. Most individuals can return to modified work activities between the two surgeries. (See the conclusion in "Work Ability and Return to Work," page 200, as well as table 12-10. The length of disability outlined in the duration table demonstrates the challenges physician face regarding return to work. Although shorter durations of disability are possible, this requires increased effort by the treating physician.)

For additional discussions of the physician's challenge, please refer to "Work Ability and Return to Work," pages 1, 9, 23.

Medical Codes

ICD-9-CM:
04.43 - Lysis of Adhesions and Decompression of Cranial and Peripheral Nerves; Carpal Tunnel Release

Rehabilitation

Individuals often receive therapy from an occupational therapist, a physical therapist, or a hand therapist. This can be helpful in regaining functions post surgery (Evans).

The progression of postoperative therapy is guided by wound healing principles and the tissue response to stress. The need for therapy following carpal tunnel release is dependent on the method of surgery (open or endoscopic) and any complications (Pomerance). No study has shown that therapy after carpal tunnel release improves long term outcomes. Although controversy exists in the literature regarding the kind and the value of postoperative rehabilitation, therapy consistently focuses on the individual's preoperative status, surgical procedure, hand dominance, bilateral symptoms, associated conditions, and home and job requirements. Special attention must be paid during the recovery phase for signs of complex regional pain syndrome (Hayes). Therapy's primary benefit comes from the encouragement to return to activities at work and at home.

Therapy addresses the anatomical regions adjacent to the surgical site and the specific needs for the postoperative care. The overall aim is to restore performance of usual and customary hand function that is both comfortable and safe. The adjacent anatomical regions are monitored for maintenance of full movement, strength patterns, and bodily posture.

For the surgical site itself, the first objective of therapy is to educate the individual on how to control pain and swelling. Cryotherapy is suggested to decrease swelling (Hegmann). Thermal modalities may be used to increase muscle flexibility, to decrease pain, and to reduce edema; however, heat is contraindicated (AAOS). Individuals learn to perform scar massage to decrease the risk of forming painful adhesions (Hegmann).

The second objective of therapy is to restore any lost range of motion at the wrist and hand that corresponds with the postoperative recovery plan; attention is also directed to safe body mechanics to protect the surgical site during healing while engaging in routine daily activities. Dynamic movement patterns are then progressed, and the individual is educated in safe patterns for exercise and activity related to CTS. Soft bandages rather than splinting are generally recommended postoperatively (Hegmann; Cebesoy). The type of surgical procedure may control progression to heavy lifting, although normally by 2 to 3 weeks return to usual activities of daily living is allowed (Wright).

Concurrently, once the postoperative edema has resolved, a third objective is to monitor hand sensation, and provide a sensory re-education program when appropriate.

The final objective of therapy is to discover if any factors in the individual's environment, either at work or home, may contribute to the CTS. If the compression can be attributed to or related to job duties or activities of daily living, education regarding the provocative positions and modifications in method or setup is provided. Such education may help abate the identified aggravating conditions, minimizing symptoms and preventing their return. The individual may benefit from an ergonomic consultation. The therapist will monitor the individual for potential complications such as severe and persistent edema, palmar pain, increased hand sensitivity, or joint stiffness (Finsen; Gerritsen).

FREQUENCY OF REHABILITATION VISITS
Surgical
SpecialistCarpal Tunnel Release
Occupational/Hand/Physical TherapistUp to 5 visits within 6 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






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