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

Ability to Work (Return to Work Considerations)

Modification of activities is the best approach for the treatment of musculoskeletal pain and carpal tunnel symptoms that are associated with activities at home and at work. Return to work depends on three conditions: capacity, risk, and tolerance. Capacity is the actual ability to perform activities, risk is the likelihood of either complications or recurrence of the condition from performing the activity, and tolerance is the individual's willingness to endure some discomfort in the healing phase.

Ergonomic evaluation of the work area is helpful to identify contributing risk factors, such as positioning keyboards too high, driving, or holding a telephone for repeated or extended periods of time. Eliminating these risk factors may allow early return to work, at least in a limited capacity. Some individuals may not be able to return to aggravating activities such as constant hammering or typing, and studies indicate that some individuals change jobs after surgery.

Users may find it helpful to read Chapters 1-3 in "Work Ability and Return to Work," which provide a framework for considering the benefits of staying at—or returning to—work.

Risk: The risk for reinjury is low because age, gender, and genetics are the highest risk factor for the initial development of CTS. Most cases labeled "recurrent carpal tunnel syndrome" are actually incomplete surgical release procedures, leaving persisting carpal tunnel syndrome. There may be decreased symptoms after surgery as a result of surgeon-imposed work restrictions. When activity levels finally increase, the persisting CTS becomes symptomatic. Until the wound is healed, very heavy use of the hand could cause the wound to disrupt, and very dirty work could result in wound infection.

Capacity: Most activities can be safety performed in the post operative period. Traditional wound healing considerations require avoiding contact with chemicals and no extended periods of soaking with the surgical incision site . Return to heavy activities gradually, much like a long distance runner in training, is appropriate (Melhorn).

Tolerance: Tolerance for symptoms is dependent on rewards. Self employed individuals often return to regular activities (including work) within a day or two , while employed individuals may have various lengths of disability. Outcomes for workers’ compensation patients are poorer than non-workers' compensation (Adams).

Accommodations: The key to limited unnecessary disability is communication. The employee should be made to understand what he/she can do instead of what he/she can not do (this enables). The employer should be informed of the health benefits for the employee of early return to work. If the individual can be assigned temporarily to one-handed light work, then return to work the day after surgery is common and not associated with an increased rate of complications.

Source: Medical Disability Advisor






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