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.

Cellulitis


Related Terms

  • Bacterial Skin Infection
  • Gram-positive Bacteria
  • Systemic Toxins

Differential Diagnosis

Specialists

  • Dermatologist
  • Hand Surgeon
  • Infectious Disease Internist
  • Internal Medicine Physician
  • Occupational Therapist
  • Physical Therapist

Comorbid Conditions

Factors Influencing Duration

Severity and location of infection and the need for intravenous antibiotics and / or hospitalization can influence the length of disability.

Medical Codes

ICD-9-CM:
681.00 - Finger, Cellulitis and Abscess, Unspecified
681.10 - Toe, Cellulitis and Abscess, Unspecified
682.0 - Cellulitis and Abscess of Face; Cheek, External; Chin; Forehead; Nose, External; Submandibular; Temple (Region)
682.1 - Cellulitis or Abscess of Neck
682.2 - Cellulitis and Abscess of Trunk; Abdominal Wall; Back [Any Part, except Buttocks]; Breasts; Chest Wall; Flank; Groin; Pectoral Region; Perineum; Umbilicus
682.3 - Cellulitis and Abscess of Upper Arm and Forearm [Any Part, except hand], including Shoulder and Axilla
682.4 - Cellulitis and Abscess of Hand, except Fingers and Thumb; Wrist
682.5 - Cellulitis and Abscess of Buttock; Gluteal Region
682.6 - Cellulitis and Abscess of Leg, Except Foot; Ankle; Hip; Knee; Thigh
682.7 - Cellulitis and Abscess of Foot, Except Toes; Heel
682.8 - Cellulitis and Abscess, Other Specified Sites; Head [except Face]; Scalp
682.9 - Cellulitis and Abscess, Other Unspecified Sites

Overview

Cellulitis is a potentially serious acute bacterial infection of skin and subcutaneous tissue, with severe inflammation and possible spreading, commonly caused by streptococcus and / or staphylococcus bacteria which are normal inhabitants on the skin. Bacteria enter the skin through any break such as cuts, burns, sores, puncture wounds, surgical wounds, dermatitis, bites (insect or animal), or even fingernail scratches. The site of entry may not always be apparent. Hands are frequent areas because of their constant exposure to microtrauma. Next are the lower legs (shins and ankles) followed by the face and neck. Cellulitis of the eye socket (orbital cellulitis) can spread from facial, sinus, or dental infections or may occur following trauma to the eyelid.

Cellulitis appears as localized inflammation of the skin and is characterized by redness (erythema), swelling (edema), tenderness or pain, and warmth. Cellulitis can remain a superficial infection or spread into the soft tissues immediately below the skin that contain blood vessels, lymphatic vessels, and nerves (see Abscess and Drainage of Abscess). It can also involve the underlying muscle or spread throughout the body via the lymphatic system and the bloodstream.

Individuals frequently develop minor skin infections, but usually, the defenses of the outer skin and the immune system eliminate the invading bacteria. Cellulitis can develop more readily if the skin break covers a large surface area, if there are multiple breaks, if the skin break is associated with damage to the blood supply, or if a large number of bacteria are present.

Incidence and Prevalence: The actual incidence of cellulitis is unknown because cases are seldom reported. Cellulitis can affect anyone of any age; cellulitis of the face is more common in children and adults over age 50 (Herchline). Orbital cellulitis is uncommon but potentially very serious.

The incidence of infection by methicillin-resistant Staphylococcus aureus (MRSA) and other antibiotic-resistant bacteria has increased dramatically in recent years (Mayo Clinic Staff). Infection by these organisms is much more serious because the initial antibiotic is not effective and the bacteria have a chance to grow and increase the size of the cellulitis.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Age is not generally considered a risk factor for cellulitis, although some studies show slightly higher incidence in individuals over age 45; the elderly and those with diabetes mellitus are at increased risk for more severe disease (Herchline). Individuals who are immunodeficient as a result of genetic conditions (e.g., Job syndrome), illness (e.g., HIV infection, cancer), or immunosuppressive drugs (e.g., chemotherapy, corticosteroids, antirejection drugs in transplant recipients) are at increased risk of infections such as cellulitis. Chronic skin conditions such as psoriasis, dermatitis, or eczema can create an opportunity for entry of infectious bacteria. Individuals who have recurrent fungal infections of the feet are greater risk for developing cellulitis. Impaired peripheral circulation such as arterial insufficiency or venous stasis is also a risk factor. Subcutaneous or intravenous drug injection, body piercing, and tattoos are all associated with higher risk for cellulitis. Cellulitis may also occur as a complication of certain surgical procedures (hip replacement, liposuction, breast surgery, vein surgery).

Source: Medical Disability Advisor



Diagnosis

History: The individual may complain of a red, hot, swollen, and tender or painful area of skin. These four signs can vary depending on location and cause of the infection. Usually the steps are as follows: As the blood flow to the area increases, the temperature increases; swelling occurs due to the breakdown of bacteria and tissue; the area turns red; and the area hurts because of tissue distension from swelling and the chemical breakdown products. Symptoms may also include fever or chills and malaise. The individual may report a recent history of trauma or a bite at the affected site. The individual who complains of redness and swelling of the eyelid may also report eye pain, impaired eye mobility, and visual changes.

Physical exam: The appearance of red, swollen, tender skin that is warm to the touch is usually sufficient for diagnosis. The texture of the skin may resemble orange peel (peau d'orange) and be firm to the touch. Regional lymph nodes may be inflamed and swollen. Adjacent skin may reveal red streaks characteristic of inflamed lymphatic vessels (lymphangitis). If the lower leg is affected, symptoms (warmth, pain, and swelling) may mimic those of clot formation in leg veins (venous thrombosis). Individuals with orbital cellulitis should undergo a thorough examination of the face, sinuses, teeth, mouth, and nasopharynx to identify the source of infection.

Tests: A complete blood count (CBC) may be performed to determine the level of white blood cells (WBC), a sensitive marker of infection. Two additional blood tests that may be helpful are: the C-reactive protein (CRP) test, which measures general levels of inflammation in the body; and the erythrocyte sedimentation rate (ESR or sed rate), which measures how quickly red blood cells (erythrocytes) settle in a test tube and is related to levels of inflammation.

Cultures of pus or other drainage from the area of infection and / or blood cultures may be performed to identify the causative organism(s). This is especially important if an unusual pathogen is suspected and can be helpful in guiding antibiotic therapy. Often, the causative agent is not identified, or the report shows multiple skin organisms that may include normal flora. Antibiotic sensitivity tests are performed on the cultures to aid in determining the most appropriate antibiotic therapy. Individuals with orbital cellulitis may require imaging studies (x-rays, computed tomography [CT], or magnetic resonance imaging [MRI] of the sinuses) to localize the source of infection.

Source: Medical Disability Advisor



Treatment

Cellulitis is treated with antibiotics and occasionally wound management (wound débridement). Rest, elevation of the infected part, cold compresses, and analgesics are also helpful. If the infection covers a large area, if there are signs indicating spread of infection throughout the body (sepsis), or if the individual is immunocompromised or high-risk (those with diabetes, organ transplants, or recovering from surgery), hospitalization for intravenous antibiotics and observation may be necessary.

Source: Medical Disability Advisor



Prognosis

Antibiotic therapy usually provides prompt and complete resolution of cellulitis, with improvement noted within 3 days (WebMD). If left untreated, cellulitis can occasionally kill the tissue (gangrene), and / or the bacteria may enter the bloodstream (bacteremia) and multiply, causing a serious, systemic, life-threatening condition (sepsis).

Source: Medical Disability Advisor



Rehabilitation

Associated functional loss is possible as a result of scaring or pain limiting range of motion.

FREQUENCY OF REHABILITATION VISITS
Surgical
SpecialistCellulitis
Occupational or Physical Therapist4 visits or less, depending on associated functional loss

Source: Medical Disability Advisor



Complications

Cellulitis can progress to lymphangitis, abscess formation, or sepsis. Infection by additional species of bacteria (superinfection) may occur, complicating treatment. Infection can also spread to the layer of tissue enveloping muscles (fascia), causing a serious infection (necrotizing fasciitis). Cellulitis of the scalp may cause scarring, leading to hair loss (alopecia). Orbital cellulitis may progress to blindness, cavernous sinus clots (thrombosis), or inflammation of all tissues of the eye (panophthalmitis). Infection may spread from the orbit to the brain or tissues lining the brain and spinal cord (meninges).

Older individuals may develop a blood clot (thrombophlebitis) as a result of cellulitis in more superficial tissues.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

If infection is located on the fingers or hand(s), certain work responsibilities (i.e., working with food, children, or the elderly, or providing direct personal health care) may need to be restricted until the infection is completely cleared. If the lower extremities are involved, sedentary work and the ability to elevate the leg(s) may be necessary. Depending on the location of infection, the use of personal protective equipment may be needed.

Risk: Recurrence is dependent on the original bacteria, the size and location of the cellulitis, and the response of the bacteria to the antibiotics. The original trauma that resulted in the skin damage that allowed for the entry of bacteria should be avoided.

Capacity: Smaller areas of cellulitis will result in less loss of function and allow for a greater capacity of activities. Capacity is influenced by the original injury or condition, the size and location of the cellulitis, the response to antibiotics, and any associated scaring.

Tolerance: Pain is common until the cellulitis is treated with antibiotics. Wound healing at the site of the infection takes time. Associated tissue damage may reduce tolerance.

Accommodations: Accommodation is the key to returning to work. Small areas of cellulitis may allow for early return to regular work depending on the job demands. As the size and location of the infection changes, so does the need for accommodation requirements.

Source: Medical Disability Advisor



Maximum Medical Improvement

30 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:

  • Has individual experienced trauma, surgery, burns, dermatitis, insect or animal bites, or other infections?
  • Does individual have a history of vein surgery or coronary artery bypass surgery?
  • Does individual have a deficient immune system, lymphedema, venous insufficiency, or diabetes? Is individual an injection drug abuser?
  • Does individual complain of an area of skin that is red, hot, swollen, and tender or painful? Are chills or fever present? Is there redness and swelling of the eyelid with pain, impaired eye mobility, fever, and malaise?
  • On exam, is the area red? Does the skin resemble the texture of orange peel? Are neighboring lymph nodes inflamed and swollen? Are red streaks present?
  • Were bacterial cultures with antibiotic sensitivity testing done? Has individual with eye socket cellulitis had imaging studies (x-rays, CT, MRI)?
  • Were conditions with similar symptoms ruled out?

Regarding treatment:

  • Is individual being treated with antibiotics and rest, elevation of the infected part, cold compresses, and analgesics?
  • Was individual hospitalized and / or given IV antibiotics?

Regarding prognosis:

  • Can individual's employer accommodate any necessary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Have any complications developed, such as abscess, superinfection, lymphangitis, sepsis, alopecia, blindness, cavernous sinus clots, panophthalmitis, or spread of the infection to the meninges?
  • Has individual developed thrombophlebitis?
  • Is infection caused by methicillin-resistant Staphylococcus aureus (MRSA) or other antibiotic-resistant bacteria?

Source: Medical Disability Advisor



References

Cited

Herchline, Thomas. "Cellulitis." eMedicine. Ed. Michael Stuart Bronze. 1 Apr. 2014. Medscape. 7 May 2014 <http://emedicine.medscape.com/article/214222-overview>.

Mayo Clinic Staff. "Cellulitis." MayoClinic.com. 23 Feb. 2012. Mayo Foundation for Medical Education and Research. 7 May 2014 <http://www.mayoclinic.com/print/cellulitis/DS00450>.

Melhorn, J. Mark, and William Ackerman, eds. Disease and Injury Causation, Guides to the Evaluation of. AMA Press, 2008.

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011.

WebMD Medical Reference. "Cellulitis." WebMD.com. Ed. Norman Levine. 2 Jul. 2012. WebMD, LLC. 7 May 2014 <http://www.webmd.com/skin-problems-and-treatments/cellulitis >.

General

Pallin, Daniel J. , and Denise Nassisi. "Skin and Soft Tissue Infections." Rosen's Emergency Medicine: Concepts and Clinical Practice. Eds. J. A. Marx, et al. 8th ed. Philadelphia: Elsevier, Inc., 2013.

Source: Medical Disability Advisor






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