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.

Contusion


Related Terms

  • Black-and-blue Mark
  • Bruise
  • Ecchymosis

Differential Diagnosis

  • Bone fracture
  • Hematoma (tender mass with or without skin discoloration)
  • Internal bleeding (with deep organ involvement)
  • Rhabdomyolysis
  • Ruptured spleen

Specialists

  • Emergency Medicine Physician
  • Family Physician
  • General Surgeon
  • Orthopedic (Orthopaedic) Surgeon

Comorbid Conditions

Factors Influencing Duration

The extent of injury and type of treatment (medical vs. surgical) may influence duration. Most contusions are not disabling. Hematoma, associated complications, concomitant fracture, and the individual's response to treatment influence the length of disability. Reinjury is a recognized factor in prolonging disability.

Medical Codes

ICD-9-CM:
906.3 - Late Effect of Contusion
921 - Contusion of Eye and Adnexa
921.1 - Contusion of Eyelids and Periocular Area
921.2 - Contusion of Orbital Tissues
921.3 - Contusion of Eyeball
921.9 - Contusion of Eye, Unspecified
922 - Contusion of Trunk
922.0 - Contusion of Breast
922.1 - Contusion of Chest Wall
922.2 - Contusion of Abdominal Wall; Flank; Groin
922.3 - Contusion of Back
922.31 - Contusion of Back
922.32 - Contusion of Buttock
922.33 - Contusion of Back, Interscapular Region
922.4 - Contusion of Genital Organs; Labium (Majus) (Minus); Penis; Perineum; Scrotum; Testis; Vagina; Vulva
922.8 - Contusion of Multiple Sites of Trunk
922.9 - Contusion of Unspecified Part of Trunk
923 - Contusion of Upper Limb
923.0 - Contusion of Shoulder and Upper Arm
923.00 - Contusion of Shoulder Region
923.01 - Contusion of Scapular Region
923.02 - Contusion of Axillary Region
923.03 - Contusion of Upper Arm
923.09 - Contusion of Shoulder and Upper Arm, Multiple Sites
923.1 - Contusion of Elbow and Forearm
923.10 - Contusion of Forearm
923.11 - Contusion of Elbow
923.2 - Contusion of Wrist and Hand(s), Except Finger(s) Alone
923.20 - Contusion of Hand(s), Except Finger(s) Alone
923.21 - Contusion of Wrist
923.3 - Contusion of Finger or Thumb (Nail); Fingernail
923.8 - Contusion of Multiple Sites of Upper Limb
923.9 - Contusion of Unspecified Part of Upper Limb
924 - Contusion of Lower Limb
924.0 - Contusion of Hip and Thigh
924.00 - Contusion of Thigh
924.01 - Contusion of Hip
924.1 - Contusion of Knee and Lower Leg
924.10 - Contusion of Lower Leg
924.11 - Contusion of Knee
924.2 - Contusion of Ankle and Foot, Excluding Toes
924.20 - Contusion of Foot, Excluding Toes; Heel
924.21 - Contusion of Ankle
924.3 - Contusion of Toe or Toenail
924.4 - Contusion of Multiple Sites of Lower Limb
924.5 - Contusion of Unspecified Part of Lower Limb
924.8 - Contusion Multiple Sites, Not Elsewhere Classified
924.9 - Contusion of Lower Limb

Overview

A contusion is a blunt, compressive injury that does not involve a break in the skin. Contusions cause damage to the skin and underlying soft tissue. Blood seeps out of damaged small blood vessels (capillaries) and collects in the surrounding tissue, forming black-and-blue marks beneath the skin (ecchymosis). After injury, gravity may pull blood downward so the ecchymosis may extend some distance from the contusion site. Over a period of days, the black and blue marks beneath the skin will change to green and yellow and eventually fade. Muscle contusions are common although any organ in the body can sustain a contusion injury.

Contusions are usually caused by a fall or direct blow from a blunt object. If the contusion is superficial, it involves only the skin and tissue immediately below the skin (subcutaneous tissue). If deep, the muscle and bone may also be involved. Blood can accumulate and form a hematoma within the muscle, initiating an inflammatory response that can result in swelling and further tissue injury.

Muscle and bone contusions can result from trauma such as a motor vehicle accident. Major trauma may cause contusions of internal organs such as the spleen, kidneys, lungs, heart, or brain. Deep contusions are tender and cannot be seen unless superficial contusions accompany them.

Incidence and Prevalence: Contusions are common and muscle contusions account for one third of sports-related injuries (Earl). Most contusions go unreported so the actual incidence is unknown.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals who are involved in manual labor or other physically active work, or participate in high-impact sports are at higher risk for contusions. Risk for contusions is increased in individuals who have a bleeding disorder (e.g., hemophilia) or another blood dyscrasia that may interfere with blood coagulation (e.g., idiopathic thrombocytopenic purpura or ITP, thrombocytopenia or leukemia), certain vitamin deficiencies, or regular use of aspirin or anticoagulants.

Source: Medical Disability Advisor



Diagnosis

History: The individual with a contusion may have a history of a recent injury, usually a blow or a fall. In general, the individual complains of skin discoloration, swelling, and pain. Depending on the location of the contusion, restricted movement or stiffness is a possibility. When questioned, the individual may report use of aspirin or anticoagulants or a history of a blood coagulation disorder such as hemophilia.

Physical exam: The contusion may appear dark blue or red or yellow-green, depending on how soon the physical exam was performed after the injury. If it is a superficial or muscle contusion of the extremities, then the discoloration may move distally, towards the hands or feet as it resolves. The site may feel firm and be tender to the touch. Swelling is usually apparent around the bruise. There may be limited range of motion (ROM) and/or loss of function of the proximal and/or distal joints. The extent of the contusion may not be obvious until 2 to 3 days after the incident. Contusions involving a larger area of discoloration in the lower legs may be associated with several weeks of general lower leg, foot and ankle swelling. Sometimes, there are no visible signs of internal contusions although pain may be reported by the individual on palpation of the chest or abdomen.

Abuse may be a factor in individuals with a history of contusion and physicians should consider this during examination. Specific to contusions in the extremities, pain out of proportion to the extent of injury can be a sign of compartment syndrome and compartment pressure should be measured.

Tests: Tests are usually not needed for this diagnosis unless fracture or internal injury is suspected. With severe contusions, plain x-rays may be needed to rule out a bone fracture. Magnetic resonance imaging (MRI) is the imaging technique of choice for soft tissue injury; CT scans may be used to diagnose deep organ contusions such as in the heart, lung, or abdomen. If the individual has a history of contusions caused by minor trauma, a complete blood count and blood-coagulation tests (prothrombin time or PT, partial thromboplastin time or PTT) may be done. Changes in blood pressure shortly after injury may indicate significant bleeding.

Source: Medical Disability Advisor



Treatment

Superficial contusions usually do not require medical attention and are seldom disabling. Ice should be applied to the injury for the first day. This may help stop the bleeding and limit the size of the contusion. After 24 to 48 hours, application of heat (hot packs, hot showers, heating pads, hot whirlpool bath) may help speed reabsorption of the blood by increasing circulation to the injured area. Heat liniments and ointments work in a similar action by causing local vasodilatation. Non-narcotic medication such as acetaminophen (analgesics) may be administered for pain. Aspirin and non-steroidal anti-inflammatory drugs are usually avoided since they can contribute to continued bleeding. It is important not to massage the injured area, as this may cause further damage to healing tissues or may cause a proliferation of bone calcification within the affected muscle area (myositis ossificans).

Deeper contusions involving muscle or bone are treated with rest, ice, compression, and elevation (RICE). A compression bandage may help reduce swelling during the first 2 to 3 days. Vigorous physical activity should be avoided for the first 48 hours after injury. Crutches may be prescribed for individuals with a contusion to the hip, pelvis, buttocks, or lower extremities. A sling may be prescribed for individuals with a clavicle, scapula, or upper extremity contusion. Contusions of internal organs may require hospitalization for observation or supportive treatment. For example, individuals with lung contusions may need oxygen and even mechanical ventilation. A contusion of the heart muscle is treated like a heart attack (myocardial infarction). Individuals who have hemophilia or another blood dyscrasia (e.g., idiopathic thrombocytopenic purpura or ITP, thrombocytopenia or leukemia) that may interfere with blood coagulation may be treated with transfusion of coagulation factors such as platelets to normalize coagulation and stop bleeding under the skin or internally.

Source: Medical Disability Advisor



Prognosis

Most contusions resolve without disability. Healing times vary with the severity of the injury. Superficial contusions disappear in a week or two with conservative treatment. Contusions involving internal organs typically resolve over weeks to months. Internal contusions are potentially serious and without treatment can result in permanent disability or death.

Source: Medical Disability Advisor



Rehabilitation

Since superficial and muscle contusions can occur in various parts of the body (i.e., elbow, forearm, hand, thigh or buttocks), treatment protocols may vary due to body location. Body part location also determines the possible severity of contusion. For example, a contusion to the mid-hand is usually mild and lasts for 2 days. A contusion to the thigh may be more severe and require months to heal. In general, superficial contusions do not need rehabilitation. Physical therapy may be required for severe contusions, but the probability of bone deposited in the muscle (myositis ossificans) is greater with upper arm and thigh contusions. Exercise and vigorous massage aggravate this condition and may cause a proliferation of bone calcification within the affected muscle area. Myositis ossificans usually begins within the first or second week after a severe contusion. Rest and ultrasound are usually the only prescription in these cases until the primary physician has given clearance for physical therapy. It should be noted that ultrasound is not initially prescribed for the contusion as it may cause further inflammatory reaction in the area.

Beginning rehabilitation techniques for contusions to the upper or lower body are similar in that the affected limb may be immobilized for the first 48 hours either by a sling or a compression bandage. If the contusion is in the forearm or thigh, the elbow or knee is wrapped in a bent position (flexed), and ice therapy is applied. Active range of motion exercises may be initiated when the individual can tolerate pain. Some passive stretching (such as the flexor stretch) is prohibited for the contusions of the arm and hand because the tissues may be too fragile and overstretching may cause further damage. Stretching the quadriceps can be initiated as soon as the individual is able to comfortably bend the knee. Duration of exercise sessions depends on the pain level of the individual and the presence or absence of myositis ossificans.

If no myositis ossificans is present, strengthening exercises that stay within the pain-free area of motion are added to the individual's routine. These exercises are performed several times per day to tolerance to keep proper blood flow through the limb. Once range of motion and flexibility have been restored (between weeks 2 and 3), the individual may engage in a progressive resistance program.

During this latter stage of contusion rehabilitation, heat, ultrasound, and massage may be beneficial in hastening recovery. During this time, the main goal is to increase strength and endurance in the affected limb. The individual may continue to engage in a structured therapy program or may be given a home routine. In addition, the individual may return to light duty at the workplace. Occupational therapy is usually not needed unless the contusion was severe enough to cause permanent muscle damage.

Pulmonary (lung) contusions and heart contusions may require respiratory therapy and physical therapy. Cerebral contusions may also cause partial paralysis, requiring more extensive rehabilitation.

Source: Medical Disability Advisor



Complications

Skin breaks (lacerations) may be prone to infection. Inflammation (cellulitis) can occur surrounding a break in the skin. Bleeding disorders (e.g., hemophilia) can prolong bleeding and lead to a more severe contusion that may increase the length of disability. Hematomas within the muscle prolong the recovery time and delay return of function. Pressure on the local blood vessels from swelling or bleeding can result in compartment syndrome, which can cause permanent muscle and nerve damage. Bleeding within the muscle can lead to loss of function. On occasion, damaged muscle can convert into a bony substance (ossification), a condition known as myositis ossificans, which occurs in 9% of all contusions and up to 18% of severe contusions (Earl). This condition may cause disfigurement and impaired muscle function. Infections may occur following surgery. Repeat injury to a joint can cause instability or arthritis. Fatal soft-tissue infection (necrotizing fasciitis) can result from a simple contusion.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions and accommodations are based on the location and severity of the contusion and if it interferes with job responsibilities. Depending on work duties, the individual may need a temporary accommodation in duty (e.g., a sedentary position rather than standing) or other modification of job duties. For example, if a standing position causes increased pain, a sedentary job may be needed for the first week. Some individuals recovering from extreme or internal contusions may be required to change occupations if the work activity is too physically or mentally challenging.

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:

  • Does individual have a history of a recent injury such as a fall, direct blow, motor vehicle accident, or sports injury?
  • Does individual have a bleeding disorder or a blood dyscrasia associated with bleeding? Vitamin deficiency? Obesity? Take aspirin or anticoagulants?
  • On exam, what color is the contusion? Is the site firm and tender to palpation? Is swelling apparent around the bruise? Is there restricted movement or stiffness?
  • Did individual have an x-ray? MRI or CT?
  • Were blood coagulation studies performed?
  • Were conditions with similar symptoms ruled out?
  • Did the individual have compartment syndrome or internal contusions?

Regarding treatment:

  • Was individual treated with ice for the first 24 to 48 hours? Was heat then applied?
  • Was individual given analgesics other than aspirin or non-steroidal anti-inflammatory drugs?
  • Were deeper contusions involving muscle or bone treated with rest, ice, compression, and elevation?
  • Was it necessary for individual to use crutches? A sling?
  • Did individual have internal contusions? Was individual hospitalized?

Regarding prognosis:

  • If necessary, is individual active in physical therapy? Is a home exercise program in place?
  • 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 infection, cellulitis, compartment syndrome, myositis ossificans, or necrotizing fasciitis? Does individual have joint instability or arthritis?
  • Has the individual’s tolerance to normal use of a limb been evaluated and shown to be decreased?

Source: Medical Disability Advisor



References

Cited

Earl, Brett J., et al. "Contusions." eMedicine. Eds. Joseph P. Garry, et al. 8 Dec. 2005. Medscape. 10 Dec. 2008 <emedicine.com/sports/TOPIC28.htm>.

General

Bealle, D., and D. L. Johnson. "Subchondral Contusion of the Knee Caused by Axial Loading From Dashboard Impact Detection by Magnetic Resonance Imaging." Journal of the Southern Orthopaedic Association 9 1 (2000): 13-18.

Kingma, J., and H. J. Ten Duis. "Severity of Injuries Due to Accidental Fall Across the Life Span: A Retrospective Hospital-Based Study." Perceptual and Motor Skills 90 1 (2000): 62-72.

Tyburski, J. G., et al. "Pulmonary Contusions: Quantifying the Lesions on Chest X-Ray Films and the Factors Affecting Prognosis." Journal of Trauma 5 5 (1999): 833-888.

Source: Medical Disability Advisor






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