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, Lower Limb


Related Terms

  • Bruise of the Leg(s)
  • Bruised Leg
  • Ecchymosis
  • Muscle Contusion

Differential Diagnosis

Specialists

  • Emergency Medicine Physician
  • Family Physician
  • General Surgeon
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist

Comorbid Conditions

Factors Influencing Duration

The part of the limb, type of treatment needed, presence of hematoma, associated complications, and the individual's response to treatment influence the length of disability.

Medical Codes

ICD-9-CM:
924.00 - Contusion of Thigh
924.01 - Contusion of Hip
924.10 - Contusion of Lower Leg
924.11 - Contusion of Knee
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
924.9 - Contusion of Lower Limb

Overview

A contusion of the lower limb is a blunt, compressive injury to the leg, ankle or foot 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. The affected area may become swollen and painful. A direct blow from a blunt object is the most common cause of limb contusion. Contusions of the lower limb are often the result of a fall or sports injury.

Contusions are classified as mild, moderate, or severe. 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.

Contusions of the thigh are common injuries sustained by athletes (e.g., football, soccer, ice hockey, and field hockey players). The knee is highly prone to contusions. It is a common injury resulting from contact with the dashboard during a motor vehicle accident. The lower leg is prone to contusions because it is often exposed to direct blows, which can include running into or tripping over a piece of furniture or other obstacle.

Contusions directly over the shinbone (tibia) are more likely to be severe because there is little room for swelling in this part of the leg. Ankle contusions are common but not usually serious. Contusions of the foot may be caused from a direct blow to the foot. Contusions of the toe or toenail result from the impact of a dropped object, stubbing the toe, or from kicking sports such as football and soccer. Because the toenail limits the ability of the tissues to swell, these contusions may be very painful. If the injury is severe, the nail may be split, damaged or may even separate from the nail bed.

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

Source: Medical Disability Advisor



Causation and Known Risk Factors

People who are involved in manual labor or other physically active work, or participate in high-impact sports are at high risk for limb contusions. Risk for contusions of the lower limb is increased in individuals who have bleeding disorders (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 may have a history of a recent injury, usually a blow or fall. In general, the individual with a contusion of the lower limb may complain of skin discoloration, swelling, pain, and possibly restricted limb movement. The individual with a knee contusion may complain of restricted movement of the knee. Cuts (lacerations) are commonly associated with knee contusions. The individual with a contusion to the lower leg may complain of pain and/or limited leg function. When questioned, the individual may report use of aspirin or anticoagulants or a history of a blood coagulation disorder such as hemophilia.

Physical exam: Contusions of the toenail appear as blackened areas beneath the nail. Contusions of the leg may appear dark blue or red, or yellow-green depending on how soon the physical exam was performed after the injury. The site may be firm and tender to the touch. Swelling is usually apparent around the contusion. There may be evidence of limited range of motion and/or loss of function of the affected limb. The full extent of the contusion may not be visible for 2 to 3 days.

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

Tests: Contusions are diagnosed by physical appearance on examination. Tests are usually not needed for this diagnosis. With severe contusions, plain x-rays may be taken to rule out bone fracture. If the individual has a history of contusions caused by very minor trauma, or is taking aspirin or anticoagulants for another condition, a complete blood count and blood-coagulation tests may be performed.

Source: Medical Disability Advisor



Treatment

Mild contusions do not need medical attention. Ice should be applied to the injury within the first 24 to 48 hours. Elevating the affected limb also helps to relieve discomfort. The affected limb should be rested for a few days. A compression bandage may help reduce swelling during the first 2 to 3 days. After 24 to 48 hours, application of heat (e.g., hot packs, hot showers, heating pads, and 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.

Therapeutic ultrasound is often used to promote tissue repair by increasing the number of new tissue cells and encouraging protein synthesis involved in healing. Although enhanced cell proliferation has been shown, this can lead to increased scar tissue and some studies have shown no benefit to outcomes (Earl).

Source: Medical Disability Advisor



Prognosis

Most contusions resolve without disability. Healing times vary with the severity of the injury. Knee contusions heal within 2 to 6 weeks, lower leg contusions in 1 to 2 weeks. Ankle contusions generally heal in 2 to 4 days, foot contusions in 1 to 2 weeks. Toenail contusions should heal within 1 to 2 weeks although it takes several months for the toenail to grow out.

Source: Medical Disability Advisor



Rehabilitation

Physical therapy may be required for serious contusions and varies depending on the area of the contusion. In general, the focus is on restoring the normal range of motion, flexibility, strength, endurance, and reducing pain. In the case of a thigh contusion, it is important to reduce persistent muscle spasms that might arise and to incorporate exercises that promote flexibility and endurance. Any pain and swelling associated with physical therapy should be addressed.

Source: Medical Disability Advisor



Complications

Lacerations may be prone to infection. Inflammation (cellulitis) can occur surrounding a laceration. Injuries that cause a lower limb contusion can compress the peroneal nerve leading to nerve inflammation (neuritis). Pressure on the muscle from swelling or bleeding especially in the lower leg can result in compartment syndrome. Left untreated, this can cause permanent muscle and nerve damage.

When contusions are caused by blunt trauma, there is a risk of developing blood clots within minor blood vessels (thrombophlebitis). These blood clots can travel to other locations in the body such as the lungs, resulting in an embolism (a clot that blocks a blood vessel and prevents normal blood flow to tissue or organs). A hematoma within the muscle prolongs recovery time and delays return of function.

Repeated injury to a joint can cause instability or arthritis. On occasion, damaged muscle can convert into a bony substance (ossification), a condition known as myositis ossificans. This may cause disfiguration and impaired muscle function. Poor nutrition and injuries (e.g., fractures, lacerations) sustained during the traumatic event may also influence the length of disability.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Contusions in a lower limb may affect the individual's ability to walk, stand, or sit for extended periods of time, requiring temporary accommodations. Movement of the affected limb may be restricted until the individual recovers. The ability to operate a motor vehicle may be affected. For severe contusions, crutches or a cane may be prescribed for temporary use. A pull-on sleeve or stabilizer may be worn over the affected limb or joint. 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.

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's work or play put them at risk for a blunt injury to the lower extremities?
  • Is individual's contusion mild, moderate or severe?
  • Does individual have a bleeding disorder or blood dyscrasia? Vitamin deficiency?
  • Is individual on anticoagulant therapy?
  • Does individual complain of skin discoloration, swelling, pain, and restricted limb movement? Any lacerations? Any fractures as a result of original injury?
  • What color was the contusion on physical exam?
  • Was the site firm and tender to palpation? Was it swollen? Limited range of motion?
  • Did individual have an x-ray? Were CBC and blood coagulation tests performed?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Did individual use ice packs for first 24 to 48 hours? Elevate the limb?
  • Was a compression bandage used?
  • Did individual switch to hot compresses after the first 48 hours?
  • Did individual use non-narcotic analgesics, avoiding aspirin or non-steroidal anti-inflammatory drugs?
  • Was the individual advised to use crutches or to avoid putting weight on the leg or foot?
  • Was therapeutic ultrasound used to treat deeper muscle contusion?

Regarding prognosis:

  • Is individual active in physical therapy?
  • Does individual have a home exercise program?
  • 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 infection, cellulitis, peroneal nerve injury with neuritis, hematoma, compartment syndrome, or myositis ossificans?
  • Has the individual had a follow-up evaluation? Is use of the limb and range-of-motion improving?

Source: Medical Disability Advisor



References

Cited

Earl, Brett J., et al. "Contusions." eMedicine. Eds. Joseph P. Garry, et al. 8 Dec. 2005. Medscape. 9 Dec. 2008 <http://emedicine.com/sports/topic28.htm>.

Source: Medical Disability Advisor






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