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, Upper Limb


Related Terms

  • Bruise of the Arm(s)
  • Bruised Arm

Differential Diagnosis

Specialists

  • Emergency Medicine Physician
  • Family Physician
  • General Surgeon
  • Hand Surgeon
  • Neurosurgeon
  • 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:
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
923.10 - Contusion of Forearm
923.11 - Contusion of Elbow
923.20 - Contusion of Hand(s), Except Finger(s) Alone
923.21 - Contusion of Wrist
923.8 - Contusion of Multiple Sites of Upper Limb
923.9 - Contusion of Unspecified Part of Upper Limb

Overview

A contusion of the upper limb is a bruise to the upper arm, forearm, wrist, or fingers. This injury does not involve a break in the skin but results in damage to the skin and underlying tissues (i.e., muscle, tendon, nerve, small blood vessels [capillaries], surface of bone). A contusion usually is caused by a fall or direct blow from a blunt object. Blood seeps out of damaged capillaries and into the surrounding tissue, forming black-and-blue marks beneath the skin (ecchymosis).

Contusions are classified as mild, moderate, or severe. If the contusion is superficial (mild), it involves only the skin and tissue immediately below the skin (subcutaneous tissue): if deep (severe), the muscle and surface of bone also may be involved. Blood can accumulate, forming a hematoma within the muscle.

Upper arm contusions primarily affect the muscles, particularly the triceps and biceps, but also may involve the rotator cuff and deltoid. Contusions located near the elbow may affect the radial nerve or the ulnar nerve, causing a tingling sensation, numbness, and a dropped wrist. Fingernail contusions may be very painful because the fingernail limits the ability of the tissues to swell. If the blunt trauma is severe, the nail itself may lift off the nail bed or may no longer be intact.

Incidence and Prevalence: Contusions are very common. Of all sports-related injuries, contusions and strains account for 60% to 70% of traumas (Herbenick). In one study of a professional football team, 47% of all shoulder injuries were rotator cuff contusions caused by a direct blow to the shoulder (Cohen).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Because a fall or direct blow from a blunt object to the upper limb typically causes a contusion, individuals at increased risk for upper limb contusions include those who participate in contact sports (e.g., football, baseball, rugby, ice hockey), especially if protective equipment is not worn. Construction workers and those participating in activities involving heavy lifting also are at increased risk. The hand is particularly vulnerable to contusions because of its use in all sports, work, and daily activities.

Individuals who have a bleeding disorder (e.g., hemophilia) or a vitamin deficiency, and those who take aspirin or anticoagulants (e.g., warfarin) are at increased risk for developing contusions of the upper limbs.

Source: Medical Disability Advisor



Diagnosis

History: The individual with a contusion of the upper limb usually complains of skin discoloration, swelling, pain, and possibly restricted limb movement. Individuals with contusions of the upper arm near the elbow may report a shocking or tingling feeling, numbness in the wrist and hand, partial loss of movement in the thumb, and a dropped wrist. Contusions of the fingernail appear as darkened areas beneath the nail.

Physical exam: The contusion may appear dark blue, red, or yellow-green depending on how soon the physical exam is performed after injury. The site feels firm and tender to the touch. Swelling usually is apparent around the bruise. There may be evidence of limited range of motion and/or partial loss of function of the affected limb. The extent of the contusion may not be visible for 2 to 3 days, and after several days, the ecchymosis may move from the contusion site due to gravitational effects after injury. Contusions in the vicinity of a nerve can produce a weakness with partial loss of movement of the hand and fingers.

Tests: Tests usually are not needed for this diagnosis. Plain x-rays may be taken for moderate-to-severe contusions to determine the extent of injury and to rule out bone fracture. If the individual has a history of contusions caused by very minor trauma, blood-clotting factors may be tested.

Source: Medical Disability Advisor



Treatment

Mild contusions do not need medical attention. PRICE (protection, rest, ice, compression, elevation) may be followed for the first 48 hours to decrease pain and swelling and reduce bleeding (AAOS, Herbenick). A compression bandage may be worn for the first 2 days. Heat may be applied after the first 24 to 48 hours in the form of hot soaks, hot showers, heating pads, heat lamps, heat liniments or ointments, or a hot whirlpool bath to promote flexibility and painless gentle stretching of affected muscles. Analgesics may be taken to relieve pain, but nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided during the initial 24 hours of injury to avoid the risk of increased bleeding and hematoma formation (Frontera). After the initial 48 hours, movement is encouraged to promote circulation and minimize swelling. If a large hematoma forms at the site of injury, needle aspiration may be performed to drain the swelling and reduce pain (AAOS).

Source: Medical Disability Advisor



ACOEM

ACOEM's Practice Guidelines, the gold standard in effective medical treatment of occupational injuries and illnesses, are provided in this section to complement the disability duration guidelines.*
 
Elbow Contusion
 
* The relationship between the MDGuidelines (MDA) content and ACOEM's guidelines is approximate and does not always link identical diagnoses. The user should consult the diagnostic codes in both guidelines, as well as the clinical descriptions, before assuming an equivalence.

Source: ACOEM Practice Guidelines



Prognosis

Most contusions resolve without disability. Healing time varies with the severity of the injury. Mild upper limb contusions usually heal in 1 to 3 weeks. Severe contusions involving deep muscle groups and bone surface may take months to heal (AAOS). Fingernail contusions generally heal within 1 to 2 weeks, although it takes several months for the nail to grow out. Bone contusions may be sensitive to pressure for a several months.

Source: Medical Disability Advisor



Rehabilitation

Basic goals in the rehabilitation of a contusion of the upper limb are to decrease pain and swelling and allow the individual to regain full motion, flexibility, strength, and endurance of the muscle/joint structures involved. The desired result is the return of the individual to full function for work and recreational activities with minimal risk of re-injury. The physical therapist determines the method for rehabilitation based on the severity of the contusion and whether any joints of the upper limb are causing difficulty with movement and function.

If the upper limb contusion produces severe pain and hematoma formation, treatments are implemented to help stop bleeding and prevent further tearing of the muscle fibers. PRICE may be used during the first 24 to 48 hours to control inflammation and pain. Later, heat treatments are useful to promote flexibility of the affected muscles.

After several days, rehabilitation includes early range of motion (from passive to active assisted to active) exercises of the upper limb, with the goal of making all movements pain-free. Early mobilization of the affected muscles and nearby joints can help reduce recovery time (Herbenick). Once range of motion is restored, the individual is instructed in gentle isometric strengthening exercises for all muscles in the area affected by the contusion. Once both range of motion and isometric exercises are tolerated, the individual progresses to isotonic strengthening exercises that involve movement at and around the joint(s) near the contusion. Individuals are instructed to perform exercises in a pain free manner so as to avoid re-injury of the healing muscle tissue (Herbenick).

The physical therapist may need to modify the program for individuals with arthritis or other joint conditions of the upper limb(s).

Source: Medical Disability Advisor



Complications

Hematoma within the muscle prolongs recovery time and may delay return of function. Pressure on the local blood vessels from swelling or bleeding can result in compartment syndrome, which can occur within 12 to 24 hours after injury, causing permanent muscle and nerve damage (Herbenick). In 4% of mild contusions, 13% of moderate contusions, and 18% of severe contusions, damaged muscle tissue can convert into a bony substance (ossification), a condition known as myositis ossificans (Herbenick). This may cause disfigurement and impaired muscle function. Contusions of the deltoid muscle near its insertion on the humerus may result in periostitis and bone spur formation (blocker's exostosis) that may require surgical removal (Simon). Contusions in the upper arm near the elbow can cause permanent damage to the radial or ulnar nerves, resulting in forearm and hand disability. Contusions of the hand can be complicated by rupture of tendons.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Depending on work duties, the individual may need to be temporarily reassigned. Movement of the affected limb may be restricted until the individual recovers. The individual with an upper limb contusion may temporarily be unable to lift and carry heavy or bulky objects, operate equipment, or perform other tasks requiring use of both hands. If the dominant arm or hand is affected, the individual may be unable to write legibly or type well. Fine motor skills, such as those needed to work in a laboratory, may also be affected. Individuals whose dominant arm or hand is affected may require a temporary or permanent reassignment of duties. If pain medication is needed, company policy on medication use should be reviewed to determine if medication usage is compatible with job safety and function.

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:

  • Did individual report a fall or direct trauma to the upper limb?
  • Was evidence of a severe contusion (such as swelling, pain, loss of function) noted in the initial physical exam?
  • Was the contusion re-examined 2 to 3 days after the initial injury to confirm the severity of the contusion?
  • Is individual’s range of motion limited?
  • Did hematoma occur?
  • Were x-rays done to rule out other injuries such as fractures that may present with similar symptoms?
  • Were joints involved? If so, which ones?
  • Was there tendon damage? If so, which ones?
  • Was there nerve damage? If so, which nerves?

Regarding treatment:

  • Have symptoms persisted despite treatment with conservative measures?
  • Has individual been compliant with prescribed therapy (PRICE)?
  • Have analgesics been used to reduce pain?
  • After the first 48 hours, has individual used heat to assist with flexibility?
  • Is needle aspiration of a hematoma needed to drain swelling and reduce pain?
  • Is physical therapy necessary?

Regarding prognosis:

  • Has individual been re-evaluated for the possibility of a more serious injury (e.g., radial nerve damage) or complications (e.g., myositis ossificans, compartment syndrome)?
  • Does individual have persistent swelling, loss of sensation, or loss of function that may be indicative of complications?
  • If so, have these complications been considered by the healthcare provider and addressed in the treatment plan?
  • Did individual resume normal activities too soon after a severe contusion?
  • Has temporary reassignment of job duties been considered?
  • Does individual have any pre-existing conditions that may affect ability to recover and further lengthen disability?

Source: Medical Disability Advisor



References

Cited

AAOS. "Muscle Contusion (Bruise)." Your Orthopaedic Connection. Jul. 2006. American Academy of Orthopaedic Surgeons. 24 Sep. 2009 <http://orthoinfo.aaos.org/topic.cfm?topic=A00341>.

Cohen, S. B., J. D. Towers, and J. P. Bradley. "Rotator Cuff Contusions of the Shoulder in Professional Football Players: Epidemiology and Magnetic Resonance Imaging Findings." American Journal of Sports Medicine 35 3 (2007): 442-447. PubMed. <PMID: 17158276>.

Frontera, Walter R., Julie K. Silver, and Thomas Rizzo, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia: Saunders, Elsevier, 2008.

Herbenick, Michael A., Michael S. Omori, and Paul Fenton. "Contusions." eMedicine. 17 Apr. 2009. Medscape. 24 Sep. 2009 <http://emedicine.medscape.com/article/88153-overview>.

Simon, Robert Rutha, Scott C. Sherman, and Steven J. Koenigsknecht. "Chapter 11: Shoulder and Arm." Emergency Orthopedics: The Extremeties. 5th ed. McGraw-Hill, 2006. 316.

General

Bonfiglio, Richard L., Anita Cone, and Francis Lagattuta. "Pathophysiology of Soft Tissue Injuries." Soft Tissue Injuries: Diagnosis and Treatment. Eds. Robert Windsor and Dennis Lox. Philadelphia: Hanley & Belfus, Inc., 1998. 1-11.

Garrett, Willaim, and Donald Kirkendall. "The Structure and Function of Skeletal Muscle." Principles of Orthopaedic Practice. Eds. Roger Dee, et al. New York City: McGraw-Hill, 1997. 119-128.

Source: Medical Disability Advisor






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