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.

Costochondritis


Related Terms

  • Costal Chondritis
  • Costosternal Chondrodynia
  • Tietze Junction Syndrome
  • Tietze’s Syndrome

Differential Diagnosis

Specialists

  • Internal Medicine Physician
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Rheumatologist

Comorbid Conditions

Factors Influencing Duration

Duration is variable. Because costochondritis is benign in its effects, the individual may experience continuing discomfort but no accompanying disability.

Medical Codes

ICD-9-CM:
733.6 - Tietzes Disease; Costochondral Junction Syndrome; Costochondritis

Overview

Costochondritis is an inflammation of the connective tissue (cartilage) of the costochondral or costosternal joints in the rib cage, producing pain and tenderness in the anterior chest wall. Tietze’s syndrome is a variation of costochondritis in which swelling is present as well as pain. The condition is also associated with headache, emotional problems, anxiety, and hyperventilation in some affected individuals.

The cartilage between the inner ribs and the breastbone or sternum (costochondral junction) is the area typically affected. Although the individual may experience localized chest pain or discomfort, costochondritis usually is benign and self-limited. No specific etiology for the condition has been identified although it is sometimes associated with other conditions affecting the chest (e.g., viral or bacterial pulmonary infection). Medical definitions vary and may describe costochondritis as a symptom of repeated minor trauma or of underlying inflammatory disease such as fibromyalgia or rheumatoid arthritis. It has been suggested that costochondritis is a form of regional fibrositis, a condition that involves inflammation of fibrous tissue; however, fibrochondritis is a distinctly separate condition from costochondritis and is characterized by inflammation of a fibrocartilage.

Incidence and Prevalence: The condition affects females more than males (70% versus 30%, respectively) (Flowers) and occurs more frequently in individuals aged 40 or older (Mayo Clinic). In one emergency department study, 30% of individuals with chest pain had costochondritis (Flowers). Idiopathic costochondritis accounts for 10% to 30% of all chest pain in children and adolescents (Singh).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors for costochondritis include repeated minor trauma to the chest wall, viral respiratory infection, straining from coughing during a viral infection, bacterial infection after surgery, and (rarely) fungal infection. Some researchers believe that a predisposition for developing costochondritis may be inherited. Most cases, however, are idiopathic, with no cause identified.

Source: Medical Disability Advisor



Diagnosis

History: Individuals may complain of mild or severe chest pain that may radiate to the back, shoulder, or arms. One or both sides of the chest can be involved. The pain can be sharp or nagging, and may be aggravated by chest wall movement related to deep breathing, coughing, or sneezing. The symptoms, which may vary in intensity, typically improve if the individual remains quiet and restricts movement. The individual may report frequent headaches and feelings of anxiety or unstable emotions. A family history of chest wall pain may be reported. The individual’s health history may include current or prior lung conditions.

Physical exam: The exam usually reveals tenderness or pain when pressure is applied (palpation) to the affected area. Without this tenderness, a diagnosis of costochondritis is unlikely. The most common site of pain is the third, fourth, fifth, or sixth rib. With costochondritis of unknown origin, no swelling (edema) is noted when pressure is applied; swelling indicates Tietze costochondral junction syndrome. The diagnosis may be confirmed if injection of a local anesthetic into the affected area relieves the pain. This injection is not done routinely because of the risk of pneumothorax.

Tests: No specific laboratory tests are performed to confirm costochondritis. A chest x-ray, electrocardiogram (ECG), and blood tests (serology) may be needed to rule out heart attack (myocardial infarction), interrupted blood flow in the heart (myocardial ischemia), pericarditis, or any possible underlying conditions. A bone scan is sometimes used to assess for infectious costochondritis.

Source: Medical Disability Advisor



Treatment

The primary treatment goal is to reduce inflammation and relieve pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the mainstay of treatment. Treatment may also include rest, gentle movement such as walking or stretching, avoidance of activities that may aggravate the pain, application of heat and/or ice, topical spray (ethyl chloride) that has a cooling effect, and local injection of an anesthetic. In some cases, a stronger anti-inflammatory agent (corticosteroid) may be used. Emergency attention may be required to rule out the possibility of a myocardial infarction. Infectious costochondritis is treated initially with intravenous (IV) antibiotics and then with oral or IV antibiotics.

Source: Medical Disability Advisor



Prognosis

Although a cause may or may not be identified, most costochondritis resolves on its own, usually within 1 year and sometimes within months. With treatment, improvement in associated pain usually occurs within 2 months. Costochondritis unrelated to other conditions typically heals completely, although it may recur. Outcomes will vary greatly when the condition is a symptom of underlying injuries or diseases, each with a different prognosis. Individuals with a possible inherited tendency for costochondritis may experience ongoing (chronic) symptoms.

Source: Medical Disability Advisor



Complications

Costochondritis can be a symptom of other inflammatory diseases, which may need to be treated independently. These conditions can include fibromyalgia, rheumatoid arthritis, inflammatory bowel disease, psoriatic arthritis, Reiter's disease, and ankylosing spondylitis. Treatment with NSAIDs may produce gastrointestinal disturbances such as gastritis and GI bleeding.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions will depend on the degree of inflammation and pain involved. Activities that aggravate pain, such as lifting or other strenuous activities, should be temporarily eliminated from responsibilities until the individual has recovered. Modifications may be needed to the workplace to encourage proper posture. Company policy on medication usage should be reviewed to determine if pain medication use 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:

  • Does individual complain of mild or severe chest pain that may radiate to the shoulder, back, or arms? Does the pain worsen with chest wall movement related to deep breathing, coughing, or sneezing?
  • If individual is quiet and restricts movement, is the pain relieved?
  • Does the physician note tenderness or pain with palpation of the affected area?
  • Was swelling noted on palpation of the chest?
  • Did physician inject a local anesthetic in the affected area, relieving pain and confirming the diagnosis?
  • Were underlying conditions ruled out with a chest x-ray, electrocardiogram (ECG), and blood tests?
  • Is a bone scan needed to confirm infectious costochondritis?
  • Has individual experienced emotional instability, anxiety, or hyperventilation?

Regarding treatment:

  • Have NSAIDs provided relief from symptoms? If not, have other medications (e.g., antidepressants, muscle relaxants) provided relief?
  • Has individual complied with physician’s recommendations for rest and activity?
  • Were activities that aggravated the condition discontinued?
  • Was individual compliant with medications and treatment recommendations?
  • Does individual need corticosteroid medication?

Regarding prognosis:

  • Did individual require treatment, or did the condition resolve on its own?
  • Was the condition caused by an injury or underlying disorder? Were these conditions addressed?
  • Does individual have a family history of costochondritis?
  • Does individual have an underlying disorder that may be causing costochondritis pain?
  • Is individual being treated for the underlying disorder?
  • Was treatment for the underlying disorder successful?
  • Would individual benefit from psychological counseling?

Source: Medical Disability Advisor



References

Cited

Mayo Clinic Staff. "Costochondritis." MayoClinic.com. 31 Jan. 2008. Mayo Foundation for Medical Education and Research. 6 Mar. 2009 <http://www.mayoclinic.com/health/costochondritis/DS00626>.

General

Flowers, Lynn K., and Brian D. Wippermann. "Costochondritis." eMedicine. Eds. William Chiang, et al. 9 Aug. 2007. Medscape. 6 Mar. 2009 <http://emedicine.medscape.com/article/808554-overview>.

Singh, Jagvir. "Costochondritis." eMedicine Health. Eds. Steven C. Gabaeff and Francisco Talavera. 22 May. 2007. WebMD, LLC. 6 Mar. 2009 <http://www.emedicinehealth.com/costochondritis/article_em.htm>.

Source: Medical Disability Advisor






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