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.

Decubitus Ulcer

decubitus ulcer in русский (Россия)

Related Terms

  • Bedsore
  • Decubitus
  • Pressure Sore
  • Pressure Ulcer

Specialists

  • General Surgeon
  • Orthopedic (Orthopaedic) Surgeon
  • Plastic Surgeon
  • Vascular Surgeon

Comorbid Conditions

Factors Influencing Duration

The underlying condition, location and size of the ulceration, presence of infection, response to treatment, and age and general health of the individual may influence the length of disability.

Medical Codes

ICD-9-CM:
707.00 - Chronic Ulcer of Skin, Including Non-infected Sinus of Skin, Non-healing Ulcer, Decubitus Ulcer; Bed Sore; Decubitus Ulcer [Any Site]; Plaster Ulcer; Pressure Ulcer, Unspecified site
707.01 - Chronic Ulcer Of Skin, Including Non-Infected Sinus of Skin, Non-healing Ulcer, Decubitus Ulcer; Bed Sore; Decubitus Ulcer [Any Site]; Plaster Ulcer; Pressure Ulcer, Elbow
707.02 - Chronic Ulcer of Skin, Including Non-infected Sinus of Skin, Non-healing Ulcer, Decubitus Ulcer; Bed Sore; Decubitus Ulcer [Any Site]; Plaster Ulcer; Pressure Ulcer, Upper Back; Shoulder Blades
707.03 - Chronic Ulcer Of Skin, Including Non-infected Sinus of Skin, Non-healing Ulcer, Decubitus Ulcer; Bed Sore; Decubitus Ulcer [Any Site]; Plaster Ulcer; Pressure Ulcer, Lower Back; Sacrum; Coccyx
707.04 - Chronic Ulcer Of Skin, Including Non-infected Sinus of Skin, Non-healing Ulcer, Decubitus Ulcer; Bed Sore; Decubitus Ulcer [Any Site Plaster Ulcer; Pressure Ulcer, Hip
707.05 - Chronic Ulcer of Skin, Including Non-infected Sinus of Skin, Non-healing Ulcer, Decubitus Ulcer; Bed Sore; Decubitus Ulcer [Any Site]; Plaster Ulcer; Pressure Ulcer, Buttock
707.06 - Chronic Ulcer of Skin, Including Non-infected Sinus of Skin, Non-healing Ulcer, Decubitus Ulcer; Bed Sore; Decubitus Ulcer [Any Site]; Plaster Ulcer; Pressure Ulcer, Ankle
707.07 - Chronic Ulcer of Skin, Including Non-infected Sinus of Skin, Non-healing Ulcer, Decubitus Ulcer; Bed Sore; Decubitus Ulcer [Any Site]; Plaster Ulcer; Pressure Ulcer, Heel
707.09 - Chronic Ulcer of Skin, Including Non-infected Sinus of Skin, Non-healing Ulcer, Decubitus Ulcer; Bed Sore; Decubitus Ulcer [Any Site Plaster Ulcer; Pressure Ulcer, Other Site; Head

Overview

Decubitus ulcers (decubiti), more commonly known as pressure sores, are erosions (ulcers) of various depths that develop from prolonged pressure of skin and underlying tissue against bony prominences.

The underlying origin of decubiti is tissue death from pressure (pressure necrosis) that reduces circulation to the tissue involved (ischemia). Local factors such as denervated skin, poor circulation, and loss of fat cushioning can predispose skin to breakdown. Ulcers may be of various sizes, shapes, and depth. Sometimes a skin ulcer that appears small will have a much larger area of destruction below the skin surface.

Decubiti are classified by size, depth, shape, infection, and type and amount of drainage. Several systems of decubitus classification have been described: the National Pressure Ulcer Advisory Panel classification system; Sessing Scale; Wound Healing Scale; Sussman Wound Healing Scale; Pressure Sore Status Tool; and Pressure Ulcer Scale for Healing. These systems help those planning treatment to categorize the wounds.

The mobility-impaired of any age and those individuals who are not able to alter their position (e.g., individuals who are restrained or heavily sedated) are at greatest risk of developing decubitus ulcers. These ulcers occur in paraplegics who have diminished or absent sensation in the pressure area and in individuals who develop a pressure point from a cast or appliance or during prolonged bed rest recovering from another condition. As little as 2 hours of unrelieved pressure can cause irreversible tissue damage.

Incidence and Prevalence: It is estimated that 1 million Americans develop decubiti annually. The incidence is higher among individuals in chronic care settings. Over 90% of decubitus ulcers occur in elderly, bedridden individuals who have chronic, debilitating disease or who are unable to change position. It is estimated that individuals who are neurologically impaired (e.g., paraplegics) have an annual rate of decubiti of 5% to 8% and a lifetime rate of 25% to 80%; rates in nursing home patients vary from 3% to 33% (Wilhelmi). In the US, over $1 billion each year is spent to treat decubitus ulcers (Revis).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals over age 70 are at highest risk for developing decubiti, accounting for about two-thirds of individuals with this condition (Wilhelmi).

Source: Medical Disability Advisor



Diagnosis

History: Individuals will have a decreased mobility. Individuals may report the appearance of a wound that may or may not be painful. If the wound is infected, the individual may complain of fever.

Physical exam: The exam reveals skin ulceration surrounded by a red area. Further exploration will determine whether underlying tissues are affected. Deeper tissues will be eroded, often with exposure of muscle, tendon, or bone.

Tests: Culture of the wound material is necessary to determine the specific bacteria causing infection (if any). A wound biopsy may be performed to rule out vasculitis and skin cancers. Since decubiti usually form over bony pressure points, an x-ray may be used to evaluate underlying bone to rule out deep bone infection (osteomyelitis). If the x-ray findings are questionable (equivocal), a bone scan (scintigram) may help to evaluate the bony changes.

Source: Medical Disability Advisor



Treatment

Decubitus ulcers are serious lesions that require prompt attention when skin first begins to turn red. With proper bodily turning and relief of pressure, decubitus ulcers can usually be prevented. If the ulcer is small and uninfected, topical drying agents and removal of pressure may be sufficient therapy. Infected wounds and bigger sores require use of systemic antibiotics, surgical excision, plastic surgery, and sometimes hyperbaric oxygen (HBO).

A comprehensive wound care program is usually necessary for these ulcers. This can involve physical therapy (range of motion exercises and hydrotherapy), frequent removal of dead tissue (débridement), wound cleansing, topical medications, and dressing changes with various specialized dressing materials. After healing, special devices to relieve pressure to prevent recurrence are necessary.

Source: Medical Disability Advisor



Prognosis

Uninfected small pressure sores may heal, leaving a scar. The outcome of larger infected ulcers is difficult to predict. Recurrence is a problem, since the situation that caused the lesion usually persists. The recurrence rate is as high as 90% (Revis). Many of these individuals are elderly and debilitated; healing in such individuals is slow and difficult. Younger, healthier individuals with post injury decubiti heal more quickly.

Source: Medical Disability Advisor



Complications

Complications include recurrence, sepsis, abscess, and slow healing. Formation of skin cancers from aggressive squamous cell carcinomas (malignant transformation) can occur in 1% of longstanding ulcers. Other complications include osteomyelitis and autonomic dysreflexia.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

The individual cannot work until healing has occurred. Once healing has occurred, pressure to the area of the previous decubitus must be avoided. For example, if the wound was on the buttocks area (sacrum), the individual may need to sit on a cushion to reduce pressure.

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 denervated skin or skin with poor circulation?
  • Does individual have loss of fat cushioning?
  • Does individual have decreased mobility?
  • Have underlying tissues been affected?
  • Is there deep tissue erosion and exposure of muscle, tendon, or bone?
  • Has the wound been cultured? Was a wound biopsy done?
  • Were an x-ray and bone scan done?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Are individual's decubiti small?
  • Did they respond to drying agents and removal of any pressure?
  • Are individual's decubiti large? Are they infected?
  • Was surgical excision needed? Was plastic surgery necessary?
  • Was hyperbaric oxygen therapy needed?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect the ability to recover?
  • Has individual had a recurrence? Is it infected?

Source: Medical Disability Advisor



References

Cited

Revis, Don R. "Decubitus Ulcers." eMedicine. Eds. Alex Jacocks, et al. 3 Mar. 2004. Medscape. 10 Sep. 2004 <http://emedicine.com/med/topic2709.htm>.

Wilhelmi, Bradon J., and Michael Neumeister. "Pressure Ulcers, Surgical Treatment and Principles." eMedicine. Eds. Albert J. Cram, et al. 25 Jan. 2005. Medscape. 10 Sep. 2004 <http://emedicine.com/plastic/topic462.htm>.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.