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


Related Terms

  • Bedsore
  • Decubitus
  • Pressure Sore
  • Pressure Ulcer

Specialists

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

Comorbid Conditions

  • Diabetes mellitus
  • Malnutrition
  • Paraplegia
  • Peripheral vascular disease
  • Skin atrophy
  • Spinal cord injury (SCI)

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 decubitus ulcers is tissue death from pressure (pressure necrosis) that reduces circulation to the tissue involved (ischemia). Local factors such as poor circulation, loss of fat cushioning, and denervated skin 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.

Decubitus ulcers 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.

Incidence and Prevalence: An estimated 1 million Americans develop decubitus ulcers annually (Kirman). The incidence is higher among individuals in acute- and chronic-care settings. It is estimated that individuals who are neurologically impaired (e.g., paraplegics) have an annual rate of decubitus ulcers of 7% to 8% and a lifetime rate of 25% to 85% (Kirman). Rates in nursing home patients vary from 2.6% to 24% (Kirman).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals over age 70 are at highest risk for developing decubitus ulcers. This age group accounts for about two-thirds of individuals with this condition (Kirman). Any condition that impairs circulation will increase the risk of developing decubitus ulcers. Mobility-impaired individuals and those who are not able to alter their position (e.g., because they 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.

Source: Medical Disability Advisor



Diagnosis

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

Physical exam: Four stages are described. At stage I there is no skin breakdown; the skin appears red, and does not blanch when touched. Individuals with darker complexion may have skin discoloration. The site may be tender or painful, firm or soft, and warm or cool. At stage II there is damage or loss of the outermost layer of the skin (epidermis) and part of the second layer of the skin (dermis).The wound is shallow and pinkish or red with a blister-like appearance. At stage III, there is a deep crater-like ulcer, usually with exposure of some fat tissue. There may be some yellowish dead tissue in the bottom of the ulcer. At stage IV there is severe loss of tissue, often with exposure of muscle, tendon, or bone.

Tests: Material from the wound may be cultured to determine the specific bacteria causing infection (if any). A wound biopsy may be performed to rule out vasculitis and skin cancers. Since decubitus ulcers 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, relief of pressure, and hygiene, 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). Pain management is important to facilitate repositioning of the individual and care of the wound.

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, application of topical medications, and regular changes of dressings composed of various specialized 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 80% (in individuals with paraplegia) (Kirman). Many of these individuals are elderly and debilitated; healing in such individuals is slow and difficult. Younger, healthier individuals with post-injury decubitus ulcers heal more quickly.

Source: Medical Disability Advisor



Complications

Complications include recurrence, sepsis, abscess, and slow healing. Formation of skin cancers (malignant transformation) such as aggressive squamous cell carcinomas can infrequently occur in longstanding ulcers. Other complications include osteomyelitis and autonomic dysreflexia. Decubitus ulcers are listed as the cause of death in 7% to 8% of deaths in paraplegic individuals (Kirman).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

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

Risk: Risk of recurrence is significant, especially if job tasks require the individual to persistently assume a position that exerts pressure on the site of the ulcer. An individual with a sacral ulcer who drives motor vehicles may need a leave of absence, during which time he or she does not sit on the buttocks for prolonged periods. An individual with a heel ulcer who must perform standing tasks may need temporary job reassignment to more sedentary work.

Capacity: Capacity may be affected during the recovery period if the location of the decubitus ulcer affects job performance. Once recovery is complete, no disability is anticipated if risk factors are adequately addressed.

Tolerance: Tolerance factors include whether the decubitus ulcer is infected and painful, as well as the level of fitness of the affected individual. Tolerance may be improved with pain management and with lifestyle changes to perform aerobic exercise and quit smoking, which will facilitate circulation and healing.

Source: Medical Disability Advisor



Maximum Medical Improvement

60 days.

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 poor circulation to the affected area or denervated skin?
  • Does individual have loss of fat cushioning?
  • Does individual have decreased mobility?
  • Is underlying tissues affected?
  • What stage is the ulcer?
  • Has the wound been cultured? Was a wound biopsy done?
  • Were x-ray and bone scan necessary?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Are individual's decubitus ulcers small?
  • Did they respond to drying agents and removal of any pressure?
  • Are individual's decubitus ulcers 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

Kirman, Christian N. , et al. "Pressure Ulcers and Wound Care." eMedicine. 1 Apr. 2015. Medscape. 22 Apr. 2015 <http://emedicine.medscape.com/article/190115-overview>.

Source: Medical Disability Advisor






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