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.

Displacement, Lumbar Intervertebral Disc Without Myelopathy


Related Terms

  • Disc Protrusion
  • Disc Rupture
  • Herniated Disc
  • Herniated Nucleus Pulposus (HNP)
  • Lumbar Disc Herniation
  • Lumbar Disc Prolapse

Differential Diagnosis

Specialists

  • Anesthesiologist
  • Neurosurgeon
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Preventive Medicine Specialist
  • Rheumatologist
  • Sports Medicine Physician

Comorbid Conditions

Factors Influencing Duration

Length of disability depends on the location and number of the affected discs, the severity of the disc disease, the nature of any neurological involvement, the presence or absence of objective sensory loss and/or muscle weakness, the duration of these neurological deficits (acute or chronic), the presence of other sources of pain (such as facet joint arthritis and mechanical instability), the type of treatment, and the individual's response to treatment. Individuals who smoke tend to have more delayed recoveries and poor outcome.

First lumbar discectomies have the best prognosis. Repeat surgeries are associated with greater disability and longer duration.

Medical Codes

ICD-9-CM:
722.10 - Lumbar Intervertebral Disc Displacement without Myelopathy; Lumbago or Sciatica Due to Displacement of Intervertebral Disc; Neuritis or Radiculitis Due to Displacement or Rupture of Lumbar Intervertebral Disc

Diagnosis

History: The individual may report the onset of symptoms with trauma such as a fall, a twist, a blow to the spine, or a strain as the result of lifting or symptoms may develop without a history of trauma. Lower back pain is a common early symptom of a herniated lumbar disc. Pain may radiate from the back to the sacroiliac area and buttocks and down the back of the thigh and calf. Radicular pain consistent with nerve root irritation frequently extends below the knee into the foot (sciatica). Central disc herniation is less common, and may cause, low back pain without radiating leg pain.

The individual may report that pain is aggravated by sitting, standing, walking, or bending and is relieved by lying down with the knees flexed and supported. Coughing or sneezing may also make the pain worse. Individuals may report numbness (sensory loss) over the thigh, leg, or foot. Some individuals report a sensation of pins and needles (paresthesia) in the affected lower extremity. The location of leg pain and leg numbness helps to identify which nerve root is involved.

Rarely, some individuals report pain in the back, legs and numbness in the perineum, with disturbances in bowel or bladder function (sphincter incontinence) indicative of massive disc herniation or extrusion. In this condition, multiple nerve roots, bilaterally, are compressed causing cauda equina syndrome, which is a surgical emergency.

Physical exam: Examination of the individual while standing may reveal flattening of the normal curvature (lordosis) of the lumbar area of the back, slight hip and knee flexion, and a tendency for the individual to avoid putting weight on the affected leg when walking (antalgic gait) if radiculopathy is present. Physical findings vary with acute vs. chronic back pain and disc herniation; for example, paraspinal spasm may be present in acute conditions but diminish significantly as the acute condition subsides. The physician will put pressure on the spine (palpation) and will tap on the affected area (percussion). Spinal motion generally will be decreased if a disc herniation has occurred. Examination of the deep tendon reflexes will be performed. The ankle jerk reflex or the knee jerk reflex is diminished when lumbar disc herniations compress the S1 nerve root, or the L3 or L4 nerve root, respectively.

Sensory examination of the lower limbs may reveal decreased sensation in the distribution of a single lumbar nerve root. Manual muscle testing may demonstrate weakness in muscles principally supplied by a single nerve root. The straight leg-raising test (SLR) is one of the most important tests in the diagnosis of a herniated lumbar disc. With the individual in a reclining position, the examiner raises the affected leg with the knee extended. This will produce radiating leg pain along the path of the sciatic nerve if herniation is present. The test may be confirmed by performing the SLR while dorsiflexing the ankle (Lasègue's sign), which places increased stretch along the nerve. The test is then repeated with the knee bent; in this position, the maneuver should not reproduce sciatic pain. It is not possible to distinguish which nerve root is affected by this test. Another reliable, valid test is the well leg-raising test, in which a SLR of the asymptomatic leg reproduces painful symptoms in the low back and/or symptomatic leg. If leg pain is less intense than back pain, or unusual pain patterns occur, the diagnosis of symptomatic herniated disc is not likely to be confirmed with applicable tests. Differential diagnosis of low back and leg pain is extensive and complex, including referred pain from spinal diseases and diseases of the urogenital, gastrointestinal, vascular, endocrine and nervous systems, as well as tumors, infection, congenital abnormalities and diseases of aging.

Tests: MRI is considered the most useful imaging modality for diagnosing a herniated lumbar disc, although myelography followed by enhanced CT scan may be useful for visualizing subtle lesions. Normal (asymptomatic) individuals frequently have findings of disc herniations on MRI or CT scan, and the findings on an imaging study must correlate exactly with the clinical nerve root syndrome to be meaningful. X-rays are generally helpful if trauma is suspected, and may be used to rule out spinal deformity or other structural lesions. Electromyography and nerve conduction studies may be performed to verify the specific nerve root involved. In questionable cases, these studies may confirm that, despite anatomic disc changes on MRI or myelography, there is no evidence of physiologic nerve root involvement.

Source: Medical Disability Advisor






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