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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.

Bursitis


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Duration Trends | Ability to Work | Maximum Medical Improvement | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
095.7 - Syphilis of Synovium, Tendon, and Bursa; Syphilitic: Bursitis, Synovitis
098.52 - Gonococcal Bursitis
726.33 - Olecranon Bursitis; Bursitis of Elbow
726.5 - Enthesopathy of Hip Region; Bursitis of Hip; Gluteal Tendinitis; Iliac Crest Spur; Psoas Tendinitis; Trochanteric Tendinitis
726.60 - Enthesopathy of knee, Unspecified; Bursitis of Knee NOS
726.61 - Pes Anserinus Tendinitis or Bursitis
726.62 - Tibial Collateral Ligament Bursitis; Pellegrini-Stieda Syndrome
726.63 - Fibular Collateral Ligament Bursitis
726.65 - Prepatellar Bursitis
726.69 - Enthesopathy of Knee, Other; Bursitis: Infrapatellar, Subpatellar
726.71 - Achilles Bursitis or Tendinitis
727.2 - Specific Bursitides Often of Occupational Origin; Beat: Elbow, Hand, Knee; Chronic Crepitant Synovitis of Wrist; Miners Elbow, Knee
727.3 - Other Bursitis Disorders; Bursitis NOS

Related Terms

  • Carpet-layer's Knee
  • Clergyman's Knee
  • Dialysis Elbow
  • Housemaid's Knee
  • Miner's Elbow
  • Student's Elbow
  • Weaver's Bottom

Overview

Image Description:
Bursitis - Two anterior views of the left arm and shoulder show (1) a normal fluid-filled bursa sac within a normal shoulder joint and (2) an inflamed bursa in a shoulder with bursitis, occurring as a result of excessive stress or friction.
Click to see Image

Bursitis is a painful inflammatory condition that affects the small fluid-filled sacs (bursae) that act as cushions that pad pressure points at bones, tendons, and muscles near joints. Bursitis can occur in any of the 150 to 160 bursae in the body but the most commonly involved are those near the shoulder, elbow, and hip joints. Bursitis may be acute or chronic and infectious or non-infectious.

The bursae are lined with synovial cells that secrete a fluid rich in collagen and proteins (synovial fluid). The synovial fluid acts as a lubricant when body parts move. When this fluid becomes infected with bacteria or when the bursa becomes irritated because of excessive pressure or unusual movement, bursitis results. Bursitis also occurs as part of systemic inflammatory diseases such as rheumatoid arthritis. Crystal mineral deposits due to gout or pseudogout may also cause bursitis. Rarely, tuberculosis may result in bursitis.

Source: Medical Disability Advisor



Causation and Known Risk Factors

The cause of bursitis is often unknown (idiopathic). Risk factors for bursitis include having a hobby or a profession that requires repetitive movement or pressure, staphylococcal infection, and advancing age. Use of certain medications, such as corticosteroids and immunosuppressants, can increase risk of infection in the bursae.

Source: Medical Disability Advisor



Diagnosis

History: Individuals with bursitis may report localized tenderness, warmth, swelling (edema), redness (erythema) of the skin, a dull ache or stiffness, worsening of pain with movement or pressure, and limited joint movement. If the bursa is infected, the individual may report systemic symptoms including fever and red streaks leading from the affected area. Questions should be directed to a history of recent trauma directly over the bursae, repetitive activity, or a change in activities.

Physical exam: Visual inspection may reveal edema and erythema. Skin should be inspected for breakdown and possible entry of a foreign object. Touching (palpation) the affected bursa and joint often reveals soft, boggy, or tense tissue depending on the amount of fluid buildup. The bursa will be tender. Motion is limited by pain and edema in acute cases. Chronic cases may show decreased range of motion from adhesions and thickening of the tissue. Muscle weakness may develop from lack of use (disuse atrophy).

Tests: Plain x-rays of the joint and surrounding area generally are not helpful in confirming the diagnosis but are used to rule out other conditions and to detect the calcium deposits often seen in chronic bursitis. It is important to look for changes in the bone from chronic irritation and to rule out bone infection (osteomyelitis). Ultrasound may be used in difficult cases to help confirm bursitis in bursae located deeper within the body, such as those in the hip. The diagnosis can usually be made without magnetic resonance imaging (MRI). A sample of the bursal fluid may be withdrawn using a needle (aspirated) and examined to rule out gout and infection (fluid analysis). If infection is suspected, complete blood count (CBC) and erythrocyte sedimentation rate (ESR) tests may be ordered. If infection is suspected in the adjacent joint, a sample of synovial fluid from the joint may be withdrawn for evaluation (arthrocentesis).

Source: Medical Disability Advisor



Treatment

Treatment for noninfectious acute bursitis consists of rest, ice, compression (e.g., elastic bandage) and elevation of the affected area above the level of the heart (RICE); padding; temporary immobilization of the affected area and/or temporary modification of activities; and pain medication (e.g., nonsteroidal anti-inflammatory drugs [NSAIDs]). In severe cases of noninfectious bursitis, an opioid analgesic may be needed to relieve pain or a corticosteroid (injected locally or oral) may be needed to relieve inflammation.

Chronic noninfectious bursitis is treated in a similar fashion, although immobilization and rest may not be of much help. Large calcium deposits in the shoulder may require removal through irrigation or surgery.

Surgical excision of bursae (bursectomy) may be required if the condition is chronic or recurs frequently. Surgery is performed only if nonoperative (conservative) treatment fails. The type of operation depends on the area affected.

In infectious bursitis, the bursae will be drained and antibiotics started as soon as blood cultures are drawn. Staphylococcus aureus is the most common organism involved (Biundo). Individuals with systemic symptoms (e.g., fever or chills) may require hospitalization and intravenous antibiotics.

Source: Medical Disability Advisor



Prognosis

In general, bursitis responds well to conservative treatment. Most individuals respond to therapy within several days to 4 weeks. In infectious bursitis, the bursae may need to be drained more than once. If the underlying cause of the condition is not corrected, chronic bursitis may develop.

Bursectomy usually yields a satisfactory outcome.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Hand Surgeon
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Rheumatologist
  • Sports Medicine Physician

Source: Medical Disability Advisor



Rehabilitation

The goal of rehabilitation for individuals with bursitis is first to decrease inflammation and pain and second to restore motion and strength to affected joints.

The occupational or physical therapist first instructs the individual how to reduce edema and minimize pressure from the inflamed bursa. Cold therapy (cryotherapy), sometimes in conjunction with electrical stimulation (transcutaneous electric nerve stimulation [TENS]), is then used to control edema and pain. Once acute pain and inflammation decrease, heat therapy can be initiated.

After the pain and edema are sufficiently reduced, passive and active range of motion exercises can help restore full motion to the affected joint and/or limb. The type of exercise program depends on the location of the affected bursa, stage of the inflammation (i.e., recent flare-up or chronic pain), and whether surgery was required.

FREQUENCY OF REHABILITATION VISITS
ClassificationSpecialistTopicVisit
NonsurgicalPhysical or Occupational TherapistBursitisLess than 4 visits
SurgicalPhysical or Occupational TherapistBursitisLess than 6 visits

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Poorly treated or untreated acute bursitis may develop into chronic bursitis. Frozen joint syndrome or permanent limitations of joint mobility are other possible complications. Bursitis caused by gout, arthritis, or chronic overuse may recur if the underlying condition is not treated or corrected.

Source: Medical Disability Advisor



Factors Influencing Duration

Factors that may influence length of disability include the number of bursae affected, site, cause, activity, type of treatment, response to treatment, the individual's understanding of the disease and treatment process and job requirements. The individual must understand the need to restrict the repetitive motion or pressure that caused the bursitis.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

If a certain activity (e.g., repetitive motion) caused the individual's bursitis, the individual may need to limit that activity or use protective measures. For example, kneepads or other cushioning should be used when kneeling during gardening or scrubbing floors. Plumbers, roofers, and carpet layers should wear knee protection. Shoes with appropriate cushioning or ankle pads may be needed. The individual should perform exercises to strengthen the muscles and improve flexibility around the affected bursa. Adequate breaks and changes in activity can reduce stress from repetitive motions and tasks. Using heat or ice treatments after work to relieve any soreness may help reduce the recurrence of bursitis. Anti-inflammatory medications can help relieve pain and inflammation. Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function.

Risk: Recurrence of bursitis depends on the location and the original cause. Infectious bursitis recurrence is dependent on the original bacteria and the response of the bacteria to the antibiotics.

Capacity: Capacity (function) is usually limited by pain, which is dependent on tolerance.

Tolerance: Pain is common until the bursitis is resolved but the level or severity will vary widely. Once the bursa is drained, the pain usually resolves fairly quickly. Surgical excision of bursae (bursectomy) will require the usual wound healing requirements.

Accommodations: Accommodation is the key to return to work. Location and cause will impact the accommodation requirements.

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:

  • Was diagnosis of bursitis confirmed?
  • Does individual have a hobby or a profession that requires repetitive movement or pressure?
  • Does individual have tuberculosis? Rheumatoid arthritis?
  • Did individual have crystal mineral deposits in the bursa from gout or pseudogout?
  • Does individual have a history of taking certain medications, such as corticosteroids and immunosuppressants?
  • Did laboratory examination of synovial fluid aspiration reveal crystals or bacterial infection?
  • Has individual experienced any complications?

Regarding treatment:

  • Did conservative treatment such as rest, ice, elevation, and compression (RICE); immobilization; and pain medication help?
  • Were opioids or oral corticosteroids necessary?
  • Is individual in physical therapy?
  • Was surgery indicated?
  • If bursitis was infectious, were antibiotics given and bursae drained?

Regarding prognosis:

  • Is joint function impaired?
  • Would individual benefit from additional physical therapy to strengthen muscles and re-establish joint's full range of motion?
  • In infectious bursitis, was the area drained until the infectious fluid no longer returned? Could infection still be present?
  • Would individual benefit from additional antibiotic therapy?
  • Were comorbid conditions such as gout, rheumatoid arthritis, or chronic overuse appropriately addressed?

Source: Medical Disability Advisor



References

Cited

Biundo, Joseph J. "Bursitis." The Merck Manual for Healthcare Professionals. Merck and Company, Inc., 2008. The Merck Manual for Healthcare Professionals. Feb. 2013. Merck & Co., Inc. 6 May 2014 <http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/bursa_muscle_and_tendon_disorders/bursitis.html>.

General

Mayo Clinic Staff. "Bursitis." MayoClinic.com. 24 Sep. 2011. Mayo Foundation for Medical Education and Research. 6 May 2014 <http://www.mayoclinic.org/diseases-conditions/bursitis/basics/definition/CON-20015102>.

Source: Medical Disability Advisor