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.

Esophageal Spasm


Related Terms

  • Diffuse Esophageal Spasm
  • Esophageal Dyskinesia
  • Esophagospasm
  • Non-achalasia Motility Disorder
  • Nonspecific Esophageal Motility Disorder
  • Nutcracker Esophagus

Differential Diagnosis

  • Achalasia
  • Chest pain caused by insufficient blood supply to the heart (angina pectoris)

Specialists

  • Cardiovascular Internist
  • Gastroenterologist
  • General Surgeon

Factors Influencing Duration

Factors influencing length of disability include age, physical condition of the individual, or medical conditions that aggravate the condition, such as reflux esophagitis.

Medical Codes

ICD-9-CM:
530.5 - Dyskinesia of Esophagus, Corkscrew Esophagus, Curling Esophagus, Esophagospasm, Spasm of Esophagus

Overview

Esophageal spasm refers to uncoordinated muscle contractions or contractions of excessive amplitude in the tube (esophagus) that leads from the throat to the stomach. The contractions occur repeatedly and are abnormally powerful. This results in a failure to effectively propel food down into the stomach after being swallowed.

There are two main variants of esophageal spasm: diffuse esophageal spasm (with simultaneous or quickly propagated contractions of normal amplitude, but uncoordinated) and hypertensive peristalsis (nutcracker esophagus—coordinated contractions of excessive amplitude). The hypercontractile esophagus (jackhammer esophagus) is an extreme phenotype of hypertensive contractions (with contractions of extreme amplitude and long duration in most of the esophagus) (Malas).

The exact cause of esophageal spasm is unknown; however, risk factors include irritation of the esophagus by acid that washes up from the stomach (reflux esophagitis), obstructions in the esophagus, emotional stress or psychiatric disorders, or other conditions that may affect the normal function of the nervous system (e.g., diabetes, multiple sclerosis, amyotrophic lateral sclerosis). Esophageal spasm may also be related to an inability of the muscles in the lower esophagus to relax (achalasia).

Incidence and Prevalence: In the United States the estimated incidence of esophageal spasm is 1 case per 100,000 population per year (Malas). There are no international incidence or prevalence measures for esophageal spasm possibly because the symptoms are generally not severe or life-threatening and the problem is uncommon. A small percentage (2% to 7%) of patients with cardiac complaints are found to have esophageal spasm (Castell). Approximately half of all patients with systemic scleroderma have GI symptoms, some including esophageal spasm (Kaye-Barrett).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk and causation of esophageal spasm is poorly understood. Esophageal spasm is usually found in individuals with comorbid conditions such as systemic scleroderma, achalasia, acid reflux, HIV, emotional stress or psychiatric disorders, obstructions in the esophagus, cardiovascular problems, and other conditions (Castell; Kaye-Barrett).

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report noncardiac pain in the chest or upper abdomen that can radiate to the back, neck, jaw, and/or arms. Difficulty swallowing (dysphagia), particularly with solids, may also occur. Eating very hot or very cold foods or drinking carbonated beverages may trigger these symptoms. Individuals usually report intermittent symptoms that generally do not worsen over time.

Physical exam: Physical findings are usually normal.

Tests: Diagnostic tests may include motility studies of the esophagus (high-resolution manometry), x-ray studies using barium as the contrast medium (esophagogram), and a procedure in which a fiber-optic viewing tube is passed down through the esophagus that allows visual examination of the inside of the esophagus (endoscopy).

Source: Medical Disability Advisor



Treatment

Esophageal spasm is generally a mild condition and is not life-threatening, although treatment may be frustrating. Muscle spasms may be relieved with calcium-channel antagonist drugs. These drugs decrease the force and duration of esophageal contractions and relieve certain associated symptoms, such as chest pain. Two antidepressants have been shown to be effective in reducing the perception of pain, trazodone and imipramine (Castell).

There is some indication that nitrates, anticholinergics, pneumatic dilatation, botulism toxin injections or phosphodiesterase inhibitors may be beneficial. Repeated injections of botulinum toxin into the esophageal muscle fibers have been shown to relieve symptoms in case series for up to 7 months. Properly designed studies of these treatments have not yet been conducted (Castell). Gastric acid suppression may be beneficial to patients with gastroesophageal reflux. Gastric suppression can be accomplished through the use of antacids or drugs known as proton pump inhibitors. A balloon catheter or cylinders of increasing size may be passed down the esophagus to relax or stretch the muscles (esophageal balloon dilatation or bougienage). Esophagomyotomy or esophagectomy may also be used (Malas).

Simple hot water may improve esophageal clearance and decrease esophageal body contractions. Hot liquids taken with meals are an inexpensive, harmless addition to any treatment plan. Peppermint oil, which is a smooth muscle relaxant, may improve symptoms of esophageal spasm as well.

Nonpharmacologic treatment, such as psychological counseling, is directed at reassuring the individual and may be beneficial. In some cases, psychological counseling has completely alleviated symptoms.

Source: Medical Disability Advisor



Prognosis

Esophageal spasm is harmless (benign) and does not worsen (nonprogressive). Limited data suggests that esophageal spasm will spontaneously improve over time (Castell).

Source: Medical Disability Advisor



Complications

Possible complications of esophageal spasm include choking and aspiration pneumonia.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations are not usually required for esophageal spasm. However, if surgical correction is necessary, the individual may require a leave of absence for recovery.

For more information, refer to "Work Ability and Return to Work," pages 354-355.

Risk: No job meeting OSHA standards would contribute to caustic esophageal changes, progressive cancer or impact webs. GERD (gastroesophageal reflux disease) can be brought out by large late night meals, obesity, alcohol, caffeine, cigarettes, anti-inflammatories, pain, stress and at times chocolate, peppermint, and spearmint. Scleroderma has been associated with exposure to silica dust, vinyl chloride and polyvinyl chloride.

Source: Medical Disability Advisor



Maximum Medical Improvement

2 weeks

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 reflux esophagitis or esophageal obstructions?
  • Is individual experiencing emotional stress or a psychiatric disorder?
  • Does individual have diabetes? Amyotrophic lateral sclerosis? Achalasia?
  • Is there chest or upper abdomen pain? Dysphagia?
  • Does eating hot or cold food or drinking carbonated beverages trigger symptoms? Do symptoms stay the same?
  • Has individual had manometry done? Esophagogram? Endoscopy?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has individual been treated with anticholinergic or calcium-channel antagonists?
  • Has elderly individual been treated with injections of botulinum toxin?
  • Has esophageal dilatation (bougienage) been done?
  • Has balloon dilatation been performed?
  • Did esophagomyotomy become necessary?
  • Has psychological counseling been tried?

Regarding prognosis:

  • Does individual have conditions that may affect ability to recover?
  • Does individual have problems with choking?
  • Has individual ever had aspiration pneumonia?

Source: Medical Disability Advisor



References

Cited

Castell, Donald O. "Diffuse Esophageal Spasm, Nutcracker Esophagus, and Hypertensive Lower Esophageal Sphincter." Uptpdate. Eds. Nicholas J. Tally and Shilpa Grover. 16 May. 2013. Wolters Kluwer Health. 3 Jun. 2013 <http://www.uptodate.com/contents/diffuse-esophageal-spasm-nutcracker-esophagus-and-hypertensive-lower-esophageal-sphincter>.

Kaye-Barrett, Stephanie A. , and Christopher P. Denton. "Gastrointestinal Manifestations of Systemic Sclerosis (Scleroderma)." Uptpdate. Eds. John S. Axford and Paul L. Romain. 7 May. 2012. Wolters Kluwer Health. 3 Jun. 2013 <http://www.uptodate.com/contents/gastrointestinal-manifestations-of-systemic-sclerosis-scleroderma>.

Malas, Ahmed, et al. "Esophageal Spasm." eMedicine. Eds. J. Katz, et al. 19 Apr. 2013. Medscape. 3 Jun. 2013 <http://emedicine.medscape.com/article/174975-overview#a0101>.

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011.

General

Cohen, S., and H. P. Parkman. "Diseases of the Esophagus." Cecil Textbook of Medicine. Eds. Lee Goldman and J. Claude Bennett. 21st ed. Philadelphia: W.B. Saunders, 2000. 665.

Storr, M., et al. "Treatment of Symptomatic Diffuse Esophageal Spasm by Endoscopic Injections of Botulinum Toxin: A Prospective Study with Long-Term Follow-Up." Gastrointestinal Endoscopy 54 6 (2001): 754-759.

Source: Medical Disability Advisor






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