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.

Fasciotomy


Specialists

  • Hand Surgeon
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Plastic Surgeon

Factors Influencing Duration

Factors include site of treatment, duration and extent of condition, development of necrosis or other complications, individual compliance, the individual's job requirements and ability to modify activities as necessary, and the particular type of physical activity the individual pursues.

If the fasciotomy was done after an acute injury, length of disability depends on recovery from the underlying injury as well as the fasciotomy. Job requirements and inability to adapt to activity changes may prolong disability.

For the forearm, duration for sedentary and light work may be shorter if one-handed work is available (modified duty). For the leg, duration for sedentary and light work may be shorter if work can be performed in a sitting position.

Medical Codes

ICD-9-CM:
82.12 - Fasciotomy of Hand; Division of Fascia of Hand
83.14 - Fasciotomy; Division of Fascia; Division of Iliotibial Band; Fascia Stripping; Release of Volkmanns Contracture by Fasciotomy

Overview

Fasciotomy is a surgical procedure to reduce pressure around muscles, nerves, tendons, or blood vessels. These structures are encased by a thin connective tissue capsule (compartment) that may not be able to expand enough to accommodate swelling inside the compartment (compartment syndrome, or CS). The connective tissue capsule is called a fascia, and fasciotomy is a surgical procedure that cuts the fascia open, usually to relieve pressure. Swelling and increased pressure may result from fractures, damage to blood vessels (vascular injury), crush injuries, or other trauma. When pressure builds within a compartment, the blood supply to the local nerves and muscle is disrupted. If the pressure is not relieved, tissue and nerve damage can result. Individuals who have suffered injuries with extensive soft tissue destruction and fracture involving the lower arm or leg are at greater risk for acute compartment syndrome requiring a fasciotomy because muscle compartments in these locations are smaller and more confining. Fingers may be involved as a result of crushing injuries or snakebites.

CS is usually acute, but in some athletes (long-distance runners) chronic compartment syndrome may develop.

Source: Medical Disability Advisor



Reason for Procedure

Fasciotomy is used to relieve pressure and lessen the likelihood of tissue injury and death. In acute injuries or postfracture care, failure to relieve this pressure may result in neurovascular compromise and, ultimately, in loss of function of the affected limb or extremity. Left untreated, severe compartment syndrome may lead to amputation.

When the pressure in a compartment rises acutely, the situation may be limb-threatening and should be treated as an emergency. In more chronic situations, the pressure in the compartment may rise and fall with activity. If a change in activity or conditioning does not relieve the pain, elective surgery may be performed. In either situation, the surgeon will open the fascia to allow the muscle to expand, increasing circulation and decreasing pressure.

In more chronic conditions in the lower leg caused by overuse, fasciotomy is performed when conservative treatment measures have failed to relieve pain or improve function. Fasciotomy may also be performed for severe cases of heel pain due to plantar fasciitis and in Dupuytren’s contracture, a thickening of the palmar fascia that can lead to contraction of the fingers.

Source: Medical Disability Advisor



How Procedure is Performed

Fasciotomy involves making incisions through the skin over the affected compartment, most commonly in the lower leg or forearm. The incision and dissection are carried down to the fascia surrounding the muscles. Careful attention must be paid to the nerves and blood vessels in the area. Sometimes multiple small incisions are made in the skin and fascia; in other situations, long continuous incisions are made over the entire compartment.

In acute cases, the incisions may be left open and covered with wet sterile dressings, which allow the muscle to swell up and out of the skin. Once the pressure in the compartment is relieved, circulation is restored and swelling decreases; this leads to a decrease in pain and, ultimately, restoration of muscle function. The individual may need additional surgery or surgeries for secondary wound closure and / or skin grafting.

When treating more chronic compartment syndrome, the surgeon leaves the fascia open and closes the overlying layers of tissue and skin with sutures.

Fasciotomy requires general or regional anesthesia and, except in extreme emergencies, is performed in the operating room. Compartment pressure readings are monitored during and after the procedure. Surgeons have performed a fasciotomy on the sole of the foot (plantar fasciotomy) using an endoscope (endoscopic plantar fasciotomy; Barrett procedure) and experienced mixed, but some highly favorable results (Saxena; Murphy).

Source: Medical Disability Advisor



Prognosis

In cases of acute compartment syndrome, treatment with fasciotomy within 12 hours of onset of symptoms results in retention of normal limb function in 68% of cases. Delay of fasciotomy for more than 12 hours after onset of acute symptoms reduces retention of normal function to 8% (Wallace, “Compartment Syndrome: Upper Extremity”). Delayed correction of CS for as little as 2 to 4 days may result in permanent damage. Left untreated, CS may result in tissue death (necrosis) and limb amputation. Return to normal function after a successful fasciotomy usually takes 2 to 3 months. Despite early and aggressive fasciotomy, nearly 20% of individuals may retain some motor or sensory deficit at a 1-year follow-up exam (Wallace, “Compartment Syndrome: Lower Extremity”).

Source: Medical Disability Advisor



Rehabilitation

Fasciotomy is a surgical treatment for acute or chronic compartment syndromes (Brennan; Tiwari). The rehabilitation treatment depends on the cause of the compartment syndrome, as well as on the integrity and condition of the soft tissue and wound following surgery (Barr; Seiler). Any factors that may have contributed to the cause of the compartment syndrome must be addressed, including biomechanical abnormalities of the limb during work or sports activities, poor flexibility, and muscular weakness (Barr),

If indicated, the therapist begins with gentle active range of motion of the adjacent joints. During the early phase of therapy, exercises must be taught and progressed very gradually so as not to compromise the blood supply or healing of the involved soft tissue.

Once the soft tissue is healed and the wound is closed, range of motion exercises are continued, and gentle strengthening exercises can be initiated, based on the physician's protocol. If these exercises are well tolerated, the therapist includes strengthening exercises of greater difficulty until full strength of the involved body part is restored. When indicated, coordination and endurance exercise can be added.

The therapist must be mindful of the underlying etiology, remaining observant for a recurrence of the preoperative symptoms and instructing the individual to do the same. If such symptoms are noted, all exercise must be discontinued and reported to the physician immediately. Before discharge from therapy, the individual should receive instruction in a home exercise program to complement supervised rehabilitation and to be continued independently until full function returns.

FREQUENCY OF REHABILITATION VISITS
Surgical
SpecialistFasciotomy
Occupational / Hand / Physical TherapistUp to 12 visits within 6 weeks
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Complications

Possible complications of the procedure include skin sloughing; infection; nerve, blood vessel, and muscle damage; and scarring. Contractures of the skin and soft tissue may result from either the initial procedure or secondary wound closure. If skin grafting is required, there could be infection, scarring, and contracture at the donor site. Muscle weakness may also occur. Compartment syndrome may recur in as many as 3% to 20% of cases after fasciotomy (Barr). Causes include excessive formation of scar tissue and inadequate initial release of the fascia.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals who have undergone lower extremity fasciotomy and have jobs that require long periods of standing or walking may need to be reassigned to more sedentary duties. Individuals who have undergone upper extremity fasciotomy may need to avoid repetitive gripping, twisting, lifting, and carrying duties that require extensive use of the arm or wrist. These individuals may need to be temporarily or permanently assigned to other duties. Postoperative reconditioning of the affected muscle groups is important.

Source: Medical Disability Advisor



References

Cited

Barr, Karen B. "Chapter 58 - Compartment Syndrome." Essentials of Physical Medicine and Rehabilitation. Eds. Walter R. Frontera, Julie K. Silver, and Thomas Rizzo. 2nd ed. Philadelphia: Saunders, Elsevier, 2008.

Brennan, F. H., and S. F. Kane. "Diagnosis, Treatment Options, and Rehabilitation of Chronic Lower Leg Exertional Compartment Syndrome." Current Sports Medicine Reports 2 5 (2003): 247-250. National Center for Biotechnology Information. National Library of Medicine. 5 Jan. 2009 <PMID: 12959704>.

Murphy, G. Andrew. "Disorders of Tendons and Fascia." Campbell's Operative Orthopaedics. Eds. S. Terry Canale and James H. Beaty. 11th ed. Philadelphia: Mosby Elsevier, 2008.

Saxena, A. "Uniportal Endoscopic Plantar Fasciotomy: A Prospective Study on Athletic Patients." Foot & Ankle International 25 12 (2004): 882-889.

Seiler, J. G., P. J. Casey, and S. H. Binford. "Compartment Syndromes of the Upper Extremity." Journal of the Southern Orthopaedic Association 9 4 (2000): 233-247. National Center for Biotechnology Information. National Library of Medicine. 5 Jan. 2009 <PMID: 12141186>.

Tiwari, A., et al. "Acute Compartment Syndromes." British Journal of Oral & Maxillofacial Surgery 89 4 (2002): 397-412. National Center for Biotechnology Information. National Library of Medicine. 5 Jan. 2009 <PMID: 11952578>.

Wallace, Stephen, and Doug Smith. "Compartment Syndrome, Upper Extremity." eMedicine. Eds. Jeffrey L. Visotsky, et al. 27 Jul. 2007. Medscape. 5 Jan. 2009 <http://emedicine.com/orthoped/topic55.htm>.

Wallace, Stephen, et al. "Compartment Syndrome, Lower Extremity." eMedicine. 14 Nov. 2007. Medscape. 5 Jan. 2009 <http://emedicine.com/orthoped/topic596.htm>.

General

Blaisdell, F. W. "The Pathophysiology of Skeletal Muscle Ischemia and the Reperfusion Syndrome: A Review." Cardiovascular Surgery 10 6 (2002): 620-630. National Center for Biotechnology Information. National Library of Medicine. 5 Jan. 2009 <PMID: 12453699>.

Brennan, F. H., and S. F. Kane. "Diagnosis, Treatment Options, and Rehabilitation of Chronic Lower Leg Exertional Compartment Syndrome." Current Sports Medicine Reports 2 5 (2003): 247-250. National Center for Biotechnology Information. National Library of Medicine. 5 Jan. 2009 <PMID: 12959704>.

Source: Medical Disability Advisor






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