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.

Fracture, Fingers and Thumb


Related Terms

  • Broken Finger
  • Broken Thumb
  • Fractures of the Phalanges of Hand
  • Phalangeal Fractures

Differential Diagnosis

Specialists

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

Comorbid Conditions

Factors Influencing Duration

Disability is dependent on whether the dominant or nondominant hand is involved, work requirements, the digit/digits involved, and the presence of complications. Since the thumb is used in most hand functions, and since many hand functions can be done using only some of the fingers, thumb fractures are much more likely to limit hand function. Fractures in multiple digits typically involve much higher forces (more violent injuries) and thus have more soft tissue damage. Thus function is more limited both by more digits being involved, and more severe injury in each digit.

Medical Codes

ICD-9-CM:
816 - Fracture, Phalanges of Hand (One or More)
816.0 - Fracture, Phalanges of Hand (One or More), Closed
816.00 - Fracture, Phalanx or Phalanges, Unspecified, Closed
816.01 - Fracture, Middle or Proximal Phalanx or Phalanges, Closed
816.02 - Fracture, Distal Phalanx or Phalanges, Closed
816.03 - Fracture, Phalanges of Hand, Multiple Sites, Closed
816.1 - Fracture, Phalanges of Hand (One or More), Open
816.10 - Fracture, Phalanx or Phalanges, Unspecified, Open
816.11 - Fracture, Middle or Proximal Phalanx or Phalanges, Open
816.12 - Fracture, Distal Phalanx or Phalanges, Open
816.13 - Fracture, Phalanges of Hand, Multiple Sites, Open

Rehabilitation

Individuals who sustain fractures of the fingers or thumb may require outpatient therapy. In such cases, rehabilitation can be administered by a physical therapist, occupational therapist, or hand therapist. The duration of treatment is related to the location, type of fracture, soft tissue injury, and length of immobilization. Protocols for rehabilitation must be based upon stability of the fracture and fracture management (operative, nonoperative). Hand dominance and the involved extremity will greatly influence the patient's degree of disability. The main focus of rehabilitation should emphasize restoring full range of motion and strength while maintaining independence in as many activities of daily living as possible. Resumption of pre-injury status is the goal with consideration of any residual deficit (Jupiter; Krop).

The goal of rehabilitation is to decrease pain and restore function. Modalities such as cold packs may be beneficial for controlling pain and reducing edema. Special attention should be paid to preserve full function of the uninvolved fingers, especially if the dominant hand is involved, provided this is not contraindicated by fracture stability. When indicated, the therapist will initiate range of motion and strengthening exercises of the involved digits, paying special attention to both the intrinsic and extrinsic hand muscles (these are the small muscle between the fingers located in the palm) (Feehan). Emphasis must be placed on regaining full range of motion at each joint. Most fractures require only limited immobilization, and early return to movement is encouraged (Browner). Simple closed fractures may do better with range of motion beginning within 21 days of the initial injury as long as the fracture site is protected (Brault). Tendon gliding exercises should be included to reduce the chance of scarring around nearby tendons that may cause loss of motion (Hardy; Meals). Mild contractures can usually be dealt with by increased hand therapy (Netscher). Fractures involving joints, multiple fractures, and spiral or oblique fractures are more complex and will usually require increased therapy. Exercise intensity and difficulty should be progressed until full function is achieved (Krop).

Occupational therapy may be indicated to assist with activities of daily living. Return to activities of daily living and work as tolerated is encouraged as part of therapy (Calandruccio).

If a finger or thumb fracture is operatively managed, the protocol of rehabilitation will be guided by the treating physician. In most cases hardware removal may be required after the initial surgery.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistFracture, Fingers and Thumb
Occupational / Hand / Physical TherapistUp to 8 visits within 4 weeks
Surgical
SpecialistFracture, Fingers and Thumb
Occupational / Hand / Physical TherapistUp to 10 visits within 4 weeks
Surgical (complex/multiple fractures)
SpecialistFracture, Fingers and Thumb
Occupational / Hand / Physical TherapistUp to 18 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






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