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, Radius and Ulna, Distal


Related Terms

  • Barton's Fracture
  • Buckle Fracture
  • Colles Fracture
  • Smith's Fracture
  • Transverse Wrist Fracture
  • Wrist Fracture

Differential Diagnosis

Specialists

  • Hand Surgeon
  • Neurosurgeon
  • Occupational Therapist
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Sports Medicine Physician
  • Vascular Surgeon

Comorbid Conditions

Factors Influencing Duration

Loss of reduction, infection, aseptic necrosis, ligament injury, and concomitant carpal injury would lengthen treatment and recovery. Other factors that could influence disability include age, type of fracture, whether the dominant or nondominant hand is involved, stability of the fracture, and job requirements. Compliance with rehabilitation may influence outcome. Disability will be longer when the fracture is distal, or at the joint (intra-articular).

Medical Codes

ICD-9-CM:
813.21 - Closed Fracture of Shaft of Radius (Alone)
813.22 - Closed Fracture of Shaft of Ulna (Alone)
813.23 - Closed Fracture of Radius with Ulna
813.30 - Open Fracture of Shaft of Radius or Ulna, Unspecified
813.31 - Open Fracture of Radius (Alone)
813.33 - Open Fracture of Radius with Ulna
813.40 - Closed Fracture of Lower End of Forearm, Unspecified
813.41 - Colles Fracture, Closed; Smiths Fracture
813.42 - Fracture, Distal End of Radius, Other (Alone), Closed
813.43 - Fracture, Distal End of Ulna (Alone), Closed
813.44 - Fracture, Radius with Ulna, Lower End, Closed
813.45 - Torus Fracture of Radius (alone)
813.50 - Fracture, Lower End of Forearm, Unspecified, Open
813.51 - Colles Fracture, Open
813.52 - Open Fracture of Distal End of Radius, Other (Alone)
813.53 - Open Fracture of Distal End of Ulna (Alone)
813.54 - Open Fracture of Radius with Ulna, Lower End
813.80 - Closed Fracture of Forearm, Unspecified Part
813.81 - Closed Fracture of Radius (Alone), Unspecified Part
813.82 - Closed Fracture of Ulna (Alone), Unspecified Part
813.83 - Closed Fracture of Radius with Ulna, Unspecified Part
813.90 - Open Fracture of Forearm, Unspecified Part
813.91 - Open Fracture of Radius (Alone), Unspecified Part
813.92 - Open Fracture of Ulna (Alone), Unspecified Part
813.93 - Open Fracture of Radius with Ulna, Unspecified Part

Rehabilitation

Routine referral for formal therapy in cases of a distal radius fracture without functional deficit is not usually necessary; however, patient education and home exercise program instruction may be best accomplished in therapy visits (Hegmann).

Rehabilitation of a fractured distal radius and / or ulna depends on the type of fracture and length of immobilization. The main focus of rehabilitation should emphasize restoring functional 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. Protocols for rehabilitation must be based upon stability of the fracture and fracture management (operative, nonoperative). The treating physician will dictate the protocol of rehabilitation.

The goal of rehabilitation is to decrease pain and to return the individual to full function with a painless wrist. Rehabilitation may be administered by a physical therapist, occupational therapist, or hand therapist. Hand dominance and the involved extremity will greatly influence the individual's degree of disability during recovery. In order to decrease pain and edema, modalities, including heat and cold, may be beneficial (Braddom).

As therapy focuses on returning the individual to full function, range of motion exercises for the adjacent joints may be beneficial unless contraindicated, based on fracture stability. When indicated, range of motion and strengthening exercises should be started at the involved wrist and hand, emphasizing both intrinsic and extrinsic hand muscles. Special attention must be paid to regaining full rotation of the forearm into both palm-up (supination) and palm-down (pronation) positions. Exercise intensity and difficulty should be progressed until full function is achieved. Individuals are guided in performing activities of daily living that correspond with the stage of recovery.

For those requiring supervised rehabilitation, the individual should also be instructed in a home exercise program to be practiced daily and continued independently after the completion of rehabilitation (Wakefield). Occupational therapy may be indicated to assist with activities of daily living if necessary.

Bone healing may occur within 6 to 12 weeks; however, the bone strength and the ability of the bone to sustain a heavy load may take up to several years (Chapman). Once healing has occurred, the individual may resume full activities of daily living. It is Important to inform the individual not to overload the fracture site until the bone has regained its full strength. The treating physician should guide the timing for resumption of heavy work and sports.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistFracture, Radius and Ulna, Distal
Occupational / Hand / Physical TherapistUp to 20 visits within 8 weeks
Surgical
SpecialistFracture, Radius and Ulna, Distal
Occupational / Hand / Physical TherapistUp to 16 visits within 8 weeks
Surgical (minimally displaced radial fractures)
SpecialistFracture, Radius and Ulna, Distal
Occupational / Hand / Physical TherapistUp to 3 visits
Note on Nonsurgical Guidelines: Rehabilitation may not begin until tissue healing, about 6 to 8 weeks after the fracture.
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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