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.

Head Injury, Superficial


Related Terms

  • Minor Head Injury

Differential Diagnosis

  • Bleeding into the brain (hematoma)
  • Concussion
  • Facial fracture(s)
  • Penetrating injury
  • Skull fracture

Specialists

  • Emergency Medicine Physician
  • Neurologist
  • Neurosurgeon

Comorbid Conditions

Factors Influencing Duration

The location, severity, and extent of the injury influence the length of disability.

Medical Codes

ICD-9-CM:
910.0 - Superficial Injury of Face, Neck, and Scalp Except Eye, Abrasion or Friction Burn without Mention of Infection
910.1 - Superficial Injury of Face, Neck, and Scalp Except Eye, Abrasion or Friction Burn, Infected
910.2 - Superficial Injury of Face, Neck, and Scalp Except Eye, Blister without Mention of Infection
910.3 - Superficial Injury of Face, Neck, and Scalp Except Eye, Blister, Infected
910.4 - Superficial Injury of Face, Neck, and Scalp Except Eye, Insect Bite, Nonvenomous, without Mention of Infection
910.5 - Superficial Injury of Face, Neck, and Scalp Except Eye, Insect Bite, Nonvenomous, Infected
910.6 - Superficial Injury of Face, Neck, and Scalp Except Eye, Superficial Foreign Body (Splinter) without Major Open Wound and without Mention of Infection
910.7 - Superficial Injury of Face, Neck, and Scalp Except Eye, Superficial Foreign Body (Splinter) without Major Open Wound, Infected
910.8 - Other and Unspecified Superficial Injury of Face, Neck, and Scalp Except Eye without Mention of Infection
910.9 - Superficial Injury of Face, Neck, and Scalp, Infected, Other and Unspecified
920 - Contusion of Face, Scalp, and Neck Except Eye(s), including Cheek, Ear (Auricle), Gum, Lip, Mandibular Joint Area, Nose, Throat
959.01 - Head Injury, Unspecified

Overview

A superficial head injury is an injury to the head that does not involve damage to the skull or brain, as evidenced by imaging studies such as x-ray, computed tomography (CT), or magnetic resonance imaging (MRI). Injuries can include scrapes, abrasions, cuts, lacerations, bruises (contusions), burns, or animal bites. The formal definition of minor head injury is loss of consciousness for less than 10 minutes, no amnesia, no coma, no skull fracture, no new neurological damage, and no detected brain injury. All head injuries are classified by the Glasgow Coma Scale (GCS). A minor head injury is given the score of 14 to 15, whereas a moderate injury has a score of 9 to 13, and a severe injury has a score of 8 or less (Biros).

Most individuals in the US experience a minor injury to their head at least once in their lifetime; injury may be from minor traffic accidents, sports injuries, falls, criminal violence, or accidents at work or home. Airbags prevent serious head injury in vehicle crashes, but can themselves cause minor injuries to the head, neck, and upper body. Helmets worn while riding bicycles, motorcycles, or horses and in sporting activity can prevent head trauma.

Incidence and Prevalence: Approximately 1.2 million cases of minor head trauma are reported in the US each year (Biros).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Children under the age of 5 years and adults over the age of 85 years are at greatest risk for minor head injuries. Automobile drivers are at increased risk for this injury, as are young males and athletes, particularly those involved in contact sports (e.g., boxing, martial arts, football, rugby).

Source: Medical Disability Advisor



Diagnosis

History: The individual may report a recent bite, bump, cut, or scrape to the head, causing minor bleeding that stops within a few minutes. Most frequently individuals will report headache; however, superficial head injuries should not include the symptoms of persistent or severe headache; blurred or double vision; difficulty walking or maintaining balance; lethargy or inability to arouse from sleep; blurred speech; numbness or loss of sensation; nausea or vomiting; bleeding; or drainage of fluid from the nose, mouth, or ear. These symptoms are suggestive of more serious head injuries, and since 50% of patients with concussions are misdiagnosed as having minor head injuries, a thorough history is essential (Biros).

Physical exam: In addition to a physical exam appropriate for the specific superficial injury, all individuals need a neurological evaluation; both an initial consultation with a neurologist and a follow up in 1 to 2 weeks may be arranged. Complete neurologic examinations should be done if there are any suggestions of neurologic problems and should be performed to rule out a more severe head injury unless the wound is very superficial. Screening neurologic examinations may be done for very minor injuries; pulse should be above 50 beats per minute in adults, pupils should be of equal in size and react equally to light, and the individual must be totally oriented (person, place, and time), but may report a mild headache, dizziness, or lightheadedness (Maiese).

Tests: Skull x-ray rules out skull fractures. CT scanning rules out delayed bleeding into the brain (hematoma), and MRI determines the degree of brain injury. These tests are generally only required if the individual experienced loss of consciousness, memory loss concerning the traumatic event, or neurologic signs that indicate the head injury is more serious (Biros). Older individuals on anticoagulant therapy may need to be screened more thoroughly for possible bleeding into the brain after a minor head injury (Maiese).

Source: Medical Disability Advisor



Treatment

Minor head injuries as minor scrapes and injuries are treated using ice packs, bandages, and mild over-the-counter pain relievers (analgesics); nonsteroidal anti-inflammatory medications are avoided as they may worsen bleeding (Maiese). Cuts deeper than 0.04 inches (1 mm) may be closed with stitches after the individual is given a topical anesthetic. Individual requiring stitches to close a wound will need to schedule a visit to a general practitioner to have the stitches removed after 7 to 10 days. A superficial animal bite additionally is treated with a course of antibiotics. The individual is observed for development of symptoms associated with more serious head injury, typically over 4 to 6 hours (Biros). Individuals may be admitted into the hospital for overnight observation if they start showing signs of concussion or brain injury after an initial diagnosis of minor head injury.

Source: Medical Disability Advisor



Prognosis

Full recovery is expected within a few days for an individual with a superficial head injury that needs no special treatment. Wounds requiring stitches should heal within 10 days, depending on the depth of injury. During the follow-up visit at 7 to 10 days for stitches removal the diagnosis will either be confirmed, and the individual can return to all his or her duties, or the diagnosis will be changed to something more serious. A changed diagnosis can lengthen the disability.

Approximately 25% of individuals with minor head injuries do not seek care (Biros). However, it is estimated that up to 5% of individuals with a score of 15 in the GCS will have an abnormal CT scan that indicates a more serious traumatic brain injury has occurred (Biros).

Source: Medical Disability Advisor



Complications

Complications of superficial head injuries are uncommon and generally involve problems of healing of wounds. Less than 1% of individuals with minor head injury will need surgical intervention for complications (Biros).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

A superficial head injury should not require any work restrictions or accommodations.

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 the diagnosis of superficial head injury confirmed?
  • Did individual experience a more serious injury such as a skull or facial fracture, concussion, penetrating injury, or hematoma?
  • Did MRI and CT rule out brain injury?
  • If individual is receiving anticoagulant therapy, were tests performed to rule out intracranial bleeding?
  • Did a neurologist examine individual?
  • Has follow up in 1 to 2 weeks of injury been scheduled with neurologist?

Regarding treatment:

  • Did individual follow the prescribed therapy?
  • Have there been any complications (such as a wound infection) despite treatment? If so, what additional treatment has been required?
  • Was individual admitted for observation? Was diagnosis updated to a more serious or more specific diagnosis?

Regarding prognosis:

  • Has diagnosis been revised?
  • Has individual had an additional head injury since the one causing the disability?
  • Since the disability, has individual reported blackouts or other symptoms indicating postconcussive syndrome?

Source: Medical Disability Advisor



References

Cited

Brios, Michelle H., and William G. Heegaard. "Chapter 38: Head Injuries." Rosen's Emergency Medicine. Eds. John A. Marx, et al. 7th ed. Mosby, Inc., 2009. MD Consult. Elsevier, Inc. 27 Oct. 2009 <http://www.mdconsult.com/das/book/body/167476838-6/908588401/2084/223.html#4-u1.0-B978-0-323-05472-0.00038-4--s0315_931>.

Maiese, Kenneth. "Head Injuries." The Merck Manual Home Edition. Merck and Company, Inc., 2008. The Merck Manuals Online Medical Library. Jan. 2008. Merck & Co., Inc. 27 Oct. 2009 <http://www.merck.com/mmhe/sec06/ch087/ch087a.html>.

Source: Medical Disability Advisor






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