Sign-in
(your email):
(case sensitive):



 
 

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.

Hernia, Incisional


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Duration Trends | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
551.21 - Incisional Hernia with Gangrene
552.21 - Incisional, with Obstruction
553.21 - Hernia, Incisional, without Mention of Obstruction or Gangrene

Related Terms

  • Ventral Hernia

Overview

Image Description:
Hernia, Incisional - An outline of the torso shows a midline incision in the abdomen below the navel. A profile of the torso reveals the intestines protruding into the abdominal wall at the incision line of a former abdominal surgery. The normal peritoneum of the abdominal wall is shown below the hernia.
Click to see Image

An incisional hernia is the protrusion of abdominal organs through a weakened area in the abdominal wall at the incision site of a previous abdominal surgery with a well-healed skin wound. Although it is a treatment-related (iatrogenic) hernia, certain lifestyle factors and physical conditions may predispose individuals to develop of this type of hernia.

Incisional hernia results from the weakened condition of the superficial sheet of connective tissue that covers and joins the rectus abdominis muscles (fascial tissue called linea alba) along the surgical incision line. Weakness occurs most commonly following lower midline abdominal surgeries (34%) (Deveney). Herniation is more likely in vertical incisions than in horizontal (transverse) incisions. Normal tissue is replaced by scar tissue along the incision as part of the healing process, but scar tissue is not as strong and is more subject to tears. When the scar tissue thins or stretches, it weakens and may rupture when intra-abdominal pressure comes to bear upon it. A number of things can create this pressure, including intense coughing, straining due to constipation, pregnancy, obesity, vomiting, or physical activity involving the abdomen. Diseases such as syphilis, diabetes, tuberculosis, and cancer, may predispose an individual to incisional hernia following surgery. The material used to close the incision also may contribute to incisional hernia, as may poor wound closure technique.

An incisional hernia is not to be confused with a surgical wound dehiscence; in an incisional hernia, the skin is healthy and has healed. Dehiscence can occur following abdominal surgery if the incision site becomes infected. This can lead to accumulation of fluid (edema) and softening of the tissues held together by the stitches (sutures). As a result, the tissue weakens, and the sutures cut through the tissue, including the skin. The wound eventually reopens (dehiscence), allowing the abdominal organs to bulge through the incision site.

Incidence and Prevalence: About 2% to 10% of the over one million abdominal surgeries performed each year result in incisional hernia (Nicks).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors include weakened tissue integrity common in advanced age or debility, inadequate nutrition, a low-fiber diet that contributes to constipation and straining, obesity, pregnancy, and any action that increases pressure in the abdominal cavity. Gender and race are not risk factors for this type of hernia.

Source: Medical Disability Advisor



Diagnosis

History: The individual may complain of pain in the area near incision from a previous abdominal operation. In addition, a bulge may appear in the abdomen near the incisional site, accompanied by a dull, aching sensation. Swelling may be the only noticeable condition, with no other symptoms reported. The onset of an incisional hernia may be sudden or, more commonly, may happen in a delayed, insidious manner. The appearance of an incisional hernia may or may not coincide with heavy lifting or abdominal straining. If strangulation of the intestine has occurred, nausea, vomiting, and other symptoms of bowel obstruction may be reported.

Physical exam: Examination is performed with the patient lying down and standing. An incisional hernia usually can be identified from bulging or weakness in the area of a surgical incision. The extent of the herniation (fascial defect and identification of hernial sac) usually can be felt by hand (palpated). In general, the mass that protrudes through the incision site can be pushed back into the abdominal cavity with a finger (reducible). If pain and tenderness continue after the hernia is manually reduced, strangulation of the hernia is a possibility. Fever or toxic appearance may be present if strangulation or perforation has occurred.

Tests: Diagnosis ordinarily presents no difficulties, and tests may not be needed. In some cases, computed tomography (CT), ultrasound, or introduction of a contrast material into the area of herniation and subsequent x-ray analysis (herniography), can visualize an incisional hernia.

Source: Medical Disability Advisor



Treatment

Incisional hernias require surgical repair. Closing the defect in the abdominal wall with sutures may repair small hernias. Large incisional hernias often require more extensive treatment using one of many different open surgical repairs for incisional hernia that can be are performed (e.g., Babcock, Koontz technique), depending on the location, severity of the defect, and the surgeon's preference. The incision sometimes is closed using a patch of polypropylene mesh material as added support for weakened fascia. As an alternative to open surgery, incisional repair with mesh implantation may be done using a lighted, flexible fiberoptic device (laparoscope) that allows visualization of the wound and inner abdomen. If the individual does not want surgery or is a poor risk for the procedure, manual reduction may be performed followed by use of an elastic corset to support the weakened area and control symptoms.

Source: Medical Disability Advisor



Prognosis

The outcome for open surgical treatment of incisional hernia depends primarily on the size of the hernia, the organ that has protruded through the weakened fascia, and the tension that remains on the incision line following surgery. Small incisional hernias recur 2% to 5% of the time; medium-sized hernias recur 5% to 15% of the time; and large hernias may recur up to 50% of the time (Deveney 765). Subsequent repair incisional hernias results in consistently poor outcomes due to continued weakening of the abdominal wall. Recurrence rates seem to be much lower if a polypropylene mesh support is implanted during surgery, but mesh detachment is also implicated as a cause of recurrence.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • General Surgeon

Source: Medical Disability Advisor



Rehabilitation

Following abdominal surgery, exercises to prevent pulmonary complications, reduce postoperative pain, and speed recovery, are necessary. Moving and walking on the day after surgery is recommended. The individual should not lift heavy weights or engage in any exercise that may place strain on the incision area for at least 6 weeks after surgery. Ongoing exercise therapy may be required, however, to educate the individual about proper body mechanics.

Although postural and biomechanical training can take up to 6 months, the individual may return to work without complications 2 to 3 weeks after surgery, so long as heavy lifting is avoided.

Since recurrent herniation often is caused by excess weight, the individual should be encouraged to maintain optimal body weight through appropriate lifestyle habits.

Source: Medical Disability Advisor



Comorbid Conditions

  • Cancer
  • Diabetes
  • Obesity
  • Pulmonary conditions that cause forceful coughing
  • Syphilis
  • Tuberculosis

Source: Medical Disability Advisor



Complications

The intestine and connective tissue bulging through the incision site may become strangulated, leading to obstruction of the intestine. Tissue death (necrosis) and decay (gangrene) can occur and may lead to production of toxic substances by bacteria in the tissue (toxemia). Drains placed in the incision line may interfere with effective healing. Open procedures carry risk of abnormal reactions to anesthesia, bleeding, and infection.

Source: Medical Disability Advisor



Factors Influencing Duration

Factors that may influence the length of disability include the location, size, and severity of the hernia, the surgical procedure used, the individual’s health status, response to treatment, the presence and nature of complications, and the individual's job requirements. Individuals over age 35 tend to have a longer period of disability. Open surgery may also increase duration.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions on lifting, climbing, and strenuous physical activity are expected for several weeks following surgical repair of incisional hernia. After full recovery, the individual should be able to perform work with no disability.

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:

  • Did individual have abdominal surgery that involved a lower midline incision?
  • Did wound heal inadequately?
  • Did individual have a wound infection?
  • What material was used to close the wound?
  • Is individual older? Debilitated? Malnourished?
  • Does individual do heavy lifting? Strain with bowel movements?
  • Did individual have pain in an incision? Was a bulge present? Is it reducible?
  • Was the onset gradual or sudden?
  • Were CT scan, ultrasound, or herniography done?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has surgery been done? Open or laparoscopic?
  • Was mesh used to support the weakened fascia?
  • Was surgery effective?
  • If individual refused surgery, was manual reduction of the hernia possible?
  • Does individual use a corset?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect the ability to recover?
  • Was necrosis or gangrene present? Was it treated?
  • Was this repeat surgery for a recurrent hernia?
  • Has incisional hernia recurred after this surgery?

Source: Medical Disability Advisor



References

Cited

Deveney, Karen E. "Hernias and Other Lesions of the Abdominal Wall." Current Surgical Diagnosis & Treatment. Eds. K. Edmondson and K. Davis. 12th ed. McGraw-Hill, 2006. 765-779.

Nicks, Bret A., and Kim Askew. "Hernias." eMedicine. Eds. Richard Lavely, et al. 4 Nov. 2008. Medscape. 28 Oct. 2009 <http://emedicine.medscape.com/article/775630-overview>.

Source: Medical Disability Advisor