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, Inguinal and Femoral


Related Terms

  • Crural Hernia
  • Enterocele
  • Femoral Herniation
  • Groin Hernia
  • Inguinal Herniation

Differential Diagnosis

Specialists

  • General Surgeon

Comorbid Conditions

Factors Influencing Duration

Factors that may influence the length of disability include type and severity of the hernia, surgical procedure used to repair the hernia, presence and nature of complications, and individual's job requirements.

Medical Codes

ICD-9-CM:
550.00 - Inguinal Hernia, Unilateral or Unspecified, with Gangrene
550.01 - Inguinal Hernia, Unilateral with Gangrene, Recurrent
550.02 - Inguinal Hernia, Bilateral with Gangrene
550.03 - Inguinal Hernia, Bilateral with Gangrene, Recurrent
550.10 - Inguinal Hernia, Unilateral with Obstruction, without Mention of Gangrene
550.11 - Inguinal Hernia with Obstruction, without Mention of Gangrene, Recurrent Unilateral or Unspecified
550.12 - Inguinal Hernia, Bilateral with Obstruction, without Mention of Gangrene
550.13 - Inguinal Hernia, Bilateral without Gangrene, Recurrent; with Obstruction
550.90 - Inguinal Hernia, Unilateral without Mention of Obstruction or Gangrene
550.91 - Inguinal Hernia, Unilateral without Mention of Obstruction or Gangrene
550.92 - Inguinal Hernia, Bilateral without Mention of Obstruction or Gangrene
550.93 - Inguinal Hernia, Bilateral without Mention of Obstruction or Gangrene
551.00 - Femoral Hernia with Gangrene, Unilateral or Unspecified (Not Specified as Recurrent)
551.01 - Femoral Hernia with Gangrene, Unilateral or Unspecified, Recurrent
551.02 - Femoral Hernia with Gangrene, Bilateral (Not Specified as Recurrent)
551.03 - Femoral Hernia with Gangrene, Bilateral, Recurrent
552.00 - Femoral Hernia with Obstruction, Unilateral or Unspecified (Not Specified as Recurrent)
552.01 - Femoral Hernia with Obstruction, Unilateral or Unspecified, Recurrent
552.02 - Femoral Hernia with Obstruction, Bilateral (Not Specified as Recurrent)
552.03 - Femoral Hernia with Obstruction, Bilateral, Recurrent
553.00 - Femoral Hernia, Unilateral or Unspecified
553.01 - Femoral Hernia, Unilateral or Unspecified, Recurrent
553.02 - Femoral Hernia, Bilateral
553.03 - Femoral Hernia, Bilateral, Recurrent

Overview

© Reed Group
An abdominal hernia is the protrusion of tissue (often a portion of the intestine) through the abdominal wall. Abdominal hernias may originate in the groin (where the lower abdomen meets the thigh) due to a weakness in the muscular wall, increased abdominal pressure, obesity, lifting, or a combination of factors. Three types of hernia occur in the groin: femoral, direct inguinal, and indirect inguinal.

In a femoral hernia, part of the intestines push the membrane that lines the abdomen (peritoneum) downward through the opening where the femoral artery and vein pass into the thigh (femoral canal). Chronic increases in abdominal pressure play a role in the development of this type of hernia, and pregnancy may be a factor in the development of femoral hernias in women.

A direct inguinal hernia passes through the abdominal wall in the groin (rather than through a canal) in an area of muscular weakness. The abdominal weakening usually occurs from a combination of aging and increased abdominal pressure that can result from chronic coughing or straining.

Indirect inguinal hernias take an indirect course through the anterior abdominal wall. They occur where the spermatic cord (in males) or a small fibrous ligament (in females) runs through an opening in the lower abdominal wall (inguinal canal). During development, the canal may not close tightly enough around the spermatic cord or the ligament, and increased pressure inside the abdomen may force the inguinal ring to open. A hernia sac containing the peritoneum, as well as a portion of the intestines, protrudes into and through the inguinal canal. As the hernia sac enlarges, it may extend into the scrotum (males) or into the groin (females).

Each of these three types of hernias can be described as reducible or incarcerated. A reducible hernia is one that can be returned to the abdomen, either spontaneously or by manipulation using a finger. An incarcerated hernia cannot be reduced, and the hernia cannot be pushed back into the abdominal cavity. The blood supply to an incarcerated hernia may be cut off (strangulation), leading to tissue death (necrosis).

Incidence and Prevalence: About 770,000 inguinal and femoral hernia repairs are done annually in the US (Nicks). Of these, about 90% are done in men. Inguinal hernias are the most common hernias in both men and women and account for approximately 75% of groin hernias (Nicks). About two-thirds of these are indirect and one-third are direct (Nicks). The lifetime incidence of inguinal hernia is about 25% in men and 2% in women. Femoral hernias are much less common, comprising about 3% of all hernias, and occur almost exclusively in women (Nicks).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Any condition that increases pressure in the abdomen (such as extreme obesity, chronic or excessive cough, chronic obstructive pulmonary disease [COPD], straining during urination or bowel movements, accumulation of abdominal fluid [ascites], heavy lifting, or multiple pregnancies) may contribute to the development of a hernia. Risk is also higher in males , those with cystic fibrosis or chronic constipation, and those whose job requires standing most of the time or doing heavy physical work. Premature birth and a personal or family history of hernias may be predisposing factors in some individuals.

Source: Medical Disability Advisor



Diagnosis

History: A thorough medical history should be obtained, including underlying medical conditions (chronic cough, straining with urination or bowel movements, constipation, symptoms of prostate disease, liver disease, obesity), medications, occupational history (job requirements regarding lifting) and family history. Many inguinal and femoral hernias are not associated with any symptoms (asymptomatic) and are discovered only on routine medical examination. Individuals with asymptomatic hernias may notice a fullness or swelling in the left or right groin area that enlarges when the individual stands or strains. The fullness or swelling may produce a burning, gurgling, or aching sensation. The individual may associate onset of the swelling with an episode of heavy lifting. An incarcerated hernia may produce steady pain or discomfort that increases with straining or coughing. If nausea, vomiting, and symptoms of bowel obstruction are present, strangulation should be considered. Femoral hernias may manifest with pain in the inner thigh in addition to pain in the groin.

Physical exam: Vital signs (temperature, pulse, respiration, blood pressure) should be recorded; fever may suggest an incarcerated hernia. Physical examination is usually performed with the individual standing up and then repeated with the individual lying down on his or her back (supine). With an inguinal hernia, a bulge or swelling appears in the groin area or within the scrotal sac. This bulge can often be accentuated by asking the individual to voluntarily increase his or her intra-abdominal pressure (Valsalva maneuver). A bulge may not be apparent with a femoral hernia. During the exam, the physician attempts to find the area allowing protrusion of the hernia. For inguinal hernias in men, this is accomplished by placing a fingertip in the scrotal sac and advancing the fingertip into the inguinal canal. Reduction of the hernia is attempted and the results noted in the medical record. Sometimes, bowel sounds can be heard in a large hernia by listening with a stethoscope (auscultation). A femoral artery aneurysm masquerading as a femoral hernia may produce a sound (bruit) that can be heard with the stethoscope (auscultation). An individual with an incarcerated hernia may have painful enlargement of a previous hernia or defect. In an incarcerated hernia, there is no spontaneous reduction of the hernia, and the hernia cannot be reduced manually. Nausea, vomiting, and symptoms of bowel obstruction may be present. An individual with a strangulated hernia may have a toxic appearance, fever, pain out of proportion to exam findings, and no decrease in pain and tenderness with reduction of the hernia.

Tests: Tests are generally not needed in the diagnosis of inguinal or femoral hernias. A complete blood count may be ordered to look for an increase in white blood cells if strangulation is suspected. Electrolytes, blood urea nitrogen (BUN), and creatinine levels may be ordered if individual is nauseated and vomiting, or prior to surgery.

Ultrasound is the best noninvasive procedure to confirm the diagnosis and distinguish the hernia from abscesses or other masses. In certain rare situations in which a strangulated or incarcerated hernia is suspected, x-rays may be ordered.

Source: Medical Disability Advisor



Treatment

Small and painless hernias can be observed (watchful waiting). Surgical repair is usually recommended for enlarging or painful inguinal hernias, as well as for those that produce difficulty in performing daily activities, since the risk of obstruction and strangulation almost always outweighs the risk of surgery. In cases in which strangulation is suspected, individuals undergo initial fluid resuscitation, antibiotic therapy, and emergency surgery consultation. If significant prostate enlargement is present, this condition may be treated first to reduce the complications of urinary retention and urinary tract infection after hernia surgery.

There are 2 general types of hernia surgeries, herniorrhaphy and hernioplasty. During herniorrhaphy, the protruding intestine or other tissue is pushed back into the abdominal cavity, and the weakened or torn opening is sewn back together. In hernioplasty, the entire inguinal area is secured with synthetic mesh to reinforce the repair and protect against future hernias (recurrence). Most inguinal or femoral hernias are uncomplicated and can be repaired with either open or laparoscopic surgery. Laparoscopic surgery produces less initial pain and an earlier return to work than conventional open surgery. However, recurrence and complication rates are higher in individuals treated laparoscopically. As a result, some clinicians recommend the use of open surgery for first-time (primary) occurrence of inguinal and femoral hernias and laparoscopic surgery for treatment of recurrent ones and for those with bilateral inguinal hernias.

Source: Medical Disability Advisor



Prognosis

Complete recovery is expected after surgical repair of a hernia. Recurrence rate for inguinal hernias is around 2.5% (Nicks). The likelihood of recurrence depends upon the size and severity of the hernia, history of any previous hernia surgery, presence of predisposing factors, and surgical technique used for repair. Some "recurrent" hernias are actually indirect hernias missed during the initial surgery. Using a synthetic mesh patch to strengthen the groin area (hernioplasty) may lessen the risk of recurrence. A strangulated hernia can be life threatening if left untreated. Mortality rate for those with strangulated hernias can be as high as 10% (Nicks).

Source: Medical Disability Advisor



Rehabilitation

Following abdominal surgery, intermittent positive pressure breathing exercises may be necessary to prevent pulmonary complications. Individuals learn splinting techniques, in which a pillow is held to the abdomen while coughing, laughing, or changing positions to decrease pain.

Certain exercises also may be performed to reduce postoperative pain and to speed recovery, including progressive relaxation and deep-breathing techniques. These may be performed several times per day until pain from inhalation/exhalation is less noticeable. Ankle flexes, knee bends, and crossed-leg muscle contractions (all performed while lying on the back) will help to increase circulation and make walking easier. These are especially valuable during the first 48 hours after surgery and should be performed 3 to 5 times per day during this time. Individuals may learn pelvic tilts in which the low back is flattened while lying on the back to increase abdominal muscle strength. Individuals may continue with these exercises for 4 to 6 weeks until recovery from surgery is complete and pain is no longer noticeable while walking or breathing.

Source: Medical Disability Advisor



Complications

The hernia may become trapped (incarcerated), which can lead to a bowel obstruction or cessation of blood flow (strangulation). This is more common in indirect hernias because they pass through a ring of muscular tissue (inguinal ring) that is a part of the inguinal canal. Strangulation is a medical emergency, and immediate surgery is required to prevent tissue death (necrosis) within the trapped tissue. Recurrence of the hernia is another possible complication.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Heavy lifting or climbing should be avoided during the recovery period following surgical repair of an inguinal or femoral hernia.

Risk: The risk of recurrence can be reduced by addressing risk factors that increase intra-abdominal pressure such as obesity, chronic constipation, smoking, and chronic cough. Recurrence is uncommon following surgical repair.

Capacity: Capacity may be temporarily reduced during recovery from surgical repair to allow for adequate healing. During this period, individuals who normally perform heavy or very heavy work may require temporary job reassignment until restrictions to avoid heavy lifting or climbing have been removed. After recovery, no disability is expected.

Tolerance: Tolerance is usually not a concern with this diagnosis as most inguinal and femoral hernias are asymptomatic. At times, possible nerve damage to the genitofemoral or ilioinguinal nerves may cloud the picture.

Source: Medical Disability Advisor



Maximum Medical Improvement

60 days.

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:

  • Does individual have swelling or a bulge in the groin area or within the scrotal sac? If so, is the bulge lower on the abdomen (near the area of the upper thigh)? Is it painless, or is there discomfort with straining or coughing?
  • If diagnosis is uncertain, were other conditions with similar symptoms ruled out?
  • Was diagnosis of inguinal or femoral hernia confirmed?

Regarding treatment:

  • Was hernia repair successful?
  • Was hernia repaired under local anesthesia in an outpatient or a hospital setting?
  • Did individual experience any complications from the surgical procedure or anesthesia?

Regarding prognosis:

  • Was strangulation or tissue necrosis present? Will further procedures be required?
  • Does individual have a coexisting condition, such as obesity or COPD, that may complicate treatment or affect recovery?
  • Based on known factors (size and severity of the hernia, history of any previous recurrence, presence of predisposing factors, and the surgical technique used for repair), is individual at risk for hernia recurrence?
  • Was a synthetic mesh used to strengthen abdominal wall and lessen risk of recurrence?
  • Have any complications developed that may affect recovery?

Source: Medical Disability Advisor



References

Cited

Rather, Assar A. , et al. "Abdominal Hernias." eMedicine. 28 Oct. 2014. Medscape. 23 Apr. 2015 <http://emedicine.medscape.com/article/189563-overview>.

Source: Medical Disability Advisor






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