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.

Impingement Syndrome


Related Terms

  • Internal Derangement of the Shoulder
  • Internal Impingement
  • Painful Shoulder
  • Rotator Cuff Impingement Syndrome
  • Subacromial Impingement Syndrome
  • Subcoracoid Impingement

Differential Diagnosis

Specialists

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

Comorbid Conditions

  • Biceps tendon rupture
  • Musculoskeletal disorders
  • Rheumatologic disorders
  • Shoulder instability
  • Tear in the contralateral shoulder

Medical Codes

ICD-9-CM:
718.81 - Other Joint Derangement, Not Elsewhere Classified; Flail Joint (Paralytic); Instability of Joint, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
726 - Peripheral Enthesopathies and Allied Syndromes
726.2 - Other Affections of Shoulder Region, Not Elsewhere Classified; Periarthritis of Shoulder; Scapulohumeral Fibrositis
840 - Sprains and Strains of Shoulder and Upper Arm
840.9 - Sprains and Strains of Shoulder and Upper Arm, Unspecified Site of Shoulder and Upper Arm; Arm NOS; Shoulder NOS

Overview

© Reed Group
Impingement syndrome is a term used to describe a disorder in which one or more soft tissues (rotator cuff tendons, bursa and biceps tendons) surrounding the ball of the shoulder joint get pinched, or impinged, on the bony surface under a portion of the shoulder blade (the acromion).

The shoulder is made up of three bones (humerus, scapula, and clavicle). The rotator cuff comprises four muscles—the subscapularis, the supraspinatus, the infraspinatus and the teres minor—and their musculotendinous attachments The tendons that attach these four muscles in the shoulder area to the humerus, fuse together to form the rotator cuff. The lateral extension of the shoulder blade is the acromion, and the area underneath it is the subacromial space. A lubricating sac of tissue protects the tendons as they move between the acromion and the glenohumeral joint (subacromial bursa). Usually there is enough room between the acromion/acromioclavicular joint and the glenohumeral joint for the rotator cuff and biceps tendons to slide easily underneath the acromion as the arm is raised. Any process which compromises this normal gliding function may lead to mechanical impingement (Schaffer). Common conditions include weakening (degeneration) of the muscles or tendons due to age, formation of bone spurs and/or inflammatory tissue. For example, when the space is made smaller, either by changes in the shape (hypertrophy) of the acromion and/or acromioclavicular joint or by bone spurs, the rotator cuff is forced to rub against the arch of the acromion. Impingement is thought to be a precursor to a rotator cuff tear. Impingement can also cause the bursa or tendons to become inflamed, resulting in bursitis and tendinitis, respectively (Papadonikolakis).

Age, repetitive overhead activity, shoulder looseness (laxity), sleeping with the shoulder abducted, previous injury, osteoarthritis with resulting bone spurs (osteophytes), and anatomical abnormalities are all causative factors. Shoulder laxity that allows the head of the upper arm bone (humerus) to ride high in the shoulder joint will force the rotator cuff against the arch, resulting in impingement. Instability simulating impingement is usually seen in young athletes with a history of significant shoulder injury. As people age, some structures slowly enlarge. Thickening of the acromion and the acromioclavicular joint that occur with age, and the development of osteophytes (spurs) on the underside of the acromion and acromioclavicular joint, are the most common causes of shoulder impingement.

Usually, the acromion has a flat inferior or lower surface (Type I acromion). Some individuals have a congenital anomaly in which the underside of the acromion is hooked or curved (Type II or III), meaning there is less room for the rotator cuff because of a congenital difference in the space available for the cuff tendons.

Shoulder impingement can have multiple causes. Understanding the functional anatomy is the key to understanding shoulder disorders (Fongemie). The rotator cuff (muscles and tendons) are the dynamic stabilizers of the glenohumeral joint. The static stabilizers are the capsule and labrum complex which include the glenohumeral ligaments. The joint formed by the bones (humerus and glenoid (of the scapula) are unstable (would fall apart) but for the static and dynamic stabilizers. Without an intact rotator cuff, the unopposed deltoid would pull the humeral head up into the acromion.

In the past, the diagnosis of shoulder impingement was often used when a specific diagnosis for shoulder pain could not be determined (Papadonikolakis) However, with improving diagnostic examinations and clinical studies, the specific cause of the impingement can be determined and the treatment directed to the specific cause. This has resulted in better outcomes.

Incidence and Prevalence: No documented information on the occurrence of shoulder impingement syndrome exists (DeBerardino).

Source: Medical Disability Advisor






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