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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.

Joint Disorders


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 | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
719.00 - Effusion of Joint; Hydrarthrosis; Swelling of Joint, With or Without Pain, Site Unspecified
719.01 - Effusion of Joint; Hydrarthrosis; Swelling of Joint, With or Without Pain, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
719.02 - Effusion of Joint; Hydrarthrosis; Swelling of Joint, With or Without Pain, Upper Arm; Elbow Joint; Humerus
719.03 - Effusion of Joint; Hydrarthrosis; Swelling of Joint, With or Without Pain, Forearm; Radius; Ulna; Wrist Joint
719.04 - Effusion of Joint; Hydrarthrosis; Swelling of Joint, With or Without Pain, Hand; Carpus; Metacarpus; Phalanges [Fingers]
719.05 - Effusion of Joint; Hydrarthrosis; Swelling of Joint, With or Without Pain, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
719.06 - Effusion of Joint; Hydrarthrosis; Swelling of Joint, With or Without Pain, Lower Leg; Fibula; Knee Joint; Patella; Tibia
719.07 - Effusion of Joint; Hydrarthrosis; Swelling of Joint, With or Without Pain, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
719.08 - Effusion of Joint; Hydrarthrosis; Swelling of Joint, With or Without Pain, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
719.09 - Effusion of Joint; Hydrarthrosis; Swelling of Joint, With or Without Pain, Multiple Sites
719.50 - Stiffness of Joint, Not Elsewhere Classified, Site Unspecified
719.52 - Stiffness of Joint, Not Elsewhere Classified, Upper Arm; Elbow Joint; Humerus
719.53 - Stiffness of Joint, Not Elsewhere Classified, Forearm; Radius; Ulna; Wrist Joint
719.54 - Stiffness of Joint, Not Elsewhere Classified, Hand; Carpus; Metacarpus; Phalanges [Fingers]
719.55 - Stiffness of Joint, Not Elsewhere Classified, Pelvic Region and Thigh; Buttock, Femur, Hip (Joint)
719.56 - Stiffness of Joint, Not Elsewhere Classified, Lower Leg; Fibula; Knee Joint; Patella; Tibia
719.57 - Stiffness of Joint, Not Elsewhere Classified, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
719.58 - Stiffness of Joint, Not Elsewhere Classified, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
719.59 - Stiffness of Joint, Not Elsewhere Classified, Multiple Sites
719.90 - Unspecified Joint Disorder, Site Unspecified
719.91 - Unspecified Joint Disorder, Shoulder Region; Acromioclavicular Joint(s); Glenohumeral Joint(s); Sternoclavicular Joint(s); Clavicle; Scapula
719.92 - Unspecified Joint Disorder, Upper Arm; Elbow Joint; Humerus
719.93 - Unspecified Joint Disorder, Forearm; Radius; Ulna; Wrist Joint
719.94 - Unspecified Joint Disorder, Hand; Carpus; Metacarpus; Phalanges [Fingers]
719.96 - Unspecified Joint Disorder, Lower Leg; Fibula; Knee Joint; Patella; Tibia
719.97 - Unspecified Joint Disorder, Ankle and Foot; Ankle Joint; Digits [Toes]; Metatarsus; Phalanges, Foot; Tarsus; Other Joints in Foot
719.98 - Unspecified Joint Disorder, Other Specific Sites; Head; Neck; Ribs; Skull; Trunk; Vertebral Column
719.99 - Unspecified Joint Disorder, Multiple Sites

Related Terms

  • Decreased Range of Motion
  • Degenerative Joint Disease
  • Frozen Joint
  • Joint Contracture
  • Joint Effusion
  • Joint Stiffness
  • Osteoarthritis
  • Rheumatoid Arthritis

Overview

Joint disorder is a general term describing any abnormal condition that involves any aspect of a joint. A joint occurs any place where two elements of the skeleton meet. Joint disorders can be caused by infection, inflammation, chronic repetitive injury, acute injury, degeneration, congenital deformity, and neoplasm.

Many diseases and conditions fall under the heading of joint disorder. A list compiled by the American College of Rheumatology contains more than 190 disorders that cause musculoskeletal pain and stiffness. Examples of joint disorders include osteoarthritis, systemic lupus erythematosus (SLE), ankylosing spondylitis, Behçet's syndrome, gout, infectious (septic) arthritis, rheumatoid arthritis, Felty's syndrome, and patella chondromalacia. Joint disorders may be associated with diseases such as regional enteritis or ulcerative colitis. Other joint disorders may involve tightening or shrinking of the joint capsule (frozen joint, joint contracture), which may occur following surgeries involving the joint (e.g., arthroscopy, arthroplasty) or after prolonged periods of immobility. Certain joint disorders may involve increased fluid within the joint (joint effusion), which results in distension of the joint capsule and swelling within the joint. Causes of joint effusion include inflammation, infection, intra-articular hemorrhage (hemarthrosis), acute trauma, joint disease, and overuse of the joint.

Arthritic conditions differ from joint disorders caused by structural problems (e.g., improper loading on the joint due to muscle imbalances) in that periods of acute swelling and pain within the joint may briefly subside, only to recur. Joint disorders such as rheumatoid arthritis (a systemic autoimmune response that targets joints) are increasingly debilitating and cause permanent joint damage.

Incidence and Prevalence: Arthralgia is a very common symptom that affects nearly everyone at some time during life. Nearly 1 in 3 adults in the US is affected by arthritis and chronic joint disorders, and nearly 1 in 20 working adults between the ages of 18 and 64 report work limitations from joint symptoms (“Arthritis”).

In the US, incidence of knee osteoarthritis is 240 per 100,000 population; 100 per 100,000 for hand osteoarthritis; 88 per 100,000 for hip osteoarthritis, (“Arthritis Types”); 70 per 100,000 for rheumatoid arthritis (“Matsumoto”).

Adhesive capsulitis has a lifetime prevalence of up to 3% of the population, occurring most frequently after a period of shoulder immobilization (“Pearsall”). Joint contractures of the shoulders, elbows, hips, knees, and ankles occur in up to 34% of individuals spending more than 6.6 weeks in an intensive care unit (ICU) (Clavet).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The risk for chronic joint disorders increases with age, obesity, traumatic joint injury, hereditary factors, repetitive activities, and participation in impact sports. Chronic arthralgia (pain in a joint) and frozen shoulder syndrome (adhesive capsulitis) are more common in women than in men and are most common in individuals ages 40 to 70 (Pearsall).

Osteoarthritis (inflammation in a joint) is more common in women than in men and affects more than 70% of individuals between the ages of 55 and 78 (Wilkie). Rheumatoid arthritis also is more common in women than men (Matsumoto).

Source: Medical Disability Advisor



Diagnosis

History: Individuals will complain of joint pain with stiffness in one or more joints and may report swelling (edema), warmth, or redness (erythema) of the affected joint(s). The pain may be of sudden onset or may have gradually worsened over a period of weeks to months. If the affected joint is in the lower extremity, individuals may report painful weight bearing. The individual may have a fever and feel lethargic or unwell.

Physical exam: The individual may present with edema, stiffness, and cracking, popping, or grinding sounds (crepitation) with joint motion. On examination, tenderness, deformity, and muscle spasm may be evident. The joint may be locked into a nonfunctional position (contracture) or may demonstrate limited range of motion caused by distension of the joint with fluid (joint effusion) or by degenerative changes.

Tests: Blood tests may include erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and complete blood count (CBC). Plain x-rays should be taken. Bone scans, CT scans, and MRI are more sensitive methods to detect early disease. Diagnostic ultrasound may be helpful to detect joint effusion in deep joints such as the hip and to guide the removal of fluid from the joint (arthrocentesis). Joint fluid may be removed for analysis including white blood cell count and laboratory cultures. Additional tests may be performed, depending on the suspected diagnosis.

Source: Medical Disability Advisor



Treatment

Conservative treatment methods include heat, ice, exercise, analgesics, anti-inflammatory agents, and selective use of injectable steroid preparations or injectable hyaluronan (viscous supplementation). Stress to the affected joint is minimized using approaches such as weight loss, avoidance of activities that produce a higher load across the joint or that require repetitive movements, judicious rest, splinting, and the use of assistive devices such as a cane for individuals with hip or knee disease. Removal of fluid from the joint (arthrocentesis) also may be helpful in reducing joint pain and swelling and in identifying potential joint infection. Physical and / or occupational therapy may be used to improve joint flexibility and strength, reduce painful symptoms, and facilitate patient education on self-management of symptoms. Infection is treated with antibacterial or antifungal agents, as applicable.

In cases in which the pain becomes severe, symptoms fail to respond to conservative measures, and joint dysfunction leads to the inability to perform activities of daily living, surgery (arthrotomy, arthroscopy) may be considered. Possible joint surgeries include removal of the joint membrane (synovectomy), bone fusion (arthrodesis), and joint reconstruction or replacement (arthroplasty).

Source: Medical Disability Advisor



Prognosis

The outcome depends on the underlying cause and can vary from complete resolution to permanent joint deformity with associated disability. Conservative measures may lead to resolution of some conditions but be ineffective for other conditions. In general, surgical treatment of joint disorders has a good outcome, but the specific condition also influences the results of surgery.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Clinical Psychologist
  • Immunologist
  • Infectious Disease Internist
  • Occupational Therapist
  • Orthopedic (Orthopaedic) Surgeon
  • Pain Medicine Physician/Pain Specialist
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Psychiatrist
  • Rheumatologist
  • Sports Medicine Physician

Source: Medical Disability Advisor



Rehabilitation

Rehabilitation is area-specific and depends on the cause (etiology) of the joint disorder. Some conditions such as chondromalacia (softening of articular cartilage of the patella due to abnormal shear forces) may take 6 months of progressive flexibility and strength training to achieve normal joint functioning.

Physical modalities to reduce pain and swelling, physical/occupational therapy, and education on joint loading during activity are part of any rehabilitation program involving the joints. The specific treatment protocol will depend on the nature of the joint disorder.

During an acute stage of joint pain, the individual is instructed to rest and possibly use a splint on the affected joint to prevent further inflammation. If exercises are prescribed at all, they will involve contraction of a muscle without joint movement (isometric exercise). The acute stage usually lasts for 7 to 10 days but can vary.

Once beyond the acute stage, it is important to get the joint active through its full range of motion. However, during this stage rest and exercise must be balanced. During the subacute phase, active assisted range of motion exercises are implemented as tolerated, taking care not to overstretch the joint or increase intra-articular pressure or joint temperature. Once the subacute phase has ended, inflammation in the joints will have decreased enough that the individual may begin gentle stretching and more dynamic low-resistance isotonic exercises.

Rehabilitation for disease states such as rheumatoid arthritis typically is more complex and involves a staged approach when implementing a rehabilitation program. Physical therapy for individuals with rheumatoid arthritis or arthritic conditions is episodic and aims to maintain joint mobility and muscle integrity as the condition progresses. Given the destructive nature of arthritic conditions, other therapeutic interventions (e.g., pain management, occupational therapy, and / or counseling) are frequently part of the rehabilitation plan.

Physical therapists instruct individuals in a progression of flexibility and strengthening exercises. Therapists educate the patient on joint mechanics and loading, so that during the chronic pain phase, the individual can moderate the exercises according to the pain level on a given day. The individual may be instructed in the use of an assistive device to improve ambulation and to decrease loading of the affected joint. A pool routine in water that is slightly heated can be used to increase strength and flexibility with minimal joint stress.

Occupational therapists may evaluate the individual's home or workplace environment to assess routine activities and recommend changes to help reduce joint stress. Therapists instruct individuals in making environmental changes and teach energy conservation techniques and the use of adaptive equipment to protect the affected joint. The individual may be instructed to wear a night splint to help reduce excess motion and joint strain during sleep.

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Complications are associated with the disease or condition that is causing the joint disorder. Possible complications include avascular necrosis, destruction of joint cartilage, joint dislocation, loss of joint function, infection, and deformity.

Source: Medical Disability Advisor



Factors Influencing Duration

The location of the joint disorder, number of joints affected, severity of pain, response to treatment, job demands, need for surgical intervention, and presence of complications can influence the length of disability.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations are related to the underlying cause of joint disorder, the location of the affected joint, and whether more than one joint is affected. If a joint in the upper extremity is involved, restrictions in overhead work or lifting may be necessary. For a lower extremity joint disorder, the individual may need to use an assistive device (e.g., cane, crutch) to help offload weight from the affected joint. Restrictions on prolonged standing and walking may be necessary. For severe lower extremity joint disorders, the individual may require a more sedentary assignment. Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function.

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:

  • What joints are involved?
  • What is the cause of individual's joint disorder?
  • Was onset of individual's pain sudden or gradual?
  • Did individual have a recent acute trauma or period of immobilization?
  • Does individual have a fever?
  • Does individual present with joint edema, stiffness, and / or crepitation with joint motion?
  • Has individual had testing, such as erythrocyte sedimentation rate (ESR), rheumatoid factor, and CBC; x-rays, bone scans, CT scans, and MRI, and joint fluid analysis performed to determine the diagnosis? What were the results?

Regarding treatment:

  • Have conservative treatment options been tried for an adequate period?
  • Is individual taking the appropriate medications? Are they helpful?
  • Did individual have steroid injections?
  • If needed, is individual on a weight loss program?
  • Has individual reduced the stress on the involved joints?
  • If needed, is individual compliant with physical/occupational therapy? Is therapy effective?
  • Is adaptive equipment or an assistive device needed?
  • Is a night splint needed?
  • If pain was secondary to infection, was infection treated with the appropriate drugs?
  • Will individual require surgery, such as arthrotomy, arthroscopy, or arthroplasty?

Regarding prognosis:

  • Does individual have a systemic disease that may cause recurrent joint pain?
  • Does individual require further physical/occupational therapy?
  • Does individual have a home exercise program? Is individual compliant?
  • Does individual modify activity for joint protection?

Source: Medical Disability Advisor



References

Cited

"Arthritis Types – Overview." Centers for Disease Control and Prevention. 8 Jun. 2008. U.S. Department of Health and Human Services. 26 Jun. 2009 <http://www.cdc.gov/arthritis/arthritis/osteoarthritis.htm>.

"Arthritis." Centers for Disease Control and Prevention. 8 Jun. 2008. U.S. Department of Health and Human Services. 26 Jun. 2009 <http://www.cdc.gov/nccdphp/arthritis/index.htm>.

Clavet, H., et al. "Joint Contracture Following Prolonged Stay in the Intensive Care Unit." Canadian Medical Association Journal 178 6 (2008): 691-697.

Matsumoto, A. K. "Rheumatoid Arthritis Clinical Presentation." Johns Hopkins Arthritis Center. 2009. Johns Hopkins Medicine. 25 Jun. 2009 <http://www.hopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/rheum_clin_pres.html>.

Pearsall, A. W. "Adhesive Capsulitis." eMedicine. Eds. Lynn A. Crosby, et al. 12 Aug. 2008. Medscape. 26 Jun. 2009 <http://emedicine.medscape.com/article/1261598-overview>.

Wilke, William S. "Osteoarthritis." Cleveland Clinic Center for Continuing Education. 25 Jun. 2009 <http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/rheumatology/osteoarthritis>.

Source: Medical Disability Advisor