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.

Lithotripsy, Extracorporeal Shock Wave


Medical Codes

ICD-9-CM:
98.51 - Extracorporeal Shock-wave Lithotripsy of the Kidney, Ureter and/or Bladder
98.52 - Extracorporeal Shock-wave Lithotripsy of the Gallbladder and/or Bile Duct

Related Terms

  • ESWL
  • Extracorporeal Shock Wave Lithotripsy
  • Shock Wave Lithotripsy

Overview

Extracorporeal shock-wave lithotripsy (ESWL) is a noninvasive procedure that breaks apart kidney stones (renal or ureteral calculi) using high-energy sound waves generated outside of the body. The focused shock waves pass through fluids and tissues and converge on the stone, causing it to break apart. The procedure requires no incisions, catheters, or insertion of special scopes. ESWL shatters calculi of up to 2 cm in size into sand-like particles less than 1 mm in size and small enough to be passed in the urine (Grasso). Rarely, ESWL may also be used to treat gallstones located in the bile duct (Paumgartner). Although ESWL is a noninvasive procedure, regional or general anesthesia is administered, because the shock waves cause some pain when they enter the body. Because the entire procedure takes approximately 1 hour, ESWL permits a shorter recovery period and allows the individual to return to normal activities with minimal delay.

Source: Medical Disability Advisor



Reason for Procedure

ESWL is performed as a noninvasive alternative to surgery for the removal of kidney stones. The procedure is especially useful for individuals who do not want to undergo traditional open surgery, which is an invasive procedure and involves a longer period of recovery.

Lithotripsy is not appropriate for every individual with kidney stones. The individual's body structure may prohibit proper positioning in the tank of water in which the individual must be submerged. Other contraindications include pregnancy, calcium deposits in the arteries, uncorrected bleeding disorders, acute urinary tract infection, renal insufficiency, obesity, obstructed urine flow (the procedure is dependent upon urinary tract patency to flush out the fragments), and exaggerated spinal curvature, which may interfere with visualization of the stones upon x-ray. ESWL is not as effective for individuals with renal calculi composed of cystine or calcium oxalate monohydrate, as the shock waves do not break up this substance easily (Rhodes).

Source: Medical Disability Advisor



How Procedure is Performed

In most cases, individuals are admitted to the hospital the morning of treatment. An anesthetic is administered based on the recommendation from an anesthesiologist, as well as on the individual's preference. Epidural or spinal anesthesia is used most often. General anesthesia is rarely necessary. Sedatives are routinely given intravenously during the procedure to make the individual more comfortable. The heart may be monitored.

The anesthetized individual is placed face up (supine) on a support platform with the hips and knees bent to flatten the curve of the lumbar spine. Individuals with stones located close to the pelvis may need to be positioned face down (prone) to allow for adequate exposure. The individual is secured with straps to prevent movement. A catheter is sometimes placed into the individual's urinary bladder after he or she has been anesthetized.

The individual is then positioned in contact with a water-filled cushion or in a water bath with the head and shoulders out of the water, so that the stones are positioned at the highest energy point of the shock waves. Two x-ray monitors are used to assist in positioning. The radiation received from the x-ray monitors is well below minimum toleration limits. When positioning is complete, shock wave treatment is initiated using a specialized machine. Approximately 800 to 2000 focused shock waves are produced by an electrode at a rate of 80 to 90 shocks per minute to shatter the kidney stone(s) (Grasso). The urologist conducting the treatment monitors stone fragmentation using fluoroscopy, ultrasonography, or a combination of the two. The individual is occasionally repositioned during the procedure

Upon completion of treatment, the individual is removed from the water-filled cushion or water bath and sent to the recovery room until the anesthetic has worn off, usually within 2 hours. Additional procedures may be done before or after the treatment, such as endoscopic examination of the bladder (cystoscopy).

A follow-up examination is required after the procedure is completed to determine if the individual is pain-free and asymptomatic. Follow-up is usually recommended within 3 to 4 weeks of the ESWL procedure.

Source: Medical Disability Advisor



Prognosis

The success of the procedure depends upon the size and number of the kidney stones, the location within the kidney or urinary tract, and the type of stone. Overall, 90% of individuals with kidney stones smaller than 2 cm become stone free after ESWL and remain stone free for up to 2 years (Grasso). Individuals with stones larger than 2 cm have a success rate of 50% (Grasso). The stone-free rate following ESWL is highest with stones in the upper part the kidney (65% to 81%), with lower success rates when treating stones lower in the kidney (58% to 67%) (Grasso). Recent research shows that using a shock rate of 60 shocks per minute results in greater stone-free rates and no increased complications despite longer treatment times (Weizer).

Although ESWL is only occasionally used to treat gallstones, after ESWL for gallstones the recurrence rate is 20.6% at 3 years, 27.1% at 5 years, and 33.1% at 7 years (Tsumita).

Source: Medical Disability Advisor



Specialists

  • Gastroenterologist
  • General Surgeon
  • Urologist

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Blood-tinged urine may be expected for a few days following treatment. Stone particles typically begin to pass during treatment and may continue to pass intermittently for several weeks; this may cause mild discomfort in some individuals. Rarely, 1% to 4% of individuals develop a urinary tract blockage from stone particle accumulation, requiring a second procedure to remove the fragments (ureteroscopy) (Grasso). Urinary tract infection may result, with bacteria in the urine noted in 7.7% to 23.5% of individuals after ESWL (Grasso). Bacterial infection of the blood (bacteremia) occurs in 14% of cases, with fewer than 1% of individuals developing sepsis (Grasso). Hypertension may result from bleeding around the kidney (hematoma).

With gallstones, ESWL has a low rate of complications (e.g., biliary pancreatitis, liver hematoma) but a high rate of stone recurrence, unless gallstones are isolated in the bile duct (Paumgartner). For this reason, gallstones are typically removed surgically (laparoscopic cholecystectomy) to reduce the risk of stone recurrence.

Source: Medical Disability Advisor



Factors Influencing Duration

The length of disability depends on the success of the procedure and the number of stones. The procedure is normally done on an outpatient basis. If kidney stones recur, this is likely to influence length of disability.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

There are no work restrictions after recovery and return to work. However, the individual must attend one follow-up examination after the procedure.

Source: Medical Disability Advisor



References

Cited

Paumgartner, G., and G. H. Sauter. "Extracorporeal Shock Wave Lithotripsy of Gallstones: 20th Anniversary of First Treatment (Abstract)." European Journal of Gastroenterology & Hepatology 17 5 (2005): 525-527. PubMed. <http://www.ncbi.nlm.nih.gov/pubmed/15827443>.

Rhodes, Monica. "Extracorporeal Shock Wave Lithotripsy (ESWL) for Kidney Stones." WebMD.com. Eds. Karen M. Ariss, et al. 30 May. 2007. WebMD, LLC. 3 Sep. 2009 <http://www.webmd.com/kidney-stones/extracorporeal-shock-wave-lithotripsy-eswl-for-kidney-stones>.

Tsumita, Reiko, et al. "Long-term Evaluation of Extracorporeal Shock-wave Lithotripsy for Cholesterol Gallstones (abstract)." Journal of Gastroenterology and Hepatology 16 1 (2001): 93-99. PubMed. <http://www.ncbi.nlm.nih.gov/pubmed/11206322>.

Weizner, Alon Z., Pei Zhong, and Glenn M. Preminger. "New Concepts in Shock Wave Lithotripsy." Urologic Clinics of North America 34 3 (2007): 375-382. PubMed. <http://www.ncbi.nlm.nih.gov/pubmed/17678987>.

General

"Lithotripsy." Surgery.com. 2009. 3 Sep. 2009 <http://www.surgery.com/procedure/lithotripsy>.

Grasso, Michael, Josh Hsu, and Massimiliano Spaliviero. "Extracorporeal Shockwave Lithotripsy." eMedicine. Eds. Daniel B. Rukstalis, et al. 14 Feb. 2008. Medscape. 3 Sep. 2009 <http://emedicine.com/med/topic3024.htm>.

Liou, Louis S., and David Zieve. "Lithotripsy." MedlinePlus. 15 Jan. 2009. National Library of Medicine. 3 Sep. 2009 <http://www.nlm.nih.gov/medlineplus/ency/article/007113.htm>.

Source: Medical Disability Advisor