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.

Muscle Injury


Related Terms

  • Avulsions
  • Bruises
  • Detached Injury
  • Strains

Differential Diagnosis

Specialists

  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Sports Medicine Physician

Comorbid Conditions

  • Coagulation disorders
  • Musculoskeletal disorders
  • Osteoporosis

Factors Influencing Duration

Length of disability may be influenced by the location of injured muscle, type of muscle injury, severity of injury, type of treatment, response to treatment, and any coexisting injuries (laceration, fracture), comorbid illness, or complications.

Medical Codes

ICD-9-CM:
724 - Other and Unspecified Back Disorders
728.8 - Other Disorders of Muscle, Ligament, and Fascia
728.83 - Rupture of Muscle, Nontraumatic
728.9 - Disorder of Muscle, Ligament, and Fascia, Unspecified
840 - Sprains and Strains of Shoulder and Upper Arm
840.0 - Sprains and Strains of Shoulder and Upper Arm, Acromioclavicular Joint (Ligament)
840.1 - Sprains and Strains of Shoulder and Upper Arm, Coracoclavicular (Ligament)
840.2 - Sprains and Strains of Shoulder and Upper Arm, Coracohumeral (Ligament)
840.3 - Sprains and Strains of Shoulder and Upper Arm, Infraspinatus (Muscle) (Tendon)
840.4 - Sprains and Strains of Shoulder and Upper Arm, Rotator Cuff (Capsule)
840.5 - Sprains and Strains of Shoulder and Upper Arm, Subscapularis (Muscle)
840.6 - Sprains and Strains of Shoulder and Upper Arm, Supraspinatus (Muscle) (Tendon)
840.7 - Sprains and Strains of Shoulder and Upper Arm, Superior Glenoid Labrum Lesion; SLAP Lesion
840.8 - Sprains and Strains of Shoulder and Upper Arm, Other Specified Sites 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
841 - Sprains and Strains of Elbow and Forearm
841.0 - Sprains and Strains of Elbow and Forearm, Radial Collateral Ligament
841.1 - Sprains and Strains of Elbow and Forearm, Ulnar Collateral Ligament
841.2 - Sprains and Strains of Elbow and Forearm, Radiohumeral Joint
841.3 - Sprains and Strains of Elbow and Forearm, Ulnohumeral Joint
841.8 - Sprains and Strains of Elbow and Forearm, Other Specified Sites
841.9 - Sprains and Strains of Elbow and Forearm, Unspecified Site; Elbow NOS
842 - Sprains and Strains of Wrist and Hand
842.00 - Sprains and Strains, Wrist, Unspecified Site
842.01 - Sprains and Strains, Wrist, Carpal Joint
842.02 - Sprains and Strains, Wrist, Radiocarpal Joint
842.09 - Sprains and Strains, Wrist, Other; Sprains and Strains, Radioulnar Joint, Distal
842.10 - Sprains and Strains, Hand, Unspecified Site
842.11 - Sprains and Strains, Hand, Carpometacarpal Joint
842.12 - Sprains and Strains, Hand or Fingers, Metacarpophalangeal Joint
842.13 - Sprains and Strains, Hand or Fingers, Interphalangeal Joint
842.19 - Sprains and Strains, Hand, Other; Midcarpal (Joint)
843 - Sprains and Strains of Hip and Thigh
843.0 - Sprains and Strains of Hip and Thigh, Iliofemoral Ligament
843.1 - Sprains and Strains of Hip and Thigh, Ischiocapsular (ligament)
843.8 - Sprains and Strains of Other Specified Sites of Hip and Thigh
843.9 - Sprains and Strains of Hip and Thigh, Unspecified Site; Hip NOS; Thigh NOS
844 - Sprains and Strains of Knee and Leg
844.0 - Sprains and Strains of Knee and Leg, Lateral Collateral Ligament of Knee
844.1 - Sprains and Strains of Knee and Leg, Medial Collateral Ligament of Knee
844.2 - Sprains and Strains of Knee and Leg, Cruciate Ligament of Knee
844.3 - Sprains and Strains of Knee and Leg, Tibiofibular (Joint) (Ligament), Superior
844.8 - Sprains and Strains of Knee and Leg, Other Specified Site
844.9 - Sprains and Strains of Knee and Leg, Unspecified Site; Knee NOS; Leg NOS
845 - Sprains and Strains of Ankle and Foot
845.00 - Sprains and Strains, Ankle, Unspecified Site
845.01 - Sprains and Strains, Ankle, Deltoid (Ligament) Ankle; Internal Collateral (Ligament) Ankle
845.02 - Sprains and Strains, Ankle, Calcaneofibular Ligament
845.03 - Sprains and Strains, Ankle, Tibiofibular Ligament, Distal
845.09 - Sprains and Strains, Ankle, Other; Achilles Tendon
845.10 - Sprains and Strains, Foot, Unspecified Site
845.11 - Sprains and Strains, Foot, Tarsometatarsal Joint (Ligament)
845.12 - Sprains and Strains, Foot, Metatarsophalangeal Joint
845.13 - Sprains and Strains, Foot, Interphalangeal Joint; Toe
845.19 - Sprains and Strains, Foot, Other
846 - Sprains and Strains of Sacroiliac Region
846.0 - Sprains and Strains of Sacroiliac Region, Lumbosacral Joint
846.1 - Sprains and Strains of Sacroiliac Region, Sacroiliac Ligament
846.2 - Sprains and Strains of Sacroiliac Region, Sacrospinatus (Ligament)
846.3 - Sprains and Strains of Sacroiliac Region, Sacrotuberous (Ligament)
846.8 - Sprains and Strains of Sacroiliac Region, Other Specified Sites
846.9 - Sprains and Strains of Sacroiliac Region, Unspecified Site
847 - Sprains and Strains of Other and Unspecified Parts of Back
847.0 - Sprains and Strains of Other and Unspecified Parts of Back, Neck; Anterior Longitudinal (Ligament), Cervical; Atlanto-Axial (Joints); Atlanto- Occipital (Joints); Whiplash Injury
847.1 - Sprains and Strains of Other and Unspecified Parts of Back, Thoracic Spine
847.2 - Sprains and Strains of Other and Unspecified Parts of Back, Lumbar Spine
847.3 - Sprains and Strains of Other and Unspecified Parts of Back, Sacrum; Sacrococcygeal (Ligament)
847.4 - Sprains and Strains of Other and Unspecified Parts of Back, Coccyx
847.9 - Sprains and Strains of Other and Unspecified Parts of Back, Unspecified Site; Back NOS
848 - Sprains and Strains, Other and Ill-defined
848.0 - Sprains and Strains, Other and Ill-defined, Septal Cartilage of Nose
848.1 - Sprains and Strains, Other and Ill-defined, Jaw; Temporomandibular (Joint) (Ligament)
848.2 - Sprains and Strains, Other and Ill-defined, Thyroid region; Cricoarytenoid (Joint) (Ligament); Cricothyroid (Joint) (Ligament); Thyroid Cartilage
848.3 - Sprains and Strains, Other and Ill-defined, Ribs; Chondrocostal (joint) without Mention of Injury to Sternum; Costal Cartilage without Mention of Injury to Sternum
848.40 - Sprains and Strains, Other and Ill-defined, Sternum, Unspecified site
848.41 - Sprains and Strains, Other and Ill-defined, Sternum, Sternoclavicular (Joint) (Ligament)
848.42 - Sprains and Strains, Other and Ill-defined, Sternum, Chondrosternal (Joint)
848.49 - Sprains and Strains, Other and Ill-defined, Sternum, Other; Xiphoid cartilage
848.5 - Sprains and Strains, Other and Ill-defined, Pelvis; Symphysis Pubis
848.8 - Sprains and Strains, Other and Ill-defined, Specified Sites
848.9 - Sprains and Strains, Other and Ill-defined, Unspecified Site
905 - Late Effects of Musculoskeletal and Connective Tissue Injuries
905.7 - Late Effect of Sprain and Strain without Mention of Tendon Injury
905.8 - Late Effect of Tendon Injury
922 - Contusion of Trunk
922.0 - Contusion of Breast
922.1 - Contusion of Chest Wall
922.2 - Contusion of Abdominal Wall; Flank; Groin
922.3 - Contusion of Back
922.31 - Contusion of Back
922.32 - Contusion of Buttock
922.33 - Contusion of Back, Interscapular Region
922.8 - Contusion of Multiple Sites of Trunk
922.9 - Contusion of Unspecified Part of Trunk
923 - Contusion of Upper Limb
923.00 - Contusion of Shoulder Region
923.01 - Contusion of Scapular Region
923.02 - Contusion of Axillary Region
923.03 - Contusion of Upper Arm
923.09 - Contusion of Shoulder and Upper Arm, Multiple Sites
923.10 - Contusion of Forearm
923.11 - Contusion of Elbow
923.20 - Contusion of Hand(s), Except Finger(s) Alone
923.21 - Contusion of Wrist
923.3 - Contusion of Finger or Thumb (Nail); Fingernail
923.8 - Contusion of Multiple Sites of Upper Limb
923.9 - Contusion of Unspecified Part of Upper Limb
924 - Contusion of Lower Limb
924.00 - Contusion of Thigh
924.01 - Contusion of Hip
924.10 - Contusion of Lower Leg
924.11 - Contusion of Knee
924.20 - Contusion of Foot, Excluding Toes; Heel
924.21 - Contusion of Ankle
924.3 - Contusion of Toe or Toenail
924.4 - Contusion of Multiple Sites of Lower Limb
924.5 - Contusion of Unspecified Part of Lower Limb
924.8 - Contusion Multiple Sites, Not Elsewhere Classified
924.9 - Contusion of Lower Limb

Overview

Any muscle in the body may be damaged or injured. The various types of muscle injuries are categorized as strains, bruises (contusions), detached injuries (avulsions), and exercise-induced injury or delayed-onset soreness. The thigh and back muscles are most commonly injured.

Muscle strain is a common injury, especially in individuals who are inflexible or who fail to warm up sufficiently prior to engaging in physical activity. It occurs when muscle tissue is elongated passively or is activated during stretching. Muscle strains are classified as mild, moderate, or severe. Mild strains refer to slightly pulled muscle without tearing of muscle or tendon fibers. Moderate strains involve tearing of fibers that result in diminished strength, and severe strains are a rupture of a tendon-bone attachment with separation of muscle fibers. Severe strains may require surgical repair.

Muscle contusions are also classified as mild, moderate, or severe. Contusions refer to impact injuries that do not involve a break in the skin but cause damage to muscle fibers, small blood vessels, and other soft tissue. Blood seeps out of torn muscle or damaged small blood vessels into the surrounding tissue, forming visible black-and-blue marks beneath the skin (ecchymosis). After injury, gravity may pull the blood downward so that the black-and-blue "bruise" may be far from the contusion site. Blood may also collect and form clots within the muscle (hematoma). Muscle contusions frequently occur in athletes participating in contact sports like football, hockey, and boxing.

Tearing or ripping the muscle away from an attachment point (avulsions) is usually caused by an intense force or dynamic overload. Avulsion injuries most frequently occur in the groin and upper connections of the hamstring muscles. Individuals with rapid growth, stress fractures, overdeveloped muscles in combination with an immature skeletal system, or weakened bones (osteoporosis) are at risk for avulsion injuries.

Exercise-induced injuries and delayed-onset soreness occur when stress applied to a muscle exceeds the tolerance level of the muscle and muscle attachments. Viral infection, performance of a new physical activity, or excessive exercise in which the muscle is contracting while lengthening (eccentric contraction) can predispose an individual to this type of injury.

Sports- and work-related muscle injuries are common, often leading to time away from sports participation and/or work.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Skeletal muscle injuries, including contusions, strains, and avulsion, occur most often in work or athletic settings. Athletes are at a particularly high-risk for muscle injuries caused by over stretching, sudden muscle contraction (weight lifting), or rapid changes in speed or direction (sprinting, tennis). Young people in periods of rapid growth or older individuals with osteoporosis or other chronic conditions resulting in loss of bone integrity are most at risk for avulsion injury.

Incidence and Prevalence: Stretch-induced injury or muscle strains represent up to 30% of all injuries seen by clinicians specializing in occupational or sports medicine (DeBernardino).

Source: Medical Disability Advisor



Diagnosis

History: Symptoms of a muscle strain include swelling, constant pain or pain with muscle use, and muscle weakness or loss of muscle function. Muscle contusion symptoms include pain, swelling, and local skin discoloration. A muscle avulsion usually causes severe pain, swelling, and loss of function in the affected limb. An exercise-induced injury may result in swelling, joint stiffness, pain, and usually a decrease or loss of muscle function 1 to 2 days after exercising. Delayed-onset soreness refers to muscle pain, weakness, and a decreased range of motion occurring 1 to 3 days following the performance of a new exercise. Headaches or dizziness (vertigo) may also be present if neck muscles are injured. The individual may report recent trauma experienced during physical activity such as “pulling” of a muscle, a fall, a direct blow, or other impact of some kind; sometimes no source of injury may be recalled.

Physical exam: The exam may reveal swelling, muscle tenderness, ecchymosis, and hard areas in the affected muscle. Specific "trigger points" of pain may be present. A disproportionately high level of pain for the degree of injury may suggest compartment syndrome. Movement may be decreased with the individual guarding the affected muscle. Gait abnormalities may be observed with quadriceps or Achilles injuries. The individual will be examined for the presence of other injuries.

Tests: Plain x-rays, CT, MRI, nerve conduction tests, or electromyography (EMG) may be done to determine the extent of the injury and rule out bone fractures. Ultrasound imaging also has high sensitivity and specificity for evaluating muscle tears. Compartment pressure measurements may be taken if compartment syndrome of a limb is suspected.

Source: Medical Disability Advisor



Treatment

Mild strains, exercise-induced injuries, delayed-onset soreness, and most contusions are treated by resting the affected muscle, applying ice initially and heat later, compression, and the use of pain relievers (analgesics) or muscle relaxants. However, use of non-steroidal anti-inflammatory drugs (NSAIDs) for pain and swelling of muscular injury is controversial because inflammatory cells are a component needed to clear away necrotic muscle fiber after an injury. Open injuries are treated with surgical cleansing (débridement), repair, and antibiotic therapy. Muscle tears may also require surgery to realign (reapproximate) the torn edges. Avulsions require surgery to reattach the muscle to the tendon. Surgery may also be needed to remove a massive hematoma. Traction, a cervical collar, splints, crutches, or a cane may be prescribed. Corticosteroids, in rare circumstances, may be given to reduce inflammation especially in chronic conditions.

Source: Medical Disability Advisor



Prognosis

Healing of muscle injury is self-limiting and full recovery is expected within a range of days to months, depending on the type of injury. Most contusions resolve completely within a few weeks without residual symptoms. Delayed-onset soreness resolves within a few days. Mild strains heal in 2 to 10 days, moderate strains in 10 days to 6 weeks, and severe strains in 6 to 10 weeks. Avulsions usually require 6 to 10 weeks to heal. A longer recovery period (6 to 10 weeks) is also necessary for any muscle injury requiring surgical repair.

Source: Medical Disability Advisor



Rehabilitation

The various types of muscle injuries are categorized as strains, bruises (contusions), detached injuries (avulsions), and exercise-induced injury or delayed onset soreness.

Rehabilitation of a muscle injury depends on the type, location, and extent of the injury. For example, muscles can be strained by excessive stretching or forced contracture. They can also be torn and need surgical repair. Each muscle performs a different function and responds differently to injury as well as treatment. Consequently, the degree of the strain will determine the rate of rehabilitation.

Muscle injuries often result in the formation of a hematoma. The immediate goal of the rehabilitation of all muscle injuries is to decrease pain and swelling. The best way is to follow the PRICE principle (protection, rest, ice, compression, elevation) (Braddom). Physical activities should be terminated immediately after the injury to avoid further damage. Application of a compression bandage and ice can reduce the formation of a hematoma. Elevation of the injured extremity decreases blood flow to the injury site and increases venous return, thus further limiting the size of the hematoma. The immobilization should be kept as short as possible. It has been shown that short immobilization is beneficial in the early phase of muscle regeneration and prolonged immobilization results in the atrophy of healthy fibers around the injury. Usually 1 to 5 days after injury gentle exercise can be started, depending on the severity of the injury, with the intensity increased as tolerated. Early stretching exercises as tolerated help to minimize the negative effects of scar formation. Modalities such as local heat can be used for pain management once the edema is controlled.

If pain and functional limitations persist, the injury needs to be re-evaluated. Besides clinical evaluation, sonography or an MRI may help to detect the extent of the injury (Noonan). Depending on the severity of the muscle injury a surgical intervention might be necessary.

Additional information may provide insight into the rehabilitation needs of these individuals (Kirkendall).

FREQUENCY OF REHABILITATION VISITS
Nonsurgical and Surgical
SpecialistMuscle Injury
Physical TherapistUp to 4 visits within 3 weeks
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Complications

Resumption of strenuous physical activity before the muscle has healed completely can lead to reinjury. A muscle may be so extensively damaged that it must be removed. Hematomas within the muscle prolong recovery time and delay return of function. Rarely, clotting of accumulated blood from muscle injury can result in migration of small blood clots (emboli) through the bloodstream to other areas of the body such as blood vessels in the brain (cerebral embolism) or lungs (pulmonary embolism), which can be life threatening. Pressure on the muscle from swelling or bleeding can result in compartment syndrome, an emergent condition causing permanent muscle and nerve damage. Disintegration of muscle (rhabdomyolysis) can occur. In a condition known as myositis ossificans, damaged muscle converts into a bone-like substance (ossification) that causes disfigurement and impaired muscle function; this can happen 3 months or more after the initial injury and should be differentiated from soft tissue tumor. Myositis ossificans develops more often in quadriceps injury than other muscle injuries.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Repetitive motion, strenuous activities, or movement of the affected limb may be restricted. For leg injuries (hamstring or quadriceps muscle injuries), crutches or a cane may be required or a brace may need to be worn over the affected muscle or limb. Muscle injuries in a lower limb may affect the individual's ability to walk, stand, or sit for extended periods of time. The individual with upper limb muscle injury may be temporarily unable to lift and carry heavy or bulky objects, operate equipment, or perform other tasks requiring the use of both hands. Muscle injury in the dominant arm or hand may affect fine motor skills such as those needed to write legibly, type well, or work in a laboratory. Depending on work duties, the individual may need to be temporarily reassigned. Training on proper lifting and movement is helpful.

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:

  • Has muscle injury been confirmed with appropriate tests and diagnostic imaging?
  • Has type of injury been identified?
  • Was injury associated with trauma? What type of trauma (e.g., direct impact, over exercise, etc.)?
  • Does individual have an underlying condition that may impact recovery?

Regarding treatment:

  • Has individual overused the injured muscle?
  • Is individual following the plan of treatment?
  • Was surgery required to repair a muscle tear?
  • Was individual treated with corticosteroids?

Regarding prognosis:

  • How severe are the persisting symptoms? Are they incapacitating?
  • Can individual perform normal activities of daily life?
  • Would individual benefit from muscle conditioning or additional physical therapy?
  • Has individual injured this same muscle before?
  • Did the individual resume strenuous physical activity before the muscle was completely healed?
  • Has individual experienced any complications such as reinjury; damage so extensive that muscle must be removed; compartment syndrome causing permanent muscle and nerve damage; rhabdomyolysis; or myositis ossificans?
  • Have x-rays, MRI, or other scans been used to detect muscle tears, avulsions, fractures, or complicating conditions?

Source: Medical Disability Advisor



References

Cited

Braddom, Randolph L. Physical Medicine and Rehabilitation. 3rd ed. Philadelphia: W.B. Saunders, 2006.

DeBerardino, T. M., et al. "Quadriceps Injury." eMedicine. Eds. Joseph P. Garry, et al. 5 Jun. 2006. Medscape. 18 Feb. 2009 <http://emedicine.medscape.com/article/91473-overview>.

Kirkendall, Donald, and W. E. Garrett. "Clinical Perspectives Regarding Eccentric Muscle Injury." Clinical Orthopaedics and Related Research 403 Suppl (2002): S81-S89. National Center for Biotechnology Information. National Library of Medicine. 18 Nov. 2008 <PMID: 12394456>.

Noonan, T.J., and W. E. Garrett. "Muscle Strain Injury: Diagnosis and Treatment." Journal of the American Academy of Orthopaedic Surgeons 7 4 (2002): 262-269. National Center for Biotechnology Information. National Library of Medicine. 18 Nov. 2008 <PMID: 10434080>.

Source: Medical Disability Advisor






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