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.

Ovarian Cyst, Benign


Related Terms

  • Adnexal Mass
  • Chocolate Cyst
  • Corpus Albicans Cyst
  • Corpus Luteum Cyst
  • Dermoid Ovarian Cyst
  • Endometrioma
  • Follicular Cysts
  • Functional Ovarian Cysts
  • Graafian Follicular Cyst
  • Physiological Ovarian Cysts
  • Serous Cyst of Ovary
  • Simple Cyst of Ovary

Differential Diagnosis

Specialists

  • Family Physician
  • General Surgeon
  • Gynecologist

Comorbid Conditions

Factors Influencing Duration

Need for surgery, and hospitalization may influence the length of disability.

Medical Codes

ICD-9-CM:
620.0 - Cyst of Ovary, Follicular
620.1 - Cyst or Hematoma, Corpus Luteum
620.2 - Ovarian Cyst, Benign

Overview

An ovarian cyst is a sac filled with a collection of fluid or semi-solid material that forms on the ovary. These cysts (functional or simple cysts) are relatively common, harmless (benign), and can develop at any time, but occur most often during childbearing years. Most ovarian cysts are asymptomatic, benign, and resolve on their own in a few weeks without treatment.

As part of the normal menstrual cycle, the ovary releases an egg (ovum). This ovum develops within a sac or pouch-like depression (follicle), which then appears as a bulge on the surface of the ovary. When the follicle bursts, the ovum is released; the ovarian follicle then collapses. Blood within the follicle clots and, under the influence of the luteinizing hormone, the remaining cells of the follicle become the corpus luteum. The corpus luteum secretes progesterone for the next 7 to 8 days in preparation for fertilization and pregnancy. If pregnancy occurs, the corpus luteum continues to produce hormones until the placenta develops. If pregnancy does not occur, the corpus luteum deteriorates, becoming the corpus albicans; it eventually is resorbed and disappears.

The most common type of ovarian cyst, a follicular cyst (graafian follicular cyst), develops during the first 2 weeks of the menstrual cycle when the ovarian follicle fails to rupture and release the ovum. These cysts continue to secrete estrogen instead of being resorbed, and the fluid within the follicle persists, forming a cyst. Follicular cysts usually resolve during the next two menstrual cycles without treatment.

A corpus luteum ovarian cyst is formed during the last half of the menstrual cycle when the ovarian follicle ruptures but fails to deteriorate. These cysts, filled with either serous fluid or blood, continue to produce progesterone. Like follicular cysts, they often disappear during the next two menstrual cycles.

Serous cysts, also known as cystomas, usually form from the surface tissue (epithelial tissue) of the ovary. Serous cysts have the potential to be malignant (Curran). These cysts also have the potential to grow so large that the abdomen may become distended.

Theca-lutein ovarian cysts may develop as a result of abnormally high levels of the hormone human chorionic gonadotropin (hCG). When the hormone level drops, the cysts usually shrink. Such cysts may be found in women who take infertility drugs to stimulate the ovaries as part of their infertility treatment. Theca-lutein cysts also may be found in association with tumors that produce excess amounts of hCG (hydatidiform mole, choriocarcinoma).

Ovarian cysts also may develop from endometrial tissue growing in the ovaries (endometriomas, "chocolate cysts") and from displaced tissues originating from other parts of the body (dermoid cysts) ("Gynecologic Problems"). Numerous small ovarian cysts can develop from an endocrine disorder causing hormonal imbalances, irregular menstrual cycles, and reduced fertility (polycystic ovary syndrome).

Incidence and Prevalence: Ovarian cysts occur in 30% of females with regular menses, 50% of females with irregular menses, and 6% of postmenopausal females (Duklewski). Polycystic ovary syndrome occurs in 10% of women (“Polycystic Ovary Syndrome”).
The annual incidence of ovarian cancer is 15 cases per 100,000 women (Helm).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk for ovarian cysts is increased in individuals who began menstruating early (early menarche), those who are being treated for infertility, and in women who smoke. Individuals receiving breast cancer treatment with tamoxifen have a 10% increase in ovarian cyst development (Duklewski).

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report symptoms such as shortened or lengthened menstrual cycles, absent or irregular menses, constant dull aching pelvic pain, pain when moving, pain shortly after beginning or ending menses (dysmenorrhea), nausea and/or vomiting, or breast tenderness. Pain during sexual intercourse (dyspareunia) may be related to a ruptured cyst. Sudden onset of severe pain or intermittent severe pain usually associated with nausea and vomiting, is suggestive of the cyst causing twisting of the ovary (ovarian torsion).

Physical exam: A complete physical exam may be performed to search for signs of infection or tumor (neoplasm). Ovarian cysts may be discovered by pressing (palpating) the abdomen with the hand or during a bimanual pelvic exam in which the ovary is pressed between the hands to evaluate its size and shape. The individual may feel tenderness on one side (unilateral) of the lower abdomen with palpation.

Tests: Tests should include a complete blood count (CBC) and a blood test for hCG to rule out pregnancy. A blood test for CA 125, a tumor marker in ovarian cancer, usually is ordered in postmenopausal women to evaluate the possibility of ovarian cancer. CA 125 may be moderately elevated in many benign conditions in younger patients, so its use in menstruating women is less helpful. An ultrasound or the insertion of a thin, lighted fiber optic instrument (laparoscope) into the abdominal cavity through a small surgical opening for a visual examination (exploratory laparoscopy), may be necessary to confirm the diagnosis and to determine the size and position of the cyst. Doppler ultrasound often is helpful in evaluating blood flow to the ovary and cyst. It also and can help the physician decide if the cyst appears benign or malignant and whether surgery will be needed. MRI and/or CT may be performed but are less helpful than Doppler ultrasound.

Source: Medical Disability Advisor



Treatment

Most ovarian functional cysts found incidentally do not require treatment. They usually disappear on their own within 60 days (Helm). Oral contraceptives sometimes are prescribed to suppress hormones that may be causing the cyst to enlarge, to help re-establish normal menstrual cycles, and to reduce cyst size and incidence of cyst formation. The woman may be examined after her next menstrual period to see if the cyst has resolved. Discontinuation of gonadotropin therapy given for infertility also may cause cysts to spontaneously disappear. It may, however, take several months for them to resolve.

Depending on the size of the cyst and how it appears on the ultrasound, it may be possible to remove the cyst during diagnostic laparoscopy. If there appears to be more than one cyst, if the ultrasound indicates the cyst is solid rather than fluid-filled, or if the cyst is larger than 8 centimeters, a larger abdominal cut (laparotomy) may be necessary to remove either the cyst or the entire ovary (oophorectomy).

Any cyst that enlarges or persists longer than 60 days probably is not a functional cyst, and surgery may be required to rule out other causes of the symptoms. Any postmenopausal ovarian enlargement should be investigated promptly regardless of its size. If a cyst causes ovarian torsion that cuts off the blood supply or if the cyst ruptures and causes severe bleeding (hemorrhage), an emergency laparoscopy or laparotomy often is necessary.

Anti-inflammatory drugs often are used to control the pelvic pain. Narcotics pain medication may be used if the pain is severe.

Source: Medical Disability Advisor



Prognosis

The majority of ovarian cysts are benign (noncancerous) (Helm). When cysts are benign, a complete recovery can be expected. The majority of ovarian cysts resolve spontaneously within 6 to 8 weeks (“Gynecologic Problems”). Medication or surgery (laparoscopy or laparotomy) effectively treats those benign cysts that do not resolve spontaneously.

Source: Medical Disability Advisor



Complications

Complications that generally require emergency surgery include ovarian torsion in the ovary containing the cyst or rupture of a cyst that results in hemorrhage. Hemorrhage is most common with right-sided ovarian cysts, and ovarian torsion is most common with cysts in the right ovary that are larger than 4 centimeters (Duklewski). Enlargement of the cyst or a cyst that persists throughout several menstrual cycles may also indicate a need for surgery.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Time off may need to be needed for treatment of symptomatic cysts for follow-up doctor visits. Heavy lifting may be restricted temporarily following surgery. If pain medication is required, 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:

  • Is woman of childbearing age?
  • Was woman receiving treatment for infertility?
  • Did woman experience symptoms consistent with the diagnosis of an ovarian cyst, such as abnormal bleeding, absent or irregular menses, pelvic pain, dysmenorrhea, dyspareunia, nausea or vomiting?
  • Did woman have symptoms of a ruptured cyst or ovarian torsion?
  • Was a mass noted during the pelvic exam?
  • Was a complete physical exam done?
  • Were a CBC and hCG done? CA 125?
  • Was there evidence of a follicular cyst? Corpus luteum cyst?
  • Was the diagnosis confirmed using laparoscopy?
  • How were other conditions ruled out?

Regarding treatment:

  • Were follow-up exams performed?
  • Did the cyst resolve or shrink in size?
  • Were oral contraceptives prescribed?
  • Were fertility drugs stopped?
  • Was surgery indicated? If so, was malignancy or torsion detected?

Regarding prognosis:

  • Did the cyst resolve without treatment?
  • Was medication or surgical intervention indicated and effective?
  • Did the individual have any associated conditions or complications that could affect recovery?

Source: Medical Disability Advisor



References

Cited

"Gynecologic Problems: Ovarian Cysts." ACOG: The American College of Obstetricians and Gynecologists. Nov. 2005. American College of Obstetricians and Gynecologists. 14 Aug. 2009 <http://www.acog.org/publications/patient_education/bp075.cfm>.

Curran, Diana, and Jennifer Ashton. "Benign Lesions of the Ovaries." eMedicine. Eds. Suzanne R. Trupin, et al. 19 Aug. 2007. Medscape. 28 Jul. 2009 <http://emedicine.medscape.com/article/265548-overview>.

Duklewski, Kimberly, and Andrew Aronson. "Ovarian Cysts." eMedicine. Eds. Dana A. Stearns, et al. 18 Jun. 2007. Medscape. 28 Jul. 2009 <http://63.240.86.189/emerg/topic352.htm>.

Helm, William C. "Ovarian Cysts." eMedicine. Eds. Michel E. Riven, et al. 19 Mar. 2008. Medscape. 28 Jul. 2009 <http://emedicine.medscape.com/article/255865-overview>.

General

"Polycystic Ovary Syndrome." MayoClinic.com. 31 Jul. 2009. Mayo Foundation for Medical Education and Research. 14 Aug. 2009 <http://www.mayoclinic.com/health/polycystic-ovary-syndrome/ds00423>.

Source: Medical Disability Advisor






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