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.

Pain in Limb


Related Terms

  • Arm Pain
  • Extremity Pain
  • Leg Pain

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Dermatologist
  • Emergency Medicine Physician
  • Family Physician
  • Hand Surgeon
  • Infectious Disease Internist
  • Internal Medicine Physician
  • Neurologist
  • Oncologist
  • Orthopedic (Orthopaedic) Surgeon
  • Pain Medicine Physician/Pain Specialist
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Psychiatrist
  • Rheumatologist

Comorbid Conditions

Factors Influencing Duration

The underlying cause, extent of treatment, presence of complications, and individual response to treatment will influence the length of disability. Disability duration is affected by tolerance.

Medical Codes

ICD-9-CM:
729.5 - Other Disorders of Soft Tissue; Pain in Limb

Overview

Pain in limb is a term used to describe discomfort affecting any part of a limb or extremity (such as an elbow or knee) or the entire limb (arm or leg). The term is general in nature and could be used to describe pain that arises from various causes. The pain may arise from the skin, nerves, muscles, bones, joints, or even the brain (in psychogenic or phantom pain). Arm pain may arise from pathology in the neck (cervical spine), whereas leg pain may originate in the low back (lumbar spine). Typically, the term "pain in the limb" would be used to describe a person's symptoms until a definitive diagnosis is made (such as broken arm, tendinitis, or peripheral neuropathy).

Incidence and Prevalence: In the United States, the incidence of musculoskeletal disorders associated with repetitive activities is 23.8 per 100,000 working individuals (CDC).

The prevalence of upper extremity musculoskeletal disorders ranges from 2.3% to 41%, with a lifetime prevalence of 29% (Huisstede).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk for pain in limb is difficult to determine. As we age, musculoskeletal pain is more common. Unhealthy aging may be accompanied by both musculoskeletal and medical conditions that may generate pain. Every individual will experience some pain yearly. Usually this type of musculoskeletal pain is self-limiting and will improve with time. The traditional approach of modifying activities is included in the RICE approach (R for rest = modified activity, I for Ice, C for compression, E for elevation). In addition to age, obese individuals are 30% to 50% more likely than individuals who are not obese to develop psychosocial factors (somatization) with painful symptoms (Molenaar). Depression also can contribute to musculoskeletal pain. The key to risk and causation is to determine the underlying medical condition that is causing the pain in limb.

Source: Medical Disability Advisor



Diagnosis

History: The history will depend on the underlying medical condition that is causing the pain in limb. The individual may complain of discomfort in all or part of an extremity. Individuals may use other descriptive terms such as burning, throbbing, aching, or stabbing to further explain the type of discomfort they are experiencing. The history should include additional information such as how the pain began, exactly where the pain is, and the factors that increase or relieve the pain, as well as a history of an injury, strain, or trauma that preceded the onset of pain.

Physical exam: Also, the physical exam will depend on the underlying medical condition that is causing the pain in limb. The physical examination may be entirely normal or may reveal tender spots, obvious deformities, redness, warmth or coolness, or swelling at the affected site. Range of motion in the affected limb may be limited, and the limb may be weaker in strength than other limbs. The affected site may also demonstrate alterations in sensation (such as numbness or tingling).

Tests: Blood tests may be done to check for arthritis and other diseases that affect the entire body (systemic disease). Imaging tests (x-rays, CT scans, MRI) may be done to detect abnormalities in the bone, joint, or tissue. X-ray exams of the arteries within the limb (arteriogram) may reveal the presence of blood clots (thrombi) or dilated and weakened blood vessels (aneurysms). Tests to detect nerve damage (nerve conduction velocity studies) or to evaluate the electrical activity of muscles (electromyography) may be done.

Source: Medical Disability Advisor



Treatment

Treatment depends upon the limb affected and the diagnosis if an underlying medical condition can be found. The treatment will vary according to the underlying cause. Treatment with painkillers (analgesics) must be preceded by or coexist with a thorough diagnostic workout in order to identify the specific underlying cause. Treatment that includes development of home exercise programs and behavior modification can help.

Source: Medical Disability Advisor



Prognosis

The prognosis depends on the underlying cause and treatment thereof and can range between full recovery and prolonged disability.

Source: Medical Disability Advisor



Rehabilitation

Occasionally, physical or occupational therapy may be helpful in providing insight to the individual on how to preform ADLs and how to remain physically activity. The therapist can answer questions regarding dos and don’ts and improve functional outcomes even if the pain is chronic. Development of home exercise programs and behavior modification are important.

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistPain in Limb
Physical or Occupational TherapistUp to 4 visits within 6 weeks

Source: Medical Disability Advisor



Complications

Chronic pain may be accompanied by issues of dependence and depression and can significantly affect treatments and outcomes. In cases in which pain persists but no cause is identified with objective testing, psychosocial factors (somatization) may be involved.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

If no underlying medical condition for the chronic pain can be identified, the ability to work or return to work will depend on tolerance. Tolerance will impact the nature of the pain and the degree of disability present. In general the more physically active is the individual the better the long term outcome and the better the individual will retain the functional capacity.

Risk: Risk for injury is difficult to determine. Risk would depend on the underlying medical condition. For example, see the topics Carpal Tunnel Syndrome or Rotator Cuff Tear for specific risk factors. For the individual without a specific underlying medical condition, the risk of persistence of pain increases with increasing time away from work and physical activities. The problem is that the individual hurts and therefore elects to be less active, increasing the likelihood of a poor outcome.

Capacity: Capacity is determined by the underlying medical condition. Specific capacity should be determined by review of the appropriate section once a specific diagnosis is made. If the condition is chronic pain or pain-in-limb, the capacity is usually limited only by pain, and hence is limited by tolerance. Although the physical capacity is there, the individual elects to limit capacity or function because of the pain.

Tolerance: Tolerance for symptoms such as pain or altered sensation determines the return-to-work trajectory in most cases. If the underlying medical condition can not be identified, then the presence of pain is difficult to determine. As a result, only the individual can choose his or her level of tolerance. The higher the tolerance, the better the function, and the better the prognosis.

Accommodations: Temporary accommodations may allow an individual to stay at work or return to work; however, their likelihood of remaining at work will be determined by their tolerance.

Source: Medical Disability Advisor



Maximum Medical Improvement

Pain in limb is a symptom, not a diagnosis, and therefore does not have a specific associated MMI.

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 pain in limb being used as a temporary diagnosis until a more exact one can be made?
  • Did exam reveal any tender spots, deformities, redness, warmth, coolness, or swelling at the affected site?
  • Were range of motion and strength affected?
  • Is there any numbness or tingling?
  • Has individual received x-rays, a CT scan, MRI, arteriogram, nerve conduction studies, or electromyography to definitively diagnose the underlying problem?
  • If no obvious reason for the pain could be determined, was the individual seen by a mental health practitioner to rule out psychogenic causes for pain?

Regarding treatment:

  • Have appropriate interventions been used to treat the underlying problem (such as splinting for fractures, etc.)?
  • Does individual need rehabilitation? Ergonomic assessment?
  • Is individual compliant with treatment recommendations?

Regarding prognosis:

  • Can individual's employer accommodate any needed restrictions?
  • Does individual have any chronic comorbid conditions, such as cancer or autoimmune disorders, that may affect recovery?
  • Has individual received mental health intervention as appropriate?
  • Has individual been referred to a pain clinic?
  • Has individual had a complete psychiatric evaluation?

Source: Medical Disability Advisor



References

Cited

"Disorders Associated with Repeated Trauma. In Chapter 2: Fatal and Nonfatal Injuries, and Selected Illnesses and Conditions." Worker Health Chartbook 2004. NIOSH Publication No. 2004-146 ed. Centers for Disease Control and Prevention, 2004.

"Musculoskeletal Disorders." U.K. Health and Safety Executive. 2 Dec. 2008. 19 Apr. 2013 <http://www.hse.gov.uk/statistics/causdis/musculoskeletal/index.htm>.

Huisstede, B., et al. "Incidence and Prevalence of Upper-Extremity Musculoskeletal Disorders: A Systemic Appraisal of the Literature." BMC Musculoskeletal Disorders 7 7 (2006): 1471-2474.

Molenaar, E. A., et al. "Considerable Comorbidity in Overweight Adults: Results from the Utrecht Health Project (translation of article in Dutch)." Ned Tijdschr Geneeskd 152 45 (2008): 2457-2463.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.