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.

Paraovarian Cyst


Differential Diagnosis

Specialists

  • General Surgeon
  • Gynecologist

Comorbid Conditions

Factors Influencing Duration

For individuals who have undergone surgery, the length of disability is determined by the type of surgery, the individual's recovery, and development of complications.

Medical Codes

ICD-9-CM:
752.11 - Embryonic Cyst of Fallopian Tubes and Broad Ligaments; Cyst: Epoophoron, Fimbrial, Paraovarian

Overview

A paraovarian cyst is a closed, fluid-filled sac that grows beside or near the ovary and fallopian tube, but is never attached to them. It is usually located on the broad connection (ligament) between the uterus and the ovary, and is often found on only one side (unilateral) of the uterus. It is thought to develop from embryological vestiges (Wolffian structures), the external covering of the Fallopian tubes (tubal epithelium), or the smooth serous membrane that lines the cavity of the abdomen (peritoneum). Paraovarian cysts are usually very small (ranging in size from 2 to 20 cm). These cysts have little clinical significance, occurring asymptomatically as incidental findings during other pelvic examinations and surgeries. Most often, they are diagnosed as benign ovarian cysts or as fluid-filled distentions of the fallopian tube (hydrosalpinx).

Although known for their small size, paraovarian cysts can sometimes grow larger, especially during pregnancies. Unlike the small cysts, the larger cysts are usually symptomatic. Depending on their size and location, large paraovarian cysts can put pressure on the bladder or bowel, and cause pelvic pain or pain during sexual intercourse (dyspareunia).

Incidence and Prevalence: Paraovarian cysts are relatively common and account for 10% of all pelvic masses (Barloon).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The smaller cysts are most commonly found in middle-aged women (in the 30 to 40 years of age group), and are often indistinguishable from simple ovarian cysts. Larger paraovarian cysts tend to develop in younger women, quite often during a pregnancy, at which time they have a tendency to grow rapidly.

Source: Medical Disability Advisor



Diagnosis

History: Many individuals with small paraovarian cysts report no symptoms. However, individuals with larger paraovarian cysts frequently complain of pelvic pain, usually on one side (unilateral), irregular periods, abnormal uterine bleeding, and pain during sexual intercourse (dyspareunia).

Physical exam: Paraovarian cysts may be discovered when the physician presses with the hands (palpation) on the lower abdomen, or when he or she inserts one or two fingers into the vagina while pressing with the other hand on the abdomen.

Tests: Both an ultrasound scan and a visual exam (using a thin, lighted microscope inserted into the abdomen, or a laparoscopy) are used to confirm the diagnosis, size, and location of a paraovarian cyst.

Source: Medical Disability Advisor



Treatment

Most paraovarian cysts that remain small and asymptomatic do not require treatment; sometimes they disappear on their own. Surgical removal of the cyst (laparoscopic cystectomy) is usually indicated for young girls who have not reached puberty, those with an ovarian mass, and for postmenopausal women. A laparoscopic cystectomy enables the surgeon to insert a tiny scope into the abdomen to determine whether more extensive surgery is needed. Sometimes, it is possible to remove the cyst during the laparoscopic procedure.

However, if the cyst is larger than 4 inches (10 cm), is complex, increasing in size, persists after several months, is solid, dense, and irregularly shaped, or is infected, bleeding or ruptured, more invasive surgery (cystectomy) may be required. Such cysts pose a problem if they put pressure on pelvic structures, thus risking damage to them, and cause pelvic pain or pain during sexual intercourse (dyspareunia).

Source: Medical Disability Advisor



Prognosis

In instances where the individual is not pregnant, a complete recovery can be expected; surgical removal of the cyst is curative and no recurrence is expected. In instances where the individual is pregnant, a complete recovery can be expected if surgery to remove the cyst is performed between 14 to 20 weeks gestation (particularly if it is very large, low in the pelvis, and not movable).

Source: Medical Disability Advisor



Complications

Complications that arise from paraovarian cyst include infection, bleeding, and rupture of the cyst. The rupture or bursting of a cyst is a medical emergency.

In pregnant women, the cyst causes the enlarging uterus to be pushed up, out, and to the opposite side of the pelvic region. Such repositioning may cause abnormal intrauterine fetal positioning and the period of gestation to be overestimated. During labor, abnormal uterine and fetal positions can make delivery difficult (dystocia). In the absence of timely intervention, damage to important pelvic structures may lead to intrauterine fetal death and life-threatening complications for the mother, such as rupture of the uterus. Additionally, the cyst may rupture due to compression by the uterus and the fetus.

Other less common complications include internal cystic bleeding (intracystic hemorrhage), and the formation of pus and its discharge (suppuration) from the cyst.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Possible work restrictions and accommodations include time off from work allotted for follow-up doctor appointments. More frequent examinations may be necessary if the individual is pregnant. If surgery is necessary, heavy lifting may need to be restricted temporarily.

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 diagnosis of paraovarian cyst been confirmed with a laparoscopy or ultrasound?
  • If the diagnosis was uncertain, were other conditions with similar symptoms such as ovarian cyst, hydrosalpinx, and tubo-ovarian abscess ruled out?
  • Has individual experienced symptoms associated with a large paraovarian cyst such as bladder or bowel pressure, pelvic pain or pain with intercourse?

Regarding treatment:

  • Was treatment unnecessary? If so, did individual receive periodic reevaluation to detect any changes in the ovarian cyst that would warrant treatment?
  • Was cyst removed laparoscopically, or was more invasive surgery involved?
  • Was emergency surgery indicated due to cyst rupture and bleeding?
  • Were any complications associated with the procedure itself, such as bleeding or infection?
  • Did cyst cause any damage to associated structures?
  • Have associated structural damage and / or complications been addressed in the treatment plan?
  • What will be the impact on recovery?

Regarding prognosis:

  • Was the treatment delayed due to pregnancy (beyond 20 weeks)?
  • Did individual suffer any complications with fetal positioning and delivery due to the size and location of the cyst?
  • Did individual suffer any other complications associated with the cyst such as bleeding, infection or rupture?

Source: Medical Disability Advisor



References

Cited

Barloon, T. J., et al. "Paraovarian and Paratubal Cysts: Preoperative Diagnosis Using Transabdominal and Transvaginal Sonography." Journal of Clinical Ultrasound 24 3 (1996): 117-122. National Center for Biotechnology Information. National Library of Medicine. 16 Dec. 2004 <PMID: 8838299>.

Source: Medical Disability Advisor






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