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.

Paresthesia


Related Terms

  • Neuropathic Pain
  • Numbness and Tingling
  • Pins and Needles
  • Sensation Disturbance

Differential Diagnosis

  • Alcoholic neuropathy
  • Carcinomatous neuropathy (breast or lung cancer)
  • Diabetic neuropathy
  • Entrapment neuropathies (carpal tunnel, cubital tunnel, radial tunnel, tarsal tunnel, meralgia paresthetica, peroneal neuropathy)
  • Guillain-Barré syndrome
  • Human immunodeficiency virus (HIV)
  • Hypocalcemia
  • Medication side effect
  • Multiple sclerosis
  • Radiculopathy (cervical or lumbar)
  • Restless legs syndrome
  • Stroke (infarction)
  • Systemic lupus erythematosus (SLE)
  • Toxicologic conditions
  • Vitamin B12 deficiency

Specialists

  • Endocrinologist
  • Family Physician
  • General Surgeon
  • Hematologist
  • Internal Medicine Physician
  • Medical Toxicologist
  • Neurologist
  • Orthopedic (Orthopaedic) Surgeon
  • Pharmacologist
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Preventive Medicine Specialist

Comorbid Conditions

Factors Influencing Duration

Length of disability is based on the primary disease, not the paresthesia. However, paresthesia can complicate the primary disease and influence the length of disability.

Medical Codes

ICD-9-CM:
782.0 - Symptoms Involving Skin and Other Integumentary Tissue; Disturbance of Skin Sensation; Anesthesia of Skin; Burning or Prickling Sensation; Hyperesthesia; Hypoesthesia; Numbness; Paresthesia; Tingling

Overview

Paresthesia is a symptom, not a disorder. It refers to an abnormal sensation that can occur without any apparent cause, although paresthesias also may occur in response to a stimulus such as hitting the "funny bone." Paresthesias are described as a tingling sensation, "pins and needles," prickling, electric shocks, burning, vibrating, buzzing, or crawling. Paresthesias also have been described as a sensation of the limb "falling asleep." Paresthesias may occur from abnormalities in the central nervous system (brain and spinal cord), the peripheral nervous system, or from direct compression of peripheral nerves.

Paresthesias are symptoms of many different conditions including entrapment neuropathies (e.g., carpal tunnel syndrome, cubital tunnel syndrome, radial tunnel syndrome, meralgia paresthetica), spinal nerve compression (e.g., cervical and lumbosacral radiculopathy), trauma, restless leg syndrome, metabolic disturbances (e.g., diabetic neuropathy, vitamin B12 deficiency, hypothyroidism, alcoholism), kidney disease, exposure to toxic chemicals (e.g., mercury, arsenic), and inflammatory connective tissue disorders (e.g., arthritis, systemic lupus erythematosus). Less common causes of paresthesias include cancer, human immunodeficiency virus (HIV), hypocalcemia, malabsorption, multiple sclerosis, stroke, Guillain-Barré syndrome, and use of certain medications (e.g., isoniazid, vincristine, diuretics, nonsteroidal anti-inflammatory drugs [NSAIDs]). Nonspecific numbness and tingling of the face, arms, and hands also is common in hyperventilation syndrome and panic attacks.

Incidence and Prevalence: Because paresthesia is a symptom rather than a diagnosis, there are no incidence statistics available for paresthesia itself. Incidence statistics vary according to the causative condition.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Because paresthesia is a symptom of other conditions, there are no specific risk factors. These vary according to the causative condition.

Source: Medical Disability Advisor



Diagnosis

History: Individuals complain of sensations of tingling, “pins and needles,” prickling, electric shocks, burning, vibrating, buzzing, crawling, or of a limb "falling asleep.” Individuals may report the presence of other symptoms such as pain, numbness, weakness, stiffness, or clumsiness. Important information obtained from the history includes location of the paresthesia, how long it has been present, and if the paresthesia worsens in any particular position or when engaged in a specific activity.

Physical exam: The exam may reveal decreased sensation over the involved area. Tinel's sign (distal tingling or electric shock sensation) is elicited by tapping the area over an entrapped nerve and is a sign of irritability of a nerve at the location stimulated by the tap. Tinel's sign may be present with carpal tunnel and cubital tunnel syndromes. Phalen's sign is elicited by sustained flexion of the wrist, which may increase median nerve paresthesia if carpal tunnel syndrome is present. Physical examination also may reveal presence of nerve root pain (radiculopathy) that is due to narrowing of the spinal canal (spinal stenosis) or nerve root opening in the cervical or lumbar spine, with decreased strength, sensation, and reflexes relating to the affected nerve root. Individuals with diabetic neuropathy may have bilateral loss of sensation to pain, touch, temperature, vibration, and proprioception. Many paresthesia manifestations occur with multiple sclerosis. Physical examination of individuals with Guillain-Barré syndrome may reveal increasing paralysis and decreasing reflexes (hyporeflexia).

Tests: Specific laboratory blood testing is indicated. A vitamin B12 blood level below 200 pg/ml indicates vitamin B12 deficiency (Oh). The blood calcium level also may be abnormal. Testing for blood sugar levels and thyroid function should be performed. Elevated antinuclear antibody levels may indicate an underlying rheumatologic condition (Moses). Abnormally elevated liver function tests and an elevated mean corpuscular volume may suggest alcohol abuse. Blood screening for heavy metals may also be appropriate.

Electromyography (EMG) and nerve conduction tests can rule out nerve dysfunction. In restless legs syndrome, polysomnography can demonstrate periodic movements during sleep. A magnetic resonance imaging (MRI) or computed tomography (CT) scan of the head may be used for diagnosis of multiple sclerosis or stroke. A spinal tap is used to obtain cerebrospinal fluid samples for diagnosis of Guillain-Barré and multiple sclerosis.

Source: Medical Disability Advisor



Treatment

Treatment for paresthesia is based on the underlying cause of the symptom. For example, carpal tunnel syndrome is treated with wrist splints, anti-inflammatory medications, or surgical decompression. Cubital tunnel syndrome is treated with splinting or surgical decompression. Compression of a nerve in the lower leg (the common peroneal nerve) may be relieved by not crossing the legs. Meralgia paresthetica, a condition characterized by numbness, tingling, and burning pain in the outer part of the thigh due to compression of the lateral femoral cutaneous nerve, usually improves with symptomatic and supportive treatment. Spinal radiculopathies are treated by avoiding activities that increase pain, following a physical therapy regimen, taking NSAIDs, corticosteroid injections, and surgery when relief is not obtained through previous therapies. Diabetic neuropathy is treated by tighter control of blood sugar levels, physical activity, and medications including NSAIDs, antidepressants, anticonvulsants, and opioids (“Diabetic Neuropathies”). Vitamin B12 deficiency is treated with vitamin supplementation. Guillain-Barré syndrome is treated with plasma exchange therapy (plasmapheresis) and intravenous immune serum globulin. Multiple sclerosis may be treated with corticosteroid medications, disease immunomodulating agents (e.g., beta-interferon, glatiramer acetate), antispasticity agents, bladder antispasmodics, selective serotonin re-uptake inhibitors, and antidepressants (Campagnolo).

Source: Medical Disability Advisor



Prognosis

Outcome depends on the underlying condition. Many individuals with mild entrapment neuropathies do well with conservative treatment; for example, approximately 90% of individuals with mild to moderate carpal tunnel syndrome respond to conservative treatment when started promptly at the onset of symptoms (Ashworth). Outcome of spinal radiculopathies varies according to the underlying cause of nerve entrapment. Diabetic neuropathy is progressive in individuals with poor control of blood sugar levels, and may be disabling. Neuropathy due to vitamin B12 deficiency is highly treatable with vitamin B12 supplementation. The outcome following Guillain-Barré syndrome is variable and recovery slow, but intervention with plasmapheresis or intravenous immune serum globulin within 4 weeks of disease onset can shorten recovery time by 50% (Miller). Multiple sclerosis may become progressively disabling, with 30% to 50% of individuals experiencing neuropathic pain and paresthesias (Campagnolo).

Source: Medical Disability Advisor



Complications

Paresthesia is a symptom that can cause complications of the primary or underlying disease causing its occurrence. For example, individuals with paresthesias can have difficulty with ambulation or grasping items in their hands when a particular extremity is affected. Individuals with impaired sensation may be unable to detect an injury (e.g., burn, puncture wound), which may result in limb- or life-threatening infection. Loss of sensation in the feet can lead to an increased risk of falling.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Accommodations may include work environment design to avoid self-injury. Individuals with carpal tunnel syndrome and other nerve entrapment syndromes may need to avoid activities that exacerbate symptoms. Ergonomic keyboards and reconfiguring the work area may be necessary to help keep the wrist and arm in proper alignment. Individuals with cervical or lumbar radiculopathy may require work restrictions and accommodations to prevent exacerbation of the symptoms and of the underlying condition. These individuals often are unable to lift and bear weight and may be unable to sit for prolonged periods. Individuals with paresthesias due to diabetic neuropathy may need the opportunity to regularly monitor their blood sugar level and receive appropriate management, which may include insulin. Time off for follow-up care may be required for individuals with multiple sclerosis, systemic lupus erythematosus, or alcoholism. Workplace exposures to potential toxins may need to be modified using appropriate industrial hygiene techniques.

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:

  • Does individual have a history of carpal tunnel syndrome, cubital tunnel syndrome, meralgia paresthetica, neck (cervical) or lower back (lumbosacral) problems, arthritis, restless leg syndrome, diabetic neuropathy, vitamin B12 deficiency (pernicious anemia), hypothyroidism, or alcoholism?
  • Does individual have a history of cancer, human immunodeficiency virus (HIV), hypocalcemia, malabsorption, multiple sclerosis, stroke, systemic lupus erythematosus, or Guillain-Barré syndrome?
  • Does individual have a history of workplace or other exposure to toxins that may cause paresthesias (e.g., heavy metal, solvents)?
  • Does the individual experience sensations of a limb falling asleep, tingling, pins and needles, prickling, electric shock, burning, vibrating, buzzing, or crawling?
  • Where are these sensations located and how long have they been present?
  • Does the paresthesia worsen or improve with position change or with a specific activity?
  • Does individual report pain, numbness, weakness, stiffness, or clumsiness?
  • Were electromyography (EMG) and nerve conduction testing done to rule out nerve dysfunction?
  • If restless leg syndrome was suspected, was polysomnography done?
  • If multiple sclerosis or stroke was suspected, was MRI performed?
  • Did a spinal tap (lumbar puncture) rule out Guillain-Barré syndrome and multiple sclerosis?
  • Was blood tested to determine if liver function levels were elevated? Were blood sugar levels, thyroid levels, vitamin B12 and calcium levels obtained? Any abnormalities?
  • Is alcohol abuse a factor?
  • Was the underlying cause for the paresthesia diagnosed?

Regarding treatment:

  • Has the underlying cause been identified and confirmed?
  • If carpal tunnel syndrome or cubital tunnel syndrome is the cause, have splints, anti-inflammatory medications, or surgical decompression been used? Did this relieve the paresthesia?
  • If vitamin B12 or calcium deficiency is the cause, has individual received appropriate supplementation?
  • If individual has Guillain-Barré syndrome, have plasmapheresis been done and / or intravenous immune serum globulin administered?
  • Is multiple sclerosis being treated with appropriate medications?
  • If individual has diabetes, is blood sugar level adequately controlled? Is individual physically active? Are medications needed to control blood sugar level and / or parasthesia symptoms?
  • Would individual benefit from an alcohol cessation program?
  • Have appropriate industrial hygiene or other measures been undertaken to control toxic exposures?

Regarding prognosis:

  • What is the underlying condition causing the paresthesia? Is underlying condition responding to treatment? If not, what other treatments are available?
  • Is individual compliant with all medication and treatment regimens for the underlying condition?
  • Could there be another condition or reason for the paresthesia?
  • Given enough time to heal, is it likely the paresthesia will resolve?
  • Have any complications occurred as a result of the underlying disorder? If so, what are they and what is expected outcome with treatment?

Source: Medical Disability Advisor



References

Cited

Ashworth, Nigel L. "Carpal Tunnel Syndrome." eMedicine. Eds. Benjamin M. Sucher, et al. 8 Dec. 2008. Medscape. 25 Aug. 2009 <http://emedicine.medscape.com/article/327330-overview>.

Campagnolo, Denise I. , et al. "Multiple Sclerosis." eMedicine. Eds. Martin K. Childers, et al. 17 Jul. 2009. Medscape. 25 Aug. 2009 <http://emedicine.medscape.com/article/310965-overview>.

Dyck, Peter J., et al., eds. "Diabetic Neuropathies: The Nerve Damage of Diabetes." National Digestive Diseases Information Clearinghouse. Eds. Peter J. Dyck, et al. Feb. 2009. National Institute of Diabetes and Digestive and Kidney Diseases. 25 Aug. 2009 <http://diabetes.niddk.nih.gov/DM/pubs/neuropathies/index.htm#what>.

Miller, Andrew, Razi M. Rashid, and Richard H. Sinert. "Guillain-Barre Syndrome." eMedicine. Eds. Edward A. Michelson, et al. 1 Jul. 2009. Medscape. 25 Aug. 2009 <http://www.medscape.com/article/792008-overview>.

Moses, Scott. "Paresthesia." Family Practice Notebook. 10 May. 2008. 24 Aug. 2009 <http://www.fpnotebook.com/Neuro/Sensory/Prsths.htm>.

Oh, Robert C. , and David L. Brown. "Vitamin B12 Deficiency." American Family Physician 67 (2003): 979-986. American Academy of Family Physicians. Mar. 2003. 24 Aug. 2009 <http://www.aafp.org/afp/20030301/979.html>.

Shapiro, Barbara E., and David C. Preston. "Entrapment and Compressive Neuropathies." Medical Clinics of North America 93 2 (2009): 285-315. PubMed. <PMID: 19272510>.

General

Rowland, Lewis P. "Chapter 5: Diagnosis of Pain and Paresthesias." Merritt's Neurology. Ed. Lewis P. Rowland. 11th ed. Lippincott, Williams & Wilkins, 2005. 29-31.

Steinberg, David R. "Nerve Compression Syndromes." The Merck Manuals. Merck & Co., Inc. 24 Aug. 2009 <http://www.merck.com/mmpe/print/sec04/ch042/ch042f.html>.

Source: Medical Disability Advisor






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