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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.

Peripheral Neuropathy


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Maximum Medical Improvement | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
356.0 - Hereditary Peripheral Neuropathy; Dejerine-Sottas Disease
356.8 - Peripheral Neuropathy, Other Specified Idiopathic; Supranuclear Paralysis
356.9 - Hereditary and Idiopathic Peripheral Neuropathy, Unspecified

Related Terms

  • Distal Sensorimotor Neuropathy
  • Peripheral Neuritis
  • Proximal Motor Polyneuropathy

Overview

Peripheral neuropathy is a condition caused by damage to nerves in the peripheral nervous system. The peripheral nervous system consists of nerves that connect the brain and spinal cord (central nervous system) to the rest of the body (muscles, glands, and internal organs).

Most neuropathies are caused by damage or irritation to the conducting fibers of the nerves (nerve axons) or to the fatty insulating substance protecting the nerve (myelin sheaths). Nerve axons may suffer a thinning, patchy, or complete loss of their myelin sheath that results in slowed or a complete block of electrical impulses.

Neuropathies are classified according to the site, extent, and distribution of damage. Distal neuropathy starts with damage to the end of a nerve farthest from the brain or spinal cord. Damage to a single nerve is called mononeuropathy, and damage to several nerves is called polyneuropathy. Neuropathies can also be described according to their underlying cause such as diabetic neuropathy or alcoholic neuropathy.

Incidence and Prevalence: The incidence varies with the specific type of neuropathy.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Degenerative changes in one or more nerves may be the result of an injury, metabolic upset (e.g., diabetes, kidney disease, liver disease, thyroid disease), poisoning, inflammation from a viral infection (e.g., shingles [varicella-zoster], Epstein-Barr virus, hepatitis C, HIV), bacterial infection (e.g., Lyme disease, leprosy, diphtheria), autoimmune disorder (e.g., rheumatoid arthritis, systemic lupus erythematosus, Guillain-Barré syndrome, Sjögren syndrome, chronic inflammatory demyelinating polyneuropathy, necrotizing vasculitis), inherited disease (Charcot-Marie-Tooth disease), vitamin deficiency (e.g., B1 [thiamine], B4 [niacin], B6 [pyridoxine], B9 [folic acid], B12 [cobalamin], vitamin E), or tumors. The most common causes of peripheral neuropathy are diabetes and alcoholism.

Source: Medical Disability Advisor



Diagnosis

History: Individuals with peripheral neuropathy usually report three types of symptoms: changes in sensation, changes in movement, and/or changes in bodily functions (autonomic nervous system changes). The most common sensation changes are tingling and numbness in the hands and feet (the longest nerves), which may progress to a burning/pricking sensation or pain. Changes in movement may include muscle weakness, lack of muscle control, and muscle atrophy. Autonomic changes may include blurred vision, decreased or absent sweating (anhidrosis), dizziness or fainting when standing (orthostatic hypotension), nausea or vomiting after meals, urinary incontinence, and impotence (in males).

Physical exam: Characteristic physical findings include weakness and wasting in affected areas of the body with a loss of tendon reflexes. The skin may be sweaty or dry, hot or cold, pale or flushed. Sores (lesions) may erupt. Neurologic and muscular examination may reveal abnormalities in movement, sensation, and organ function.

Tests: Electromyography (a recording of electrical activity in the muscles), nerve conduction tests, and nerve biopsies may be performed to determine the extent of nerve damage. X-rays or other procedures may be performed. The suspected cause of the neuropathy, as determined by history and symptoms, guides necessary testing such as blood tests to rule out thyroid, liver, and renal abnormalities and tests for thiamine, vitamin B12, and folic acid levels. In individuals with suspected diabetic neuropathy, fasting blood glucose and hemoglobin A1c levels are measured. A test to measure inflammation, the erythrocyte sedimentation rate (ESR), may be elevated. A 24-hour urine screening for heavy metals may be indicated if individual has history of heavy metal exposure or work in certain industrial settings. Additional screens for HIV, heavy metals, and syphilis may rule out other etiologies.

Source: Medical Disability Advisor



Treatment

Treatment is directed toward the underlying cause. Treatment may include control of blood sugar levels, abstinence from alcohol, and specific nutritional supplementation for documented deficiencies. When neuropathy is caused by compression of a neighboring anatomic structure, surgical release or decompression may be necessary.

Over-the-counter analgesics or prescription pain medications may be needed to control pain (neuralgia). Inflammation may be treated with a short course of steroids. Transcutaneous electrical nerve stimulation (TENS) is also effective in reducing localized pain. Anti-seizure medications and certain tricyclic antidepressant drugs are often useful in controlling the burning and/or shooting pains characteristic of neuropathy. Some individuals may also benefit from physical and occupational therapy.

Source: Medical Disability Advisor



Prognosis

Full recovery from peripheral neuropathy may be possible if the underlying cause can be identified and successfully treated before nerve cell bodies are destroyed.

In some cases, partial or complete loss of movement, function, or sensation may result in disability. Nerve pain may be extremely uncomfortable and persist for a prolonged period. Rarely, the neuropathy may cause life-threatening symptoms such as rapid or irregular heartbeats (arrhythmias) or difficulty in breathing or swallowing.

Source: Medical Disability Advisor



Differential Diagnosis

  • Acromegaly
  • Acute inflammatory demyelinating polyradiculoneuropathy
  • Alcohol (ethanol) related neuropathy
  • Amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease)
  • Bladder outlet obstruction
  • Charcot-Marie-Tooth disease
  • Chronic inflammatory demyelinating polyradiculoneuropathy
  • Coagulopathies
  • Cytomegalovirus (CMV)
  • Diabetic neuropathy
  • Drug-induced paraneoplastic syndromes
  • Drugs
  • Electrolyte imbalance
  • Epstein-Barr virus
  • Gastrointestinal malignancy
  • Guillain-Barré syndrome
  • Heavy metal toxicity
  • Hepatitis C
  • Herpes infection
  • HIV
  • Hypothyroidism
  • Isoniazid
  • Kidney disease
  • Lambert-Eaton myasthenic syndrome
  • Leprosy
  • Liver disease
  • Lyme disease
  • Metabolic neuropathy
  • Mononeuritis multiplex
  • Myasthenia gravis
  • Myocardial infarction (MI)
  • Necrotizing vasculitis
  • Nerve entrapment and compression
  • Neuropathy of leprosy
  • Paraneoplastic autonomic neuropathy
  • Peptic ulcer disease
  • Poisoning
  • Postsurgical vagotomy
  • Rheumatoid arthritis
  • Sjögren syndrome
  • Systemic lupus erythematosus
  • Tumor
  • Uremia
  • Uremic neuropathy
  • Vacuolar myelopathy
  • Varicella zoster virus
  • Vasculitides
  • Vitamin B12 associated neurological diseases
  • Vitamin B6 intoxication
  • Vitamin deficiencies
  • Volume depletion

Source: Medical Disability Advisor



Specialists

  • Family Medicine Physician
  • Internal Medicine Physician
  • Neurologist
  • Neurosurgeon
  • Occupational Therapist
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Vocational Therapist

Source: Medical Disability Advisor



Rehabilitation

Rehabilitation of peripheral neuropathy depends on its cause. If the peripheral neuropathy is a result of a compressed nerve, immobilizing the affected area often relieves the symptoms. For example, the physical or occupational therapist may fabricate a wrist splint to relieve pressure on a nerve located within the wrist region.

The physical therapist uses techniques to help reduce the inflammation that may be causing pressure on a nerve resulting in peripheral neuropathy. Massage techniques affect the central nervous system and are used in rehabilitation to treat peripheral neuropathy by temporarily relieving pain. Physical therapy also uses massage to improve circulation of the limbs affected by this condition, and may use modalities such as TENS or hot or cold application to help relieve pain.

Improved circulation to the legs and feet can lead to relief from pain through a general exercise program created by the physical therapist. Strengthening exercises in addition to education with regard to the importance of activity address muscle weakness. Vocational therapy and occupational therapy may be recommended. Wheelchairs, braces, and splints may be necessary to improve mobility or the ability to use an affected extremity.

The rehabilitation program varies for individuals with peripheral neuropathy just as the intensity and progression of the exercise depend on the stage of the disease and overall health of the individual. If a chronic disease such as diabetes is causing the peripheral neuropathy, controlling the disease may not eliminate the neuropathy but may play a key role in managing it.

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

If the cell bodies of the damaged nerves have been destroyed, functional loss (sensory loss or muscle weakness) may become permanent. Complications are commonly associated with diabetic, amyloid, and hereditary sensory neuropathies. Other neuropathies may result in heightening of the arch of the foot (pes cavus), backward and lateral curvature of the spine (kyphoscoliosis), and loss of hair or ulceration in the affected area. X-ray examination may reveal loss of bone density, pathologic fractures, or joint disease (neuropathic arthropathy).

Source: Medical Disability Advisor



Factors Influencing Duration

Length of disability depends on the success of identifying and treating the underlying cause, the location of the nerve damage, the severity of the symptoms, and the amount of functional loss (sensory loss and/or muscle weakness).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and/or special accommodations depend on the site, extent, and distribution of nerve damage and must be determined on an individual basis. Lack of muscle control or decreased sensation may increase the risk of falls or other injury. Safety measures include hand railings and removal of obstacles. Safety measures for individuals experiencing lack of sensation may include adequate lighting and protective shoes. Individuals susceptible to nerve injury at pressure points need to avoid positions that result in prolonged pressure on these areas (e.g., kneeling, crossing the legs, or leaning on the elbows).

For more information refer to "Work Ability and Return to Work," pages 332–337.

Risk: Risk factors include the severity of any sensory, motor, or autonomic deficits. If sensation is impaired in the feet, risk of skin ulceration is a concern with job duties involving prolonged standing and walking. If gait and coordination are affected, the individual may be unsafe to work at heights and with hazardous equipment.

Capacity: Capacity may be reduced in individuals with job duties that require coordination, strength, or prolonged standing and walking. Functional testing or a trial of supervised work activity may be helpful in determining work ability.

Tolerance: Tolerance factors include whether the neuropathy is painful; however, affected individuals may choose to work despite pain. In general, reasonable participation in work activities may be beneficial to help improve circulation and manage pain.

Accommodations: Accommodations may be made on a case-by-case basis, and may include enabling the individual to use wheelchairs, braces, and splints as needed to improve mobility and the ability to perform work tasks.

Source: Medical Disability Advisor



Maximum Medical Improvement

180 days.

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 cause of peripheral neuropathy been confirmed (uncontrolled diabetes, alcoholism, active varicella zoster infection)?
  • Have nerve conduction tests been performed? Have nerve biopsies been taken? Are biopsies consistent with neuropathy or myelopathy?
  • What is the extent of neuropathy? Have nerve cell bodies been damaged? Will function be permanently affected?

Regarding treatment:

  • Is the underlying cause being effectively treated or controlled? By what standards?
  • Does treatment plan include nutritional supplements?
  • Has individual been able to abstain from alcohol?
  • Are analgesics or anti-seizure medications helping to relieve the pain? Tricyclic antidepressants?
  • Are steroids included in the treatment plan?
  • Would individual benefit from the use of a TENS device?
  • Was physical therapy prescribed for the individual? Is the individual compliant with physical therapy program?
  • If neuropathy was caused by compression of a neighboring anatomic structure, was surgical release or decompression effective in relieving symptoms?

Regarding prognosis:

  • Has underlying cause been identified and successfully treated before nerve cell bodies were destroyed? If diabetic, is the individual maintaining normal blood sugar levels?
  • If neuropathy is alcohol-induced, is the individual abstaining from alcohol? Would individual benefit from enrollment in a community program or support group?
  • Is neuropathy permanent?
  • Did neuropathy result in partial or complete loss of movement, function, or sensation?
  • How severe are the symptoms? Does individual have permanent disability?
  • Depending on the site, extent, and distribution of nerve damage, would work accommodations allow the individual to continue in same occupational duties?

Source: Medical Disability Advisor



References

Cited

Laker, Scott R. , et al. "Alcoholic Neuropathy." eMedicine. 21 Apr. 2015. Medscape. 27 Apr. 2015 <http://emedicine.medscape.com/article/315159-overview>.

Quan, Dianna, et al. "Diabetic Neuropathy." eMedicine. 29 May. 2014. Medscape. 27 Apr. 2015 <http://emedicine.medscape.com/article/1170337-overview>.

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011.

General

Rutchik, Jonathan S., et al. "Toxic Neuropathy." eMedicine. 30 Apr. 2014. Medscape. 27 Apr. 2015 <http://emedicine.medscape.com/article/1175276-overview>.

Source: Medical Disability Advisor