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.

Pilonidal Cyst


Related Terms

  • Coccygeal Sinus
  • Hair-Containing Abscess or Cyst
  • Jeep Disease
  • Nest of Hair Disease
  • Pilonidal Abscess
  • Pilonidal Disease
  • Sacrococcygeal Cyst
  • Tailbone Abscess or Cyst

Differential Diagnosis

Specialists

  • Colon and Rectal Surgeon
  • Emergency Medicine Physician
  • Family Physician
  • General Surgeon
  • Infectious Disease Internist
  • Internal Medicine Physician

Comorbid Conditions

  • Endocrine disorders
  • Immune system disorders
  • Local hirsutism
  • Obesity

Factors Influencing Duration

The length of disability depends on the extent of sinus tract formation, surgical method employed, and development of complications following surgery.

Medical Codes

ICD-9-CM:
685.0 - Pilonidal Cyst; Fistula, Coccygeal or Pilonidal; Sinus, Coccygeal or Pilonidal, with Abscess
685.1 - Pilonidal Cyst; Fistula, Coccygeal or Pilonidal; Sinus, Coccygeal or Pilonidal, without Mention of Abscess

Overview

A cyst is a closed sac that contains a liquid or semisolid material. Pilonidal cysts usually are located at the bottom of the spine (sacrococcygeal pilonidal cyst) between the buttocks (gluteal cleft). In about half of all cases, pilonidal cysts contain hairs. Although usually harmless, pilonidal cysts can become infected by bacteria and walled off to form an abscess, a condition referred to as pilonidal cyst disease. A draining channel (sinus) or an abnormal tube-like passage (fistula) also may develop. The disease has been referred to as "Jeep disease" because so many US Army soldiers were diagnosed with the infected pilonidal cysts during World War II.

Pilonidal cysts are thought to be an acquired condition involving midline pits in the gluteal cleft. These pits are actually enlarged hair follicles in the skin. Gravity and movement of the buttocks create a vacuum that pulls on the hair follicle, allowing bacteria from the skin and/or the area between the genital organs and the anus and debris from the anus to enter this area, leading to local inflammation and infection. The resulting swelling (edema) closes the mouth of the follicle, while the follicle continues to expand and finally ruptures into the fatty tissue that underlies the area. This releases keratin (the principal component of hair) and pus, setting into motion a foreign body reaction that produces acute and chronic abscesses and sometimes fistulae.

Incidence and Prevalence: The incidence of pilonidal disease is 26 in 100,000 individuals (Lanigan).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors associated with the development of pilonidal cysts include repeated local traumatic irritation, sedentary occupation and lifestyle, obesity, family history of the disease, congenitally increased depth of the gluteal cleft, poor hygiene, and activities resulting in increased sweating. Those individuals who have dark, stiff, or coarse hair tend to develop the disease more frequently. The disease most often affects individuals between the ages of 15 and 24, with the average age at presentation of 21 years in males and 19 years in females (Lanigan).

The ratio of men to women in developing pilonidal cysts is 3:1 to 4:1 (Lanigan). Although the disease occurs in all races, it occurs much more frequently in whites.

Source: Medical Disability Advisor



Diagnosis

History: A pilonidal cyst generally produces no symptoms until it becomes infected. Many individuals do not seek medical attention until they experience progressive tenderness after physical activity or a period of prolonged sitting, such as during a long drive. When cysts become infected, forming an abscess, individuals may report local pain, tenderness, and swelling. On occasion, the individual may also have chills, fever, and generalized discomfort (malaise). The cyst may suddenly drain pus (purulent material).

Physical exam: A cyst that looks like a swollen area or nodule, feels warm, and is tender to touch, will be apparent along the midline of the lower spine, approximately 1 to 2 inches (2 to 5 cm) above the anal opening. Channels (sinuses) and openings 1 to 2 inches (2 to 5 cm) in length may be seen in chronic or recurrent disease. Foul-smelling pus may drain from the lesion, and a tuft of fine hair may protrude from the cyst. The surrounding area may appear reddened. A manual anorectal examination may be performed to detect fistulae or other defects. If any defect is detected by the manual exam, a short, tubular instrument (anoscope) will be used to view the rectum (anoscopy).

Tests: A laboratory culture of pus may be performed to identify the bacteria responsible for the infection. A complete blood count (CBC) will done to determine if there is an increase in white blood cells, which indicates an infection. In individuals with advanced recurrent disease, a computed tomography (CT) scan may be performed.

Source: Medical Disability Advisor



Treatment

Asymptomatic pilonidal cysts require only observation and information on improving hygiene practices, including keeping the area free of hair. Additionally, patients should be instructed to avoid sitting for long periods, and, if overweight they should strive to lose weight. In first-time acute episodes of the disease with abscess formation, the treatment of choice is simple incision and drainage, which is done on an outpatient basis. With incision and drainage, the individual lies face down (prone) and the area is cleaned and prepped with an iodine solution before a local anesthetic is injected. A small incision is made off the midline, the abscess is drained, and hair and other debris are removed. The wound is then packed loosely with gauze to allow continued drainage over the following 2 days. Afterwards, the individual is encouraged to clean the site with warm sitz baths or showers 2 to 3 times per day for 1 to 2 weeks (Lanigan). The individual is advised to avoid prolonged sitting.

If minimal surgical procedures fail to keep pus from forming, opening of sinus tracts may be indicated. In this procedure, the sinus tracts are opened surgically, granulation tissue at the base of the sinus is scraped away (débrided), the edges of skin are cut away (excised), and the wound is kept clean and is allowed to heal (open wound procedure). A skin graft or flap may be used to reduce the risk of infection and shorten healing time (closed wound procedure) (Mayo Clinic).

In individuals with chronic disease, complete excision may be performed. This procedure includes excision of the cyst area and all other affected skin areas and tissues (i.e., both the cyst and the sinus tract are removed). The wound is then either left open or closed as part of the surgery. Alternatively, an incision with marsupialization may be performed. This is a lengthy surgical procedure in which the cyst is incised and stitched (sutured) to form a pouch that allows the wound to slowly drain and heal. Analgesics and antibiotics are used as needed, but antibiotics are not necessary in the majority of cases; they generally are used only in cases where spreading infection (cellulitis) is suspected.

After an excision procedure with a primary closure (which also includes a drain for flushing the operative area with an antiseptic solution), individuals are typically hospitalized for 1 to 3 days, and have their stitches removed in 2 weeks (Al-Khayat).

Source: Medical Disability Advisor



Prognosis

The outcome is generally favorable but depends upon the surgical method employed. Conservative treatment can be effective in minor pilonidal disease, with a cure rate of 73% (Velasco). The recurrence rate after simple incision and drainage performed for first-time acute episodes of the disease is 40% to 50% (Lanigan). With open excision procedures, cysts generally recur between 1% and 6% of the time (Prasad). Excision and wound closure using skin grafts or flaps usually is successful. With marsupialization, the average healing time is 4 weeks, and the recurrence rate is 6% (Velasco).

Source: Medical Disability Advisor



Complications

Pilonidal cysts may progress to form extensive sinus tracts and fistulae. Up to 1% of individuals who have experienced pilonidal cysts for a very long period (i.e., years) are at risk for developing aggressive squamous cell carcinoma at the affected site (Prasad). Other complications include recurrence, infection, and abscess; overall, the risk of wound infection is 12.8% and is most frequent in individuals who are obese and in those who smoke (Al-Khayat). After surgical excision and drainage, poor wound healing is common.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

A pilonidal cyst may affect the individual's ability to walk, stand, or sit for extended periods, so temporary accommodations may be necessary. Operation of a vehicle may temporarily be limited; depending on work duties, the individual may need to be temporarily reassigned. If pain medication is needed, company policy on medication use should be reviewed to determine if medication usage 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 individual a young white male with stiff, coarse, or dark hair? Obese?
  • Is there a family history of the disease?
  • Does individual have a sedentary lifestyle?
  • Has individual had repeated local traumatic irritation?
  • Does individual report participating in activities resulting in increased sweating?
  • Did individual report local pain, tenderness, and swelling?
  • Is the cyst symptomatic or asymptomatic?
  • Did individual have chills, fever, or malaise?
  • On exam, was the cyst located about 1 to 2 inches above the anus?
  • Were channels and openings apparent?
  • Was purulent drainage present?
  • Was there a tuft of hair present?
  • Was a manual anorectal exam done? An anoscopy?
  • Have a culture and sensitivity testing of the pus been done?
  • Was a CBC done?
  • Have conditions with similar symptoms been ruled out, and has a definitive diagnosis of pilonidal cyst disease been established?
  • If individual has an advanced recurrent disease, was a CT scan done?

Regarding treatment:

  • If asymptomatic, is cyst it being observed?
  • Has individual received information on improving hygiene practices?
  • Did abscess or sinus tract form?
  • Were antibiotics necessary?
  • Did surgery become necessary? Which type of procedure?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect the ability to recover?
  • If surgery was necessary, did wound infection occur?
  • Has individual experienced pilonidal cysts for a very long time?
  • Has aggressive squamous cell carcinoma developed at the site?
  • Does individual have recurrent infections or abscess?

Source: Medical Disability Advisor



References

Cited

Al-Khayat, Haitham, et al. "Risk Factors for Wound Complication in Pilonidal Sinus Procedures." Journal of American College of Surgeons 205 3 (2007): 439-444. MD Consult. Elsevier, Inc. 15 Oct. 2009 <http://www.mdconsult.com/das/article/body/164993623-3/jorg=journal&source=MI&sp=19942592&sid=902632846/N/606735/1.html?issn=1072-7515>.

Lanigan, Michael D. "Pilonidal Cyst and Sinus." eMedicine. Eds. Jerry Balantine, et al. 6 Aug. 2009. Medscape. 15 Oct. 2009 <http://emedicine.medscape.com/article/788127-overview>.

Mayo Clinic Staff. "Pilonidal Cyst." MayoClinic.com. 17 Jun. 2009. Mayo Foundation for Medical Education and Research. 15 Oct. 2009 <http://www.mayoclinic.com/health/pilonidal-cyst/DS00747>.

Prasad, Arundathi G., , and . "Pilonidal Disease." Ferri's Clinical Advisor: Instant Diagnosis and Treatment. Mosby, Inc., 2010. MD Consult. Elsevier, Inc. <http://www.mdconsult.com/das/book/body/164993623-3/902632847/2088/499.html#4-u1.0-B978-0-323-05609-0.00025-3--s2895_10270>.

Velasco, Alfonso L., and Wade W. Dunlap. "Pilonidal Disease and Hidradenitis." Surgical Clinics of North America 89 3 (2009): 689-701. PubMed. 15 Oct. 2009 <http://www.ncbi.nlm.nih.gov/pubmed/19465205>.

General

Doerr, Steven E. "Pilonidal Cyst." MedicineNet.com. Ed. William C. Shiel. 2009. MedicineNet, Inc. 15 Oct. 2009 <http://www.medicinenet.com/pilonidal_cyst/article.htm>.

Source: Medical Disability Advisor






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