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.

Repetitive Strain Injury


Related Terms

  • CTD
  • Cumulative Trauma Disorder
  • MSD
  • Repetitive Motion Disorder
  • Repetitive Task Disorder
  • RSI

Differential Diagnosis

  • Any condition or diagnosis that can cause musculoskeletal pain

Specialists

  • Hand Surgeon
  • Orthopedic (Orthopaedic) Surgeon

Factors Influencing Duration

The response to treatment is often intermittent and inconsistent. Symptoms can remain disproportional to the clinical findings despite appropriately conservative medical care and reasonable modifications to the workplace.

For more information, refer to "Work Ability and Return to Work," page 209.

Medical Codes

ICD-9-CM:
354.0 - Carpal Tunnel Syndrome; Median Nerve Entrapment; Partial Thenar Atrophy
723.3 - Cervicobrachial Syndrome (Diffuse)
724.2 - Lumbago; Low Back Pain; Low Back Syndrome; Lumbalgia
726.32 - Lateral Epicondylitis; Golfers Elbow; Tennis Elbow
727.03 - Trigger Finger (Acquired)
727.04 - Radial Styloid Tenosynovitis; de Quervains Disease
729.5 - Other Disorders of Soft Tissue; Pain in Limb
840.3 - Sprains and Strains of Shoulder and Upper Arm, Infraspinatus (Muscle) (Tendon)
840.5 - Sprains and Strains of Shoulder and Upper Arm, Subscapularis (Muscle)
840.6 - Sprains and Strains of Shoulder and Upper Arm, Supraspinatus (Muscle) (Tendon)
840.8 - Sprains and Strains of Shoulder and Upper Arm, Other Specified Sites of Shoulder and Upper Arm
841.8 - Sprains and Strains of Elbow and Forearm, Other Specified Sites
841.9 - Sprains and Strains of Elbow and Forearm, Unspecified Site; Elbow NOS
842.00 - Sprains and Strains, Wrist, Unspecified Site
842.02 - Sprains and Strains, Wrist, Radiocarpal Joint
842.09 - Sprains and Strains, Wrist, Other; Sprains and Strains, Radioulnar Joint, Distal

Overview

Repetitive strain injuries (RSI), also known as cumulative trauma disorders (CTD), are labels for musculoskeletal pain that is associated with physical activity. All cases have in common the overuse of muscle-tendon units.

The terms RSI and CTD are often used indiscriminately; it is preferable to search for a specific anatomic diagnosis for a painful disorder based on the ICD-9 definitions instead of using the labels of RSI, CTD, or musculoskeletal disorders (MSD). (For more information, refer to "Work Ability and Return to Work," page 24.)

If the individual has pain with activities but still lacks a specific diagnosis, it would be appropriate to use Pain in Limb (ICD-9-CM 729.5), which is a billable medical code that can be used to specify a diagnosis on a reimbursement claim. In ICD-10-CM (2014), 729.5 converts approximately to Pain in Unspecified Limb (M79.609) (Melhorn, "Why Can't I Work?"). (For more information, refer to "Work Ability and Return to Work," page 205.)

For information on specific injuries that are often lumped into the category of repetitive strain injury, see Carpal Tunnel Syndrome, Radial Styloid Tenosynovitis, Epicondylitis Medial And Lateral, Trigger Finger or Thumb, Raynaud Phenomenon, and Low Back Pain.

Incidence and Prevalence: It is difficult to find incidence numbers for this topic as it represents a label for musculoskeletal pain rather than a specific diagnosis. For more information, refer to "Disease and Injury Causation," Chapter 11.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Each individual has unique risk factors for the likelihood of developing musculoskeletal pain. These include age, sex, inherited characteristics, deconditioning, increased body mass index (BMI), and biosocial traits (behavioral issues such as job dissatisfaction or conflict in the workplace, which may be confounding factors when interpreting complaints attributed to RSI). A job likely to cause repetitive strain also has unique risk factors commonly described by ergonomists as repetition, high force, awkward joint position, direct pressure, vibration, cold temperatures, and prolonged constrained posture. Work-related risk factors can be aggravated by inadequate work-rest cycles, excessive pace or duration of work, unaccustomed work and lack of task variability, and machine-paced work (Melhorn, “Causation”).

The suggested but currently scientifically unproven concept is that small but cumulative tissue damage results from performance of repeated and sustained tasks.

Source: Medical Disability Advisor



Diagnosis

History: There is gradual onset of symptoms (muscle pain or tenderness, stiffness, tingling or numbness, cramp, weakness, and loss of function) usually not associated with a specific acute injury. Symptoms often expand to areas other than the initial location.

Physical exam: The physical examination is usually normal, without specific, clinically observable signs that would suggest a specific anatomical diagnosis.

Tests: Multiple tests may be considered. The results are often normal, which support the labeling of Pain in Limb (ICD-9 729.5).

Source: Medical Disability Advisor



Treatment

Treatment usually involves nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy. The most successful approaches for this group of patients have been education and prevention of further injury. In general, the goal is to encourage maximum function and limit dysfunction.

Source: Medical Disability Advisor



Rehabilitation

Physical therapy modalities such as heat or cold packs, elastic support or splint, rest, and massage may be used.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

For more information, refer to "Work Ability and Return to Work," page 208.

Risk: For more information, refer to "Disease and Injury Causation," Chapter 11.

Capacity: Because the individual often lacks a specific musculoskeletal diagnosis, unless limited capacity is currently present on the basis of deconditioning, nonspecific hand and/or arm pain does not usually affect capacity.

Tolerance: Pain is the limiting factor for tolerance of work activities.

Accommodations: Since the primary component is musculoskeletal pain, employers willing to consider accommodations during the evaluation period, education, and return to work–stay at work phase are more likely to retain their employees.

Source: Medical Disability Advisor



Maximum Medical Improvement

Repetitive strain Injury is a label not a specific diagnosis. MMI is reached when no specific medical diagnosis can be determined.

Source: Medical Disability Advisor



Regarding diagnosis

Regarding diagnosis:
  • Does individual have gradual onset of symptoms?
  • Are symptoms not associated with one specific acute injury?
  • Is there expansion of symptoms to areas other than the initial location?

Regarding treatment:

  • Has individual been treated with NSAIDs?
  • What type of physical therapy was provided?

Source: Medical Disability Advisor



References

Cited

Melhorn, J. M. "Causation." 15th Annual AAOS Occupational Orthopaedics and Workers' Compensation: A Multidisciplinary Perspective. Eds. J. M. Melhorn and J. B. Talmage. American Academy of Orthopaedic Surgeons, 2013.

Melhorn, J. M. Unpublished paper given at the 14th Annual Occupational Orthopaedics and Workers' Compensation: Why Can't I Work? Eds. J. M. Melhorn and E. J. Carragee. American Academy of Orthopaedic Surgeons, 2012.

Melhorn, J. Mark, and William Ackerman, eds. Disease and Injury Causation, Guides to the Evaluation of. AMA Press, 2008.

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

Talmage, J. B., and J. M. Melhorn, eds. "Why Staying at Work or Returning to Work is in the Patient's Best Interest." A Physician's Guide to Return to Work. Chicago: AMA Press, 2005.

Source: Medical Disability Advisor






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