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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.

Rib Resection


Text Only Home | Graphic-Rich Site | Overview | Reason for Procedure | How Procedure is Performed | Prognosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Medical Codes | References

Medical Codes

ICD-9-CM:
77.61 - Local Excision of Lesion or Tissue of Bone, Scapula, Clavicle, and Thorac [Ribs and Sternum]
77.71 - Excision of Bone for Graft, Scapula, Clavicle, and Thorac [Ribs and Sternum]
77.81 - Other Partial Ostectomy, Scapula, Clavicle, and Thorax [Ribs and Sternum]
77.91 - Total Ostectomy, Scapula, Clavicle and Thorax (Ribs and Sternum)

Related Terms

  • Obtaining Bone Graft
  • Removal of Rib
  • Thoracic Outlet Syndrome

Overview

A rib resection is the surgical removal of a segment of rib or ribs. Resection may be necessary to treat fractures that are at risk for damaging lung tissue, to remove sections of rib damaged by diseases such as cancer, or to obtain bone for a bone graft. A rib resection may also be performed as part of the treatment for thoracic outlet syndrome. Thoracic outlet syndrome results from the compression of blood vessels or nerve fibers between the neck and the axilla.

Resection is commonly a part of surgical procedures that require access to the chest (thoracic) cavity. It is also done in the course of correcting a chest wall deformity called sunken chest (pectus excavatum).

Rib resection is a rare procedure.

Source: Medical Disability Advisor



Reason for Procedure

A rib resection is usually performed to gain access to organs in the chest cavity or to the kidneys or to use the rib as a bone graft in some other part of the body. A rib resection may also be done to drain an abscess between the diaphragm and liver (subphrenic abscess). Other indications are for cancer or for noncancerous conditions that change the shape or damage the rib, thus causing pain. In the case of thoracic outlet syndrome, the first rib may be removed, as may a cervical rib (extra rib) if one is present.

Source: Medical Disability Advisor



How Procedure is Performed

Rib resection or removal is done in a hospital operating room under general anesthesia. The site of surgical incision will depend not only on the location of the rib to be cut or removed but also on the nature of any accompanying procedure. Although the resection may be a relatively minor, isolated procedure, the associated procedures may be extremely complicated.

Resection is accomplished through a skin incision, dissecting down to the involved rib, and then cutting the rib section free with surgical instruments designed for cutting bone (osteotomes and rongeurs). Bone wax may be used to cover the ends of the exposed bone to control bleeding. The wound is closed over a drain, if necessary, and a chest tube may need to be inserted to facilitate re-inflation of the lung.

Ribs are attached to the spine, and the upper ribs also attach to the breast bone (sternum). For this reason, rib sections used for bone grafting are most easily obtained from the lowest rib, which remains free-floating in the front.

Source: Medical Disability Advisor



Prognosis

Rib resection itself is most often very successful. Any underlying or associated problems, however, may not have as successful an outcome.

Source: Medical Disability Advisor



Specialists

  • Occupational Therapist
  • Physical Therapist
  • Thoracic Surgeon
  • Vascular Surgeon

Source: Medical Disability Advisor



Rehabilitation

The goal of rehabilitation after rib resection is to decrease pain, prevent respiratory complications and restore function. Physical therapy is indicated in those individuals with a compromised respiratory system, limitations in use of the upper extremities, and functional limitations associated with postural muscles (Gregory). Prior to initiating any form of treatment, the therapist must understand the underlying etiology or condition leading to rib resection.

Local application of heat or cold may provide temporary relief of discomfort (Braddom) in conjunction with pharmacological treatment. Some evidence supports the use of transcutaneous electrical nerve stimulator (TENS) for pain management in individuals with uncomplicated minor rib fractures (Oncel), and, unless contraindicated, TENS may prove beneficial for resection of the rib as well.

In order to prevent respiratory complications, individuals are trained to perform deep breathing exercises. These exercises promote full lung expansion, relieve intercostals muscle spasm, and mobilize lung secretions.

If shoulder movement is limited, therapy begins with gentle active assisted range of motion and progresses to active range of motion exercises. With approval of the treating physician, therapy should include strengthening exercises of the shoulder and progress until full function is restored. Because individuals may also experience postoperative postural limitations, exercises to stretch and strengthen these muscles are also indicated as part of rehabilitation. In addition to undergoing supervised rehabilitation, the individual is instructed in a home exercise program to be continued independently after the completion of rehabilitation. An occupational therapist may provide instruction in activities of daily living and adaptive equipment that may be useful until pain and function improve.

FREQUENCY OF REHABILITATION VISITS
ClassificationSpecialistTopicVisit
SurgicalPhysical TherapistRib ResectionUp to 8 visits within 4 weeks
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Comorbid Conditions

  • Bleeding disorders
  • Compromised immune system
  • Conditions affecting the chest cavity
  • Conditions affecting the heart and lungs
  • Conditions influencing the healing capacity of bones

Source: Medical Disability Advisor



Complications

The risk of complication depends upon whether the resection is performed as an isolated procedure or is associated with other procedures. Unintentional collapse of a lung (pneumothorax), nerve damage, fracture along the rib in other locations, perforation of the diaphragm, infection, and pneumonia are possible complications of an isolated procedure.

Source: Medical Disability Advisor



Factors Influencing Duration

Factors that may influence the length of disability include the reason for the procedure and the location and length of rib removed. Because the underlying lung may be collapsed during surgery, a chest tube used to re-expand the lung may remain in place for several days after the operation. During recovery, individuals may be limited in performing certain job tasks that require upper body strength and flexibility.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work involving strenuous use of the arm on the side of the surgery may need to be temporarily avoided. Underlying conditions or diseases must be considered when evaluating work restrictions.

Source: Medical Disability Advisor



References

Cited

Braddom, Randolph L. Physical Medicine and Rehabilitation. 3rd ed. Philadelphia: W.B. Saunders, 2006.

Gregory, P., A. C. Biswas, and M. E. Batt. "Musculoskeletal Problems of the Chest Wall in Athletes." Sports Medicine 32 4 (2002): 235-250. National Center for Biotechnology Information. National Library of Medicine. 9 Dec. 2008 <PMID: 11929353>.

Oncel, M., et al. "Transcutaneous Electrical Nerve Stimulation for Pain Management in Patients with Uncomplicated Minor Rib Fractures." European Journal of Cardiac-Thoracic Surgery 22 1 (2002): 13-17. National Center for Biotechnology Information. National Library of Medicine. 9 Dec. 2008 <PMID: 12103366>.

Source: Medical Disability Advisor