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.

Rotator Cuff Repair

rotator cuff repair in 中文(中华人民共和国)

Related Terms

  • Rotator Cuff
  • Shoulder Surgery

Specialists

  • Occupational Therapist
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist

Comorbid Conditions

  • Adhesive capsulitis
  • Frozen shoulder
  • Muscle weakness
  • Nerve injury
  • Osteoarthritis AC joint
  • Osteoarthritis glenohumeral joint

Factors Influencing Duration

Age and size of tear are the key factors affecting duration. All of the following factors have some impact on duration: use of the affected arm, whether the affected arm is dominant, work requirements for overhead activity, heavy lifting, the type of repair, the age of the individual, and the individual's response to rehabilitation. Return to work depends heavily on achieving rehabilitation goals of function, strength, and endurance.

Medical Codes

ICD-9-CM:
83.63 - Rotator Cuff Repair

Overview

The rotator cuff is a group of four muscles that surround the ball-like humeral head of the upper arm The rotator cuff comprises four muscles — the subscapularis, the supraspinatus, the infraspinatus and the teres minor — and their musculotendinous attachments. The tendons that are linked to these four muscles attach to the humerus and fuse together to form the rotator cuff.

The tendons attached to these muscles come under stress from activities that require lifting and rotating the arm. The tendons can become frayed, partially torn, or completely torn. Rotator cuff repair is surgery to repair the torn portion of the rotator cuff.

Several different surgical procedures are used in repairing the rotator cuff. One procedure involves smoothing (débriding) the ragged edges of the torn tendon and suturing the tissue edges together. Often, the end of the tendon must be reattached to the upper arm (humeral head) as well. If the gap created by the tear is too large and/or the tissue too stiff to be pulled together again, a graft may be necessary to cover the humeral head. Alternatively, the remaining tendon can be sutured into a bone trough made in the humeral head. To provide adequate space and decrease friction, the spur (excess bone) on the undersurface at the top of the shoulder blade (acromion) may be removed and less commonly the coracoacromial ligament cut. These added procedures (acromioplasty, coracoacromial ligament release, acromionectomy) may enlarge the area under the acromion, where the rotator cuff passes during arm motion.

Source: Medical Disability Advisor



Reason for Procedure

The goal of a rotator cuff repair is to restore arm and shoulder motion and alleviate pain. Rotator cuff repair may restore the ability of the rotator cuff muscles to work as a unit and move the arm in many directions. The final outcome is dependent on the individual's age, mechanism of injury, severity of the injury, and general health of the individual.

Source: Medical Disability Advisor



How Procedure is Performed

If the procedure is done by arthroscopy, several small incisions are made in the skin of the shoulder to insert the arthroscope and other surgical instruments. The torn rotator cuff is examined, and then a decision is made about the type of repair required. Some tears can be repaired by arthroscopic techniques using specially designed equipment to reattach the torn tendon(s) to the arm bone (humerus).

Other tears require a more extensive open repair. An open repair begins with an incision 2 ½ to 4 inches (6 to 10 centimeters) long along the top and front of the shoulder to gain access to the entire cuff mechanism. Mini-open repairs (deltoid-splitting) may be performed using smaller incisions of 1 ¼ to 2 inches (3 to 5 centimeters (Mayo). Once access to the rotator cuff is gained, it may be possible to pull the existing tendon(s) back together and secure it to the humerus with staples, wire, or sutures. This technique requires that a tunnel be drilled in the top of the humeral head to provide an attachment area for the reconstructed tendon. In other situations, a tissue graft is used to repair the rotator cuff. Surgeons may also remove bone spurs or calcium deposits during rotator cuff repair. Open rotator cuff repair is done under interscalene block or general anesthesia.

After surgery, the arm is placed in a sling strapped across the waist to restrict shoulder motion. Often the sling contains a small bolster or pillow to maintain correct tension on the repair. The sling may be worn for up to 6 weeks after open repairs (Miller). Extensive rehabilitation is essential for optimum recovery. An ongoing home exercise program can help prevent recurrence. Excessive overuse of the arm and shoulder during the first 6 to 12 months after surgery can lead to disruption of the repair (Miller).

Source: Medical Disability Advisor



Prognosis

Surgical repair of a rotator cuff tear has a good to excellent outcome (relief of pain, restoration or improvement in function and range of motion) in approximately 80% to 90% of cases (Miller). Success is greatest when the original tear is small (less than 3 cm), there are no co-morbid conditions or complications from surgery, and the individual's general health is good. Surgical repair in elderly individuals has a poorer outcome, due to degeneration of the tendons and slower healing with age. Massive tears have a poorer prognosis and are associated with a high degree of disability. Recovery from surgery is often very slow, limited by pain and the need for extensive rehabilitation. In younger individuals with acute injury and repair and no complications, return to normal function is often gained in 6 to 12 months. Some individuals never regain full range of motion or strength in the affected shoulder.

Time from injury to diagnosis and diagnosis to surgical repair is critical. The longer the delay, particularly for full-thickness tears, the greater the probability of poor outcome or less than satisfactory repair and risk of re-tear in future.

Source: Medical Disability Advisor



Rehabilitation

The initial goals of rehabilitation following rotator cuff repair are to decrease pain and inflammation associated with the surgery, to protect the repaired tendon(s), and to prevent the development of joint stiffness, which can severely complicate recovery (Miller). All postoperative rehabilitation should be guided by the treating physician. To protect the repair, the individual's arm and shoulder may be immobilized in a sling for up to 6 weeks (Miller; Gartsman). The immobilization period can be short depending on the type of repair, size of the tear, and the availability of modified activities. Individuals are instructed in the use of cold therapy during this time. Prevention of stiffness and joint contracture is usually achieved through passive flexion and external rotation range of motion exercises (Miller). These exercises are instructed by the therapist, and then performed by the individual. Some individuals may have difficulty independently performing these exercises without stressing the repaired tendon and will require supervision when performing the passive range of motion exercises. During this time, the individual will often be instructed in range of motion exercises of the hand, wrist, and elbow, and may be allowed to begin very limited isometric strengthening exercises, depending on the characteristics of the tear and repair (Millstein).

When appropriate, the sling is discontinued and individuals can begin using shoulder pulleys for overhead range of motion and advance isometric exercises as appropriate (Miller). No strengthening exercises involving the repaired tendon are performed at this stage. However, some individuals may be allowed to perform strengthening exercises of the adjacent joints (Kelley). The therapist instructs the individual to perform these exercises as part of the home exercise program.

Between 4 and 8 weeks, the individual may begin active shoulder movement and gradual progressive strengthening of all muscles of the shoulder, including the deltoid, scapular stabilizers, and rotator cuff muscles, which may show signs of atrophy (Miller; Gartsman). At 12 weeks, most activities of daily living are allowed, but strenuous work or sports requiring heavy lifting or quick movements should not be performed. As strength improves and the tendon continues to heal, the individual will be able to slowly resume activities that are more strenuous. In the case of individuals who do not achieve normal range of motion after 12 weeks, aggressive stretching may be necessary. Individuals might require up to 1 year of continued strengthening and range of motion exercises to maximize the outcome (Millstein). Over-aggressive use of the shoulder may lead to disruption for up to 12 months (Miller).

FREQUENCY OF REHABILITATION VISITS
Surgical
SpecialistRotator Cuff Repair
Physical or Occupational TherapistUp to 24 visits within 12 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



Complications

Complications from a rotator cuff repair include failed repair, repeat tear to the repaired tendon, nerve or blood vessel damage in the shoulder area, infection, frozen shoulder (adhesive capsulitis), and decreased range of motion and/or strength.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Activities may need to be limited per physician instructions with gradual increase in activities dependent on the size of tear and the type of repair. Limiting movement of the arm away from the body (abduction) and external rotation (e.g., the position when throwing a baseball) is helpful. Immediately after the surgery, the individual may wear a sling that holds the arm close to the body reducing tension on the repair. Use of prescription painkillers (analgesics) and other medications following surgery can affect dexterity and alertness. Use of these medications may require review of drug policies.

Each individual's resumption of activities should be based on the type of repair and the surgeon’s instructions. Long-term restrictions on limited overhead work, lifting, carrying, throwing, and repetitive activities may follow the recovery period.

Risk: Reinjury is possible and is dependent on multiple factors listed above, but the key factors are age and size of tear. Most individuals will receive extended or permanent guides for modified work. Refer to "Work Ability,” page 183, table 12-2 and page 186.

Capacity: Capacity is dependent on age and physical conditioning before onset of symptoms or before the tear. Refer to "Work Ability and Return to Work," pages 187 -188, table 12-4.

Tolerance: The ability to work through pain is unique to each individual. If the tear cannot be repaired to a normal anatomical position, range of motion and strength will be permanently reduced. The ability to accommodate will determine the ability to return to previous employment. Refer to "Work Ability and Return to Work" page 187.

Accommodations: As the individual ages, the need for permanent work guides will increase. Tolerance and accommodation determine the final ability to return to work. For example, a study found 51 full-thickness rotator cuff tears in 49 NFL football players. After being injured, the majority continued to play at their usual level of activity and delayed surgery until the post-season. After surgery, most returned to professional football, but many were not totally symptom-free (Foulk).

Source: Medical Disability Advisor



Maximum Medical Improvement

4 to 8 months to allow for improvement in range of motion and strength or if two consecutive visits demonstrate stable ROM without symptoms

Source: Medical Disability Advisor



References

Cited

Codman, E. "The Shoulder: Rupture of the Supraspinatus Tendon and Other Lesions in or about the Subacromial Bursa. Boston." Archives of Surgery 47 (2) (1943): 121-135.

Foulk, D. A. , et al. "Full thickness rotator cuff tears in professional football players." American Journal of Orthopedics 31 (11) (2002): 622-624.

Hegmann, K. T. , et al., eds. Occupational Medicine Practice Guidelines: Evaluation and Management of Common Health Problems and Functional Recovery in Workers. Third ed. ACOEM, 2011.

Kelley, M. J., and William A. Clark, eds. Orthopedic Therapy of the Shoulder. Philadelphia : J.B. Lippincott Company, 1995.

Marx, R. G. , C. Bombardier, and J. G. Wright. "What do we know about the reliability and validity of physical examination tests used to examine the upper extremity." Journal of Hand Surgery 24A (1) (1999): 185-193.

Mayo Clinic Staff. "Rotator Cuff Injury." MayoClinic.com. 21 Aug. 2010. Mayo Foundation for Medical Education and Research. 1 Feb. 2013 <http://www.mayoclinic.com/health/rotator-cuff-injury/DS00192>.

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

Miller, Robert H., and Jeffrey A. Dlaback. "Chapter 44 - Shoulder and Elbow Injuries." Campbell's Operative Orthopaedics. Eds. S. Terry Canale and James H. Beaty. 11th ed. Philadelphia: Mosby Elsevier, 2008.

Millstein, E. S., and S. J. Snyder. "Arthroscopic Evaluation and Management of Rotator Cuff Tears." Orthopedic Clinics of North America 34 4 (2003): 507-520. National Center for Biotechnology Information. National Library of Medicine. 25 Sep. 2008 <PMID: 14984190>.

Speed, Cathy. "Shoulder Pain." BMJ Clinical Evidence Handbook: Musculoskeletal disorders. Eds. N. Collins, et al. BMJ Publishing Group, 2007. 400-402.

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.

Source: Medical Disability Advisor






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