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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.

Sprains and Strains


Text Only Home | Graphic-Rich Site | Definition | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Duration Trends | Return to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
840 - Sprains and Strains of Shoulder and Upper Arm
840.0 - Sprains and Strains of Shoulder and Upper Arm, Acromioclavicular Joint (Ligament)
840.1 - Sprains and Strains of Shoulder and Upper Arm, Coracoclavicular (Ligament)
840.2 - Sprains and Strains of Shoulder and Upper Arm, Coracohumeral (Ligament)
840.3 - Sprains and Strains of Shoulder and Upper Arm, Infraspinatus (Muscle) (Tendon)
840.4 - Sprains and Strains of Shoulder and Upper Arm, Rotator Cuff (Capsule)
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)
840.7 - Sprains and Strains of Shoulder and Upper Arm, Superior Glenoid Labrum Lesion; SLAP Lesion
840.8 - Sprains and Strains of Shoulder and Upper Arm, Other Specified Sites of Shoulder and Upper Arm
840.9 - Sprains and Strains of Shoulder and Upper Arm, Unspecified Site of Shoulder and Upper Arm; Arm NOS; Shoulder NOS
841 - Sprains and Strains of Elbow and Forearm
841.0 - Sprains and Strains of Elbow and Forearm, Radial Collateral Ligament
841.1 - Sprains and Strains of Elbow and Forearm, Ulnar Collateral Ligament
841.2 - Sprains and Strains of Elbow and Forearm, Radiohumeral Joint
841.3 - Sprains and Strains of Elbow and Forearm, Ulnohumeral Joint
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 - Sprains and Strains of Wrist and Hand
842.00 - Sprains and Strains, Wrist, Unspecified Site
842.01 - Sprains and Strains, Wrist, Carpal Joint
842.02 - Sprains and Strains, Wrist, Radiocarpal Joint
842.09 - Sprains and Strains, Wrist, Other; Sprains and Strains, Radioulnar Joint, Distal
842.10 - Sprains and Strains, Hand, Unspecified Site
842.11 - Sprains and Strains, Hand, Carpometacarpal Joint
842.12 - Sprains and Strains, Hand or Fingers, Metacarpophalangeal Joint
842.13 - Sprains and Strains, Hand or Fingers, Interphalangeal Joint
842.19 - Sprains and Strains, Hand, Other; Midcarpal (Joint)
843 - Sprains and Strains of Hip and Thigh
843.0 - Sprains and Strains of Hip and Thigh, Iliofemoral Ligament
843.1 - Sprains and Strains of Hip and Thigh, Ischiocapsular (ligament)
843.8 - Sprains and Strains of Other Specified Sites of Hip and Thigh
843.9 - Sprains and Strains of Hip and Thigh, Unspecified Site; Hip NOS; Thigh NOS
844 - Sprains and Strains of Knee and Leg
844.0 - Sprains and Strains of Knee and Leg, Lateral Collateral Ligament of Knee
844.1 - Sprains and Strains of Knee and Leg, Medial Collateral Ligament of Knee
844.2 - Sprains and Strains of Knee and Leg, Cruciate Ligament of Knee
844.3 - Sprains and Strains of Knee and Leg, Tibiofibular (Joint) (Ligament), Superior
844.8 - Sprains and Strains of Knee and Leg, Other Specified Site
844.9 - Sprains and Strains of Knee and Leg, Unspecified Site; Knee NOS; Leg NOS
845 - Sprains and Strains of Ankle and Foot
845.00 - Sprains and Strains, Ankle, Unspecified Site
845.01 - Sprains and Strains, Ankle, Deltoid (Ligament) Ankle; Internal Collateral (Ligament) Ankle
845.02 - Sprains and Strains, Ankle, Calcaneofibular Ligament
845.03 - Sprains and Strains, Ankle, Tibiofibular Ligament, Distal
845.09 - Sprains and Strains, Ankle, Other; Achilles Tendon
845.10 - Sprains and Strains, Foot, Unspecified Site
845.11 - Sprains and Strains, Foot, Tarsometatarsal Joint (Ligament)
845.12 - Sprains and Strains, Foot, Metatarsophalangeal Joint
845.13 - Sprains and Strains, Foot, Interphalangeal Joint; Toe
845.19 - Sprains and Strains, Foot, Other
846 - Sprains and Strains of Sacroiliac Region
846.0 - Sprains and Strains of Sacroiliac Region, Lumbosacral Joint
846.1 - Sprains and Strains of Sacroiliac Region, Sacroiliac Ligament
846.2 - Sprains and Strains of Sacroiliac Region, Sacrospinatus (Ligament)
846.3 - Sprains and Strains of Sacroiliac Region, Sacrotuberous (Ligament)
846.8 - Sprains and Strains of Sacroiliac Region, Other Specified Sites
846.9 - Sprains and Strains of Sacroiliac Region, Unspecified Site
847 - Sprains and Strains of Other and Unspecified Parts of Back
847.0 - Sprains and Strains of Other and Unspecified Parts of Back, Neck; Anterior Longitudinal (Ligament), Cervical; Atlanto-Axial (Joints); Atlanto- Occipital (Joints); Whiplash Injury
847.1 - Sprains and Strains of Other and Unspecified Parts of Back, Thoracic Spine
847.2 - Sprains and Strains of Other and Unspecified Parts of Back, Lumbar Spine
847.3 - Sprains and Strains of Other and Unspecified Parts of Back, Sacrum; Sacrococcygeal (Ligament)
847.4 - Sprains and Strains of Other and Unspecified Parts of Back, Coccyx
847.9 - Sprains and Strains of Other and Unspecified Parts of Back, Unspecified Site; Back NOS
848 - Sprains and Strains, Other and Ill-defined
848.0 - Sprains and Strains, Other and Ill-defined, Septal Cartilage of Nose
848.1 - Sprains and Strains, Other and Ill-defined, Jaw; Temporomandibular (Joint) (Ligament)
848.2 - Sprains and Strains, Other and Ill-defined, Thyroid region; Cricoarytenoid (Joint) (Ligament); Cricothyroid (Joint) (Ligament); Thyroid Cartilage
848.3 - Sprains and Strains, Other and Ill-defined, Ribs; Chondrocostal (joint) without Mention of Injury to Sternum; Costal Cartilage without Mention of Injury to Sternum
848.40 - Sprains and Strains, Other and Ill-defined, Sternum, Unspecified site
848.41 - Sprains and Strains, Other and Ill-defined, Sternum, Sternoclavicular (Joint) (Ligament)
848.42 - Sprains and Strains, Other and Ill-defined, Sternum, Chondrosternal (Joint)
848.49 - Sprains and Strains, Other and Ill-defined, Sternum, Other; Xiphoid cartilage
848.5 - Sprains and Strains, Other and Ill-defined, Pelvis; Symphysis Pubis
848.8 - Sprains and Strains, Other and Ill-defined, Specified Sites
848.9 - Sprains and Strains, Other and Ill-defined, Unspecified Site
905.7 - Late Effect of Sprain and Strain without Mention of Tendon Injury

Related Terms

  • Joint Dislocation
  • Joint Separation
  • Muscle Pull
  • Muscle Tear
  • Stretched Ligaments
  • Subluxation
  • Torn or Ruptured Ligaments
  • Torn or Ruptured Tendons

Overview

Sprains are injuries to ligaments, the fibrous bands that connect bones to bones and stabilize joints. Strains are injuries to muscles or to tendons, the tough, fibrous bands that connect muscles to bones. Sprains and strains involve stretching or tearing of tissue and are defined by the amount of damage caused to the ligament or muscle and its attached tendons.

A first-degree (grade I) injury is a stretching of the ligament (sprain) or muscle (strain) with few torn fibers and no loss of strength. Second-degree (grade II) sprains and strains involve a greater number of injured muscle or tendon fibers with noticeable loss of strength; however, the ligament or muscle remains partially intact. A third-degree (grade III) injury is complete disruption (rupture) of the ligament or muscle resulting in complete functional loss of the affected muscle or tendon.

By bridging the joint from bone to bone, ligaments function as stabilizing bands to help keep the joint in alignment during movement. A sprain of the ligament disrupts the joint, allowing it to move outside of its normal range of motion (subluxation), or in the case of a third-degree sprain, resulting in a complete displacement (dislocation). A dislocated joint may involve all the ligaments in a joint, in which case the joint has no stability, or may involve individual ligaments, in which case some of the joint's stability remains.

Muscles lose strength and function when injured. While first-degree strains may be the result of a bruise (contusion) or overstretching, a second-degree strain involves injury to the muscle-tendon junction (musculotendinous junction). Third-degree strains involve tearing or disruption of the muscle fibers and the sheath (fascia) around it.

Incidence and Prevalence: Sprains and strains are extremely common. Ankle sprains, for example, occur in about 25,000 individuals each day (Young). Trauma to the knee is the second most common occupational accident in the United States, where knee injuries in general affect over 3 million Americans annually (Levy). Third-degree shoulder sprains (dislocations) occur in 11.2 individuals per 100,000, usually as the result of trauma (Wilson).

Source: Medical Disability Advisor



Diagnosis

History: In acute sprains, the individual may report localized pain that worsens with activity or use, swelling (edema), and sometimes discoloration from bleeding into the muscle (ecchymosis). The individual may have heard a "pop" or "snap" or experienced a sensation of the joint slipping with continued instability or the sensation of something tearing in ligament injuries. In the case of strains, the individual may complain of pain, loss of function, change in sensation, or may feel a defect or swelling along the body of the muscle. In chronic strains from repetitive stress, symptoms of stiffness, soreness, and generalized tenderness may appear gradually and worsen with increased use of the muscle.

Physical exam: Inspection reveals edema, swelling within a joint (effusion), ecchymosis, tenderness, and in severe injury, inability to use a muscle or changes in joint stability. There may be some deformity of a joint in the case of sprains. Complete muscle tears (third-degree strains) may appear as a ball or knot under the skin. Touching (palpation) in the area of either sprains or strains may produce diffuse or point-specific pain. In sprains, joints should be tested for laxity. Evaluation of muscle strength is important in strains.

The individual may have decreased active and passive motion that is limited by pain and loss of function. In general, ligamentous sprains are indicated if passive joint motion reproduces complaints, whereas a musculotendinous strain is indicated if resisted joint motion reproduces the complaint. A neurological examination may be necessary as the tendons and nerves often lie very close to each other and damage can occur to both.

Tests: X-rays may reveal fractures caused by the muscle pulling away from the bone (avulsion fracture) or from dislocations. Stress x-rays help evaluate the severity of a sprain. MRI is useful to determine the integrity of the muscle or ligament. Arthrograms, tests used to view the joint space, are infrequently used now that MRI is available.

Source: Medical Disability Advisor



Treatment

First and second-degree sprains are treated with protection, rest, ice, compression, and elevation (PRICE). Early movement and activity therapy should be explored. If needed, rest may be accomplished with supportive devices such as splints, casts, slings, or crutches. With the use of assistive devices, individuals usually can bear partial weight on leg and foot injuries. This promotes normal motion while providing rest. In second-degree sprains, ligament tissue does not grow back together, but immobilization of the area allows scar tissue to form, which provides joint stability. Third-degree sprains either are immobilized or repaired surgically (joint capsulorrhaphy or ligament repair/reconstruction). Regaining normal joint function as quickly as possible while guarding against abnormal motion is essential, thus physical therapy is very important during the healing process.

First-degree muscle strains repair with little intervention except applications of compression and ice and/or heat. It is important to protect against further injury during this time, especially through either too little or too much activity. Second-degree strains rarely require surgery, unless complete loss of function has occurred and other muscles near the injury cannot compensate. Cosmetic deformity is sometimes an indication for surgery to repair the torn muscle or tendon. Third-degree muscle strains sometimes require surgical repair to restore function. Muscle tissue will regenerate and heal, but physical therapy is important to regain the full range of motion, muscle length, and strength.

Source: Medical Disability Advisor



Prognosis

With proper rehabilitation, first- and second-degree injuries should heal without significant change in function. Third-degree injuries are much more significant, and while resolution of pain can be expected over time, there may be a degree of residual impairment.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

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

Source: Medical Disability Advisor



Rehabilitation

The focus of rehabilitation for sprains and strains is to control pain and restore function. The involved body part and the severity of the injury will dictate the type and intensity of rehabilitation required.
First-degree sprains and strains are treated conservatively with PRICE (protection, rest, ice, compression, elevation) for the first 48 hours or until the swelling has stabilized (Braddom). Nonsteroidal anti-inflammatory drugs (NSAIDs), compressive wraps, and muscle strengthening exercises may be included in conservative treatment.

Second-degree sprains or strains may need to be treated with braces or assistive devices (e.g., crutches) that restrict but do not eliminate normal movement. Physical therapy modalities to decrease inflammation, strengthen muscles, and restore balance and agility are an integral part of the treatment.

Third-degree sprains and strains may require surgical intervention for repair or reconstruction of torn tissue. The decision to repair or reconstruct a ligament is based on the amount of instability, likelihood of increased injury without repair, number of ligaments, tendons, or muscles injured, and any associated injuries.

Physical therapy focuses on range of motion and strengthening of involved structures. Modalities such as heat and ice may be used to facilitate motion and control edema. Early in treatment, individuals should be instructed in a home exercise program to be continued daily, with all exercises progressed as tolerated (Biundo). The therapist should consider those factors that may have led to the development of this condition. If work tasks are suspected as contributing to the symptoms, an ergonomic evaluation is advised to modify workplace risk factors that may have led to sprains and strains (Lincoln). If leisure activities are suspect, the individual should be instructed in adjustments that might lessen the likelihood of re-injury.

FREQUENCY OF REHABILITATION VISITS
ClassificationSpecialistTopicVisit
NonsurgicalPhysical TherapistSprains and StrainsUp to 12 visits within 6 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

Source: Medical Disability Advisor



Complications

Bleeding into the surrounding tissues is common with sprains or strains. Bleeding into a joint space (hemarthrosis) may require removal (evacuation, aspiration) of fluid. Rarely, deposits of calcium in the areas of bleeding in the muscle (myositis ossificans) can lead to stiffness and muscle pain. Damage to the surface (articular) cartilage in joints with lax ligaments is possible. Occasionally, a frozen joint (joint contracture) may develop from prolonged immobility.

If the injury is thought to be slight and treatment is delayed, recovery may be slow. Treatment that lacks strengthening and proprioceptive exercises can result in poor tissue repair and decreased protective reflex responses. This may, in turn, lead to re-injury during or after the healing phase.

Source: Medical Disability Advisor



Factors Influencing Duration

Factors include the location of the injury, the degree of injury, and how it affects the individual's job performance. Surgery will lengthen the period of disability. Re-injury caused by early return to inappropriate activity will delay full recovery. For sprains and strains associated with the spine, duration depends on severity of injury.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

A return to activity and an early return to work are important, despite discomfort, because this results in better outcomes, however, assignment to modified duties may be needed. If the lower extremity is involved, use of assistive or protective devices such as crutches, wheelchair, cast, or brace may be necessary. If the upper extremity is involved, restrictions may include little to no use of arm, hand, or shoulder, with limited lifting, carrying, and overhead reaching. Dexterity may be affected by the injury and use of protective splints. Back strain may be totally incapacitating for a period during recovery. Company policy on medication usage should be reviewed to determine if pain medication use 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:

  • Does individual have a sprain or a strain?
  • Did individual complain of pain, loss of function, or change in sensation?
  • Did individual hear a “pop” or “snap”? Experience a sensation of the joint slipping?
  • Is lack of function or stability present?
  • On exam was soft tissue swelling present? Effusion? Ecchymosis? Tenderness?
  • Is individual unable to use a muscle or are there changes in joint stability?
  • Is individual able to bear weight?
  • Is there a ball or a knot under the skin? Joint deformity?
  • Is there laxity in the joint?
  • What were the results of the neurological exam?
  • Has individual had plain x-rays and stress x-rays? MRI?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Is the injury first-, second-, or third-degree?
  • Has it been treated with PRICE?
  • Was it necessary to immobilize the area?
  • Was physical therapy required?
  • Was surgery necessary?

Regarding prognosis:

  • Is individual active in physical therapy? Does individual have a home exercise program?
  • Is individual compliant with recommendations for use of protective equipment?
  • Is individual's employer able to implement any necessary accommodations and restrictions?
  • Does individual have any underlying conditions that may affect ability to recover?
  • Does individual have any complications such as hemarthrosis or myositis ossificans? Joint contracture?
  • Was any damage done to the cartilage?
  • Are associated in injuries delaying recovery?

Source: Medical Disability Advisor



References

Cited

"Sprains and Strains: Risk Factors." MayoClinic.com. 18 Oct. 2008. Mayo Foundation for Medical Education and Research. 31 Jul. 2009 <http://www.mayoclinic.com/health/sprains-and-strains/DS00343/DSECTION=risk-factors>.

Biundo, J. J., R. W. Irwin, and E. Umpierre. "Sports and Other Soft Tissue Injuries Tendinitis, Bursitis, and Occupation-related Syndromes." Current Opinion in Rheumatology 13 2 (2001): 146-149. National Center for Biotechnology Information. National Library of Medicine. 3 Dec. 2004 <PMID: 11224739>.

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

Levy, David B., Howard I. Dickey-White, and June E. Sanson. "Knee Injury, Soft Tissue." eMedicine. Eds. Eric Kardon, et al. 12 Dec. 2008. Medscape. 31 Jul. 2009 <http://emedicine.medscape.com/article/826792-overview>.

Lincoln, A. E., et al. "Impact of Case Manager Training on Worksite Accommodations in Workers' Compensation Claimants with Upper Extremity Disorders." Journal of Occupational and Environmental Medicine 44 3 (2002): 237-245. National Center for Biotechnology Information. National Library of Medicine. 3 Dec. 2004 <PMID: 11911025>.

Wilson, Sharon, and Daniel Price. "Dislocation, Shoulder." eMedicine. Eds. James E. Keany, et al. 27 Feb. 2008. Medscape. 31 Jul. 2009 <http://emedicine.medscape.com/article/823843-overview>.

Young, Craig C. "Ankle Sprain." eMedicine. Eds. David T. Bernhardt, et al. 28 Apr. 2009. Medscape. 31 Jul. 2009 <http://emedicine.medscape.com/article/85393-overview>.

Source: Medical Disability Advisor