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.

Syringomyelia


Related Terms

  • Spinal Cord Cyst

Differential Diagnosis

  • Amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease)
  • Ankylosing spondylitis
  • Arnold Chiari malformations
  • Arteriovenous malformations
  • Atlantoaxial instability in individuals with Down syndrome
  • Brainstem syndromes
  • Central pontine myelinolysis
  • Cervical disc syndromes
  • Cervical rib
  • Cervical spondylosis
  • Chronic inflammatory demyelinating polyradiculoneuropathy
  • Chronic regional pain syndrome, type I
  • Craniovertebral junction anomalies
  • Diabetic neuropathy
  • Hereditary motor and sensory neuropathies
  • Hydrocephalus
  • Intrinsic tumors of the spinal cord
  • Limb-girdle muscular dystrophy
  • Medulloblastoma
  • Meningioma
  • Meningitis
  • Metastatic disease to the spine and related structures
  • Multiple sclerosis
  • Neural tube defects
  • Peripheral neuropathy (paralysis)
  • Sarcoidosis
  • Spinal cord hemorrhage
  • Spinal cord infarction
  • Spinal epidural abscess
  • Spinal muscular atrophy
  • Tumors
  • Vascular malformations
  • Vasculitis

Specialists

  • Neurologist
  • Neurosurgeon
  • Occupational Therapist
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Psychiatrist
  • Recreational Therapist
  • Urologist

Comorbid Conditions

  • Cancer
  • Infection
  • Neurologic conditions
  • Obesity

Factors Influencing Duration

Factors influencing length of disability include the extent and type of condition, individual response to treatment, and presence of complications.

Medical Codes

ICD-9-CM:
336.0 - Syringomyelia and Syringobulbia

Overview

© Reed Group
Syringomyelia describes the condition where a fluid-filled cavity (cyst or syrinx) grows within the spinal cord, usually in the neck area (cervical spinal cord). If the cavity forms within the lower brain stem, the condition is referred to as syringobulbia. As the fluid-filled cavity gradually expands, it presses on nerves that serve the hands and arms (in the case of syringomyelia, affecting the cervical spinal cord) or the lower extremities (when syringomyelia affects the lumbar spinal cord). As a result, pain, lack of nerve sensation, weakness, and loss of muscle bulk (muscular atrophy) typically occur.

In about 20% to 70% of cases, the disorder is present at birth (congenital) and may be associated with a congenital abnormality of the brain (Chiari type I malformation) (Saremi). Although the cause of the abnormality is unknown, taking folic acid during pregnancy may help prevent birth defects such as syringomyelia. The expansion of the cavity within the spinal cord often occurs during the teen or young adult years.

Syringomyelia can also be caused by spinal cord trauma, infection (meningitis), inflammation (arachnoiditis), or the development of a spinal cord tumor. Syringomyelia may be inherited (familial), but this is rare. Individuals with thoracic scoliosis are more likely to have syringomyelia of the thoracic spine.

Incidence and Prevalence: Syringomyelia affects approximately 8.4 of every 100,000 individuals in the US; the prevalence in other countries is roughly the same worldwide as it is in the US (Al-Shatoury).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Symptoms often begin between the ages of 30 to 50 (Al-Shatoury). The disease is more common in men.

Source: Medical Disability Advisor



Diagnosis

History: The individual may have a lack of sensation in the fingers, first noticed as a painless burn or cut or painless ulcers on one or more of the extremities. Individual may report decreased or absent sensation to pain, temperature, or touch in a cape-like pattern over the shoulders and back, followed by pain, weakness, and stiffness in the back, shoulders, arms, or legs. Other symptoms may include headaches. In syringobulbia, the individual frequently complains of dizziness and a sensation of spinning (vertigo), jerky eye movements (nystagmus), tongue wasting, facial sensory impairment on one or both sides of the face, other lower cranial nerve palsies, and swallowing difficulty (dysphagia) or slurred speech (dysphasia). Symptoms tend to develop slowly, but may come on suddenly with coughing or straining.

Physical exam: The most prominent early signs include decreased reflexes in the arm, although increased reflexes and spasticity may occur in the lower extremities. There may be a lack of sensation (dissociated anesthesia) below the level of the syrinx often in the pattern of a cape or shawl. Symptoms are nearly always present on both sides of the body (bilateral) but may be asymmetrical or affect one side only (unilateral). Due to the loss of pain and temperature sensation in the hands and inner forearms, painless ulcers of the extremities may follow trauma.

Tests: CT, photographs of the spinal cord taken after the injection of a contrast material (myelography), MRI, and x-rays of the skull and cervical spine are utilized in making a definitive diagnosis. Nerve conduction velocity testing or electromyography may be used to demonstrate nerve damage; more sensitive electrodiagnostic testing examining evoked potentials (somatosensory evoked potentials, or SSEPs) may also be utilized. A lumbar puncture, in which a needle is inserted between the individual’s vertebrae to obtain cerebrospinal fluid (CSF), should be performed. Angiography can rule out neurologic causes of symptoms.

Source: Medical Disability Advisor



Treatment

There is no medical treatment for syringomyelia. Surgery is used in an attempt to drain the fluid from the cavity, reduce pain, and stop further progression of neurological symptoms (syringotomy). Congenital syringomyelia may require that pieces of cervical vertebrae in the area of the cavity be removed (cervical laminectomy) in an effort to drain the cavity and decompress the spinal cord. It may be necessary to drain the syrinx with a catheter, drainage tubes, or valves leading to the abdomen. Terminal ventriculostomy, when part of the lumbar vertebrae is removed (lumbar laminectomy) over the end of the fluid-filled sac in the spinal cord may be considered if the individual does not have a Chiari malformation. After the patient has been released from the hospital, non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants can be used to help with chronic pain.

Source: Medical Disability Advisor



Prognosis

Approximately 50% of individuals over the course of many years do not experience any worsening of their disease (Al-Shatoury). The other half, although relieved of some pain, eventually become wheelchair-bound. Delay in treatment may result in irreversible spinal cord injury. About one-fifth of individuals with syringomyelia die at an average age of 47 (Al-Shatoury).

Source: Medical Disability Advisor



Rehabilitation

Individuals with syringomyelia require physical and occupational therapy 2 to 3 times a week for 8 to 12 weeks. Individuals may require speech therapy if the tumor is present in the lower brain stem (syringobulbia).

Therapy focuses on educating the individuals about the disease process, improving communication, maintaining range of motion, increasing strength, and improving coordination, balance, and functional abilities such as gait.

Education about the disease process helps explain the expected prognosis of the disease. Individuals also learn to prevent secondary problems such as the formation of decubitus ulcers that may result from decreased skin sensation. Individuals or their caregivers learn to inspect the skin for irritation or skin breakdown and learn to keep the skin dry and tell their physicians about any skin irritation.

To improve communication, speech therapists teach individuals specific lip, tongue, and facial muscle positions to clarify speech. Individuals with the inability to communicate orally may learn to communicate through a variety of other methods such as sign language or by use of a communication board where basic needs can be indicated by pointing to written words or pictures. A computer may be used where a computer-generated voice "speaks" as individuals type out what they want to vocalize.

Since individuals experience weakness and decreased function in their arms and / or legs, a comprehensive stretching program is critical to maintaining range of motion in the joints. Occupational and physical therapists instruct individuals and their family members on how to safely stretch the arms and legs. The occupational and physical therapists create a strengthening program to maintain functional abilities for the arms and legs. All strengthening exercises are performed to the individual's tolerance.

Individuals may have impaired coordination with syringomyelia. Occupational therapists assign fine motor coordination exercises and, in physical therapy, individuals work on gross motor coordination.

Both sitting and standing balance are important in physical and occupational therapy. For example, occupational therapists may work on dynamic sitting balance to promote dressing and grooming abilities. Physical therapists may focus on standing balance to help preserve the ability to walk.

The main focus of physical and occupational therapy is to maximize functional capabilities. Occupational therapists teach individuals skills such as getting in and out of the shower, dressing, and meal preparation. They may order equipment such as a tub seat, a long-handled shoehorn, or kitchen utensils with thick handles to make these tasks easier. Physical therapists teach skills such as getting in and out of bed, walking, or using a wheelchair. They may order equipment such as a trapeze bar to hang over the bed, crutches or a cane, or self-propelled or power wheelchairs, as appropriate. Physical therapists may also refer an individual to an orthotist if leg braces are deemed appropriate.

Source: Medical Disability Advisor



Complications

Neurologic deficits, intense pain, permanent loss of sensation, loss of voluntary movement, and / or loss of mobility are possible complications. Following surgery, syringomyelia may recur and require additional operations. Injury to the extremities can complicate loss of sensation that protects against temperature extremes or other painful stimuli. Individuals may develop lung infection, skin ulcers, neurogenic bowel and bladder difficulties, or impotence; these outcomes may be debilitating and potentially life-threatening.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations require consideration on a case-by-case basis. The physical environment may need to be adapted if the individual must use a wheelchair for mobility. Individuals may have difficulty with jobs that require physical labor, the ability to walk without difficulty, or fine manipulation with the hands. Alternative job duties may be needed for these individuals. The individual may need breaks to move about in order to avoid becoming stiff and to relieve pressure on the buttocks especially if confined to a wheelchair. Ability to operate equipment depends on the individual's voluntary control of the limbs and the physical requirements of operating specific equipment and machinery. Vocational rehabilitation may be needed.

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:

  • Has diagnosis of syringomyelia been confirmed?
  • Has extent of nerve damage been assessed?
  • Have conditions with similar symptoms been ruled out?
  • Has individual experienced any complications related to syringomyelia?
  • Does individual have a coexisting condition that may impact recovery?

Regarding treatment:

  • Has individual been involved in a comprehensive physical/occupational rehabilitation program?
  • If tumor is present in the lower brain stem (syringobulbia), has individual also received speech therapy to improve communication?
  • If symptoms are progressing, would individual benefit from surgical intervention (syringotomy)?

Regarding prognosis:

  • Has permanent neurological damage already occurred?
  • Is individual still a candidate for surgical intervention?
  • Would the individual benefit from additional or extended physical or occupational therapy?
  • If alternative job duties are now indicated, would individual benefit from vocational rehabilitation?

Source: Medical Disability Advisor



References

Cited

Al-Shatoury, Hassan A., and Franklin C. Wagner. "Syringomyelia." eMedicine. Eds. Christopher C. Luzzio, et al. 1 Feb. 2002. Medscape. 29 Dec. 2004 <http://emedicine.com/neuro/topic359.htm>.

Saremi, Farhood, Chi-Shing Zee, and John L. Go. "Syringohydromyelia." eMedicine. Eds. J. Randy Jinkins, et al. 8 Jul. 2003. Medscape. 29 Dec. 2004 <http:/emedicine.com/radio/topic670.htm>.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.