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.

Thoracic Spine Pain


Related Terms

  • Middle Back Pain
  • Thoracalgia
  • Upper Back Pain

Differential Diagnosis

Specialists

  • Anesthesiologist
  • Cardiovascular Internist
  • Chiropractor
  • Internal Medicine Physician
  • Neurosurgeon
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Pulmonologist
  • Rheumatologist

Comorbid Conditions

  • Cervical pain
  • Cervicobrachial syndrome
  • Musculoskeletal disorders
  • Obesity
  • Osteoporosis
  • Scoliosis

Factors Influencing Duration

The demands of lifestyle and work influence the recovery from thoracic spine pain. Heavy lifting and vigorous movement of the upper body can aggravate the symptoms. A more extensive degenerative disease process of the discs increases the length of disability. Individuals diagnosed with idiopathic thoracic spine pain are expected to have a full recovery.

Medical Codes

ICD-9-CM:
724.1 - Thoracic Spine Pain

Overview

The diagnosis of thoracic spine pain is made only when the cause of pain in the spine of the upper back (thorax) is of unknown origin (idiopathic). This type of thoracic spine pain is less common than low back pain. Specific causes for thoracic pain usually are discovered when pain persists and tests are done. Pain in the thoracic spine can be the first sign of an undiagnosed disease or unrecognized injury. A recent trauma or strain to the back may have occurred. Scoliosis, a condition in which the thoracolumbar spine abnormally curves sideways (laterally), can produce thoracic spine pain. Other causes of thoracic pain include vertebral compression fractures, which are common when there is underlying weakness in the bone (e.g., osteoporosis, osteopenia), or a herniated thoracic disc. Many times, pain in the thoracic spine is of muscular, rather than spinal origin, especially in individuals with poor posture or those with an abnormally forward-bent thoracic spine (thoracic kyphosis).

Some diseases with thoracic spine pain as a symptom include musculoskeletal diseases and non-orthopedic conditions such as diseases of the heart, lungs, abdominal organs, and kidneys. The spine is a frequent location of cancerous tumors that develop in other organs (metastatic cancer).

Incidence and Prevalence: Information on the incidence of idiopathic thoracic pain is not available.

Up to 15% of individuals in the general population have asymptomatic thoracic disc herniations; 100 per 100,000 population will have symptoms (Malanga).

Each year there are 260,000 thoracic compression fractures caused by osteoporosis (Kochan).

Prevalence of scoliosis is 150 per 100,000 individuals in the US (Rajiah).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals who are obese, have a sedentary lifestyle, have concurrent musculoskeletal disorders, or who participate in strenuous sports have an increased risk for musculoskeletal thoracic spine pain. Vertebral compression fractures from underlying osteoporosis are twice as common in women as in men (Reiter). Osteoporosis-related thoracic compression fractures occur in 26% of women by the age of 50; however, such fractures may be painful only in one-third of cases (Kochan).

Source: Medical Disability Advisor



Diagnosis

History: The individual is usually unable to point to a specific area of pain. The individual may report recent overhead activity.

Physical exam: Examination of the thoracic spine determines whether the spine is abnormally curved. Increased forward curve of the spine may reflect thoracic kyphosis. Increased lateral curvature may indicate scoliosis. Measurement of chest expansion when inhaling and flexibility of the upper trunk should be normal; otherwise a specific diagnosis such as ankylosing spondylitis may be given. Lightly pressing with the fingertips (palpation) along the spine may elicit specific sites of pain or abnormalities. The examiner may be able to palpate spasms in the muscles adjacent to the thoracic spine. Loss of height may indicate underlying osteoporosis.

Tests: X-rays of the thoracic spine may be taken if physical exam findings are unclear. X-rays help exclude tumors and infection and may show congenital or developmental deformities of the spine, such as scoliosis or kyphosis. If necessary, additional tests may rule out diagnoses of cancer, scoliosis, and other diseases or injuries.

Source: Medical Disability Advisor



Treatment

Treatment is conservative. Physical modalities and pain relievers may help reduce the pain. Initially, physical activity restriction and spine manipulation may be helpful in lessening pain. The goal of treatment is to promote postural education, general conditioning, and independence with appropriate exercises. Ergonomics may need to be assessed. Preventive and maintenance measures (such as exercise, proper body mechanics) should be continued indefinitely. If the thoracic pain is a symptom of a diagnosed disease or injury, then treatment entirely depends on the nature of the disease or injury.

Source: Medical Disability Advisor



Prognosis

Whether the individual fully recovers depends on whether the thoracic spine pain is idiopathic or whether it is a symptom of an undiagnosed disease or unrecognized injury. If the individual is diagnosed with idiopathic spine pain, he or she is expected to recover completely with time. If thoracic spine pain is caused by a diagnosed illness or injury, treatment for that illness or injury can result in full recovery from thoracic spine pain.

Source: Medical Disability Advisor



Rehabilitation

The basic goal in the rehabilitation of thoracic spine pain is to decrease discomfort and swelling when present and to regain full motion, flexibility, strength, and endurance of the muscle/soft tissue involved. The ultimate aim is to return the individual to full function for work and recreational activities with minimal risk of re-injury. The method to achieve this is largely determined in part by the origin and severity of the thoracic spine pain and whether any thoracic joints are involved that cause difficulty with movement and function.

If the pain is severe or if the injury is acute, application of cold to the involved area is performed to help reduce inflammation. After this period, heat treatments are beneficial to reduce pain and to relax the affected muscles. Physical therapy modalities such as ultrasound or electrical stimulation can help to relax irritated thoracic muscles that may be in spasm.

In general, after 48 hours, gentle passive stretching of the trunk region to relieve stiffness and tight musculature is initiated. However, sustained flexion does not usually benefit the thoracic spine and may be contraindicated in the presence of osteoporosis or compression fractures. Physical therapists may help educate the individual in correct ergonomics when sitting, and in proper body mechanics when making transitions between positions or when lifting. A workstation assessment should be performed.

Therapists should progress individuals to an independent home exercise program involving aerobics, neck and trunk stabilization exercises, and education in body mechanics. Exercises help support correct posture and reduce strain in the thoracic spine. General conditioning of the trunk may be achieved by swimming, as the water provides a mild resistance for trunk motions.

Source: Medical Disability Advisor



Complications

When the cause of thoracic spine pain is an undiagnosed illness or injury, treatment is not effective, and may be harmful.

If the individual has significant soft tissue damage to skin, muscle, and/or ligaments, the healing response may take longer before the individual is able to return to work. This is especially the case if the rib cage region is involved, making inhalation difficult and painful because of the need to expand the chest/rib cage.

Recovery from a fracture to the thoracic spine depends on fracture type, whether there is an associated spinal cord injury, and individual's age and general health. When there is thoracic spine fracture without a spinal cord injury, there may be associated damage to muscles and ligaments requiring rehabilitation. Once the individual is allowed to return to work, it is important to initially minimize excessive bending, lifting, and twisting of the trunk.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work activities requiring loading on the thoracic spine should be restricted. These include lifting heavy weights, working overhead, twisting, and side bending. Restrictions would be appropriate for no more than 90 days, unless a specific disorder is recognized.

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:

  • Can individual point to a specific area of pain?
  • Does individual have poor posture?
  • Was there a recent injury to the area?
  • On physical exam, were there changes in the normal curvature of the spine (scoliosis, kyphosis)?
  • Is chest expansion normal? Is flexibility of the upper trunk normal?
  • Has individual lost height?
  • Was there any pain with palpation?
  • Has individual had radiographic testing or laboratory testing (MRI, bone scan, erythrocyte sedimentation rate)?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Is the pain idiopathic or secondary to another disease?
  • Has individual responded to conservative treatment?
  • Is individual aware of correct posture, and is using good body mechanics with activities?
  • Has an ergonomic assessment been performed?
  • Was physical therapy necessary?
  • Was spine manipulation helpful?

Regarding prognosis:

  • Is individual active in rehabilitation?
  • Can individual's employer accommodate necessary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Are there any other diseases that may be causing the pain?

Source: Medical Disability Advisor



References

Cited

Briggs, A. M., et al. "Prevalence and Associated Factors for Thoracic Spine Pain in the Adult Working Population: A Literature Review." Journal of Occupational Health 51 3 (2009): 177-192.

Kochan, J. P. "Vertebroplasty and Kyphoplasty, Percutaneous." eMedicine. Eds. Robert A. Koenigsberg, et al. 23 Apr. 2009. Medscape. 1 Aug. 2009 <http://emedicine.medscape.com/article/423209-overview>.

Malanga, Gerard A., et al. "Thoracic Discogenic Pain Syndrome." eMedicine. Eds. Craig C. Young, et al. 8 Jan. 2009. Medscape. 1 Aug. 2009 <http://emedicine.medscape.com/article/96284-overview>.

Rajia, P. "Soliosis, Idiopathic." eMedicine. Eds. Henrique M. Lederman, et al. Mar. 2009. Medscape. 1 Aug. 2009 <http://emedicine.medscape.com/article/413157-overview>.

Reiter, Timothy G. "Vertebral Fracture." eMedicine. Eds. Michael G. Nosko, et al. 13 Apr. 2009. Medscape. 1 Aug. 2009 <http://emedicine.medscape.com/article/248236-overview>.

Source: Medical Disability Advisor






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