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.

Torticollis


Related Terms

  • Cervical Dystonia
  • Head and Neck Dystonia
  • Loxia
  • Spasmodic Torticollis
  • Wry neck
  • Wryneck

Differential Diagnosis

Specialists

  • Chiropractor
  • Neurologist
  • Neurosurgeon
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist

Comorbid Conditions

Factors Influencing Duration

The individual's age, severity of symptoms, and response to treatment are factors that may influence length of disability. The presence of an underlying cause such as injury, degenerative cervical disc disease, cervical osteomyelitis, cervical osteoarthritis, or infection, may increase duration.

Medical Codes

ICD-9-CM:
333.83 - Fragments of Torsion Dystonia; Spasmodic Torticollis
723.5 - Torticollis, Unspecified; Contracture of Neck

Overview

Spasmodic torticollis (ST) is a neurological movement disorder characterized by involuntary, intermittent, or prolonged muscle contractions (dystonia) of the neck muscles that lead to abnormal postures and movement of the head. Torticollis is both a symptom and a disease with many underlying pathologies. The condition may occur without a known cause (idiopathic), may be genetic (inherited), or may be acquired secondary to damage to the nervous system or muscles. Idiopathic torticollis is believed to develop when circuit abnormalities within the nervous system trigger a biochemical process that results in neurologic deficit. It may also be psychogenic. Torticollis may be a symptom of a fracture or dislocation of C1-C2 discs in the upper cervical spine or of cervical degenerative disc disease. The condition is also called cervical dystonia, referring to these potential causes. Stress does not cause torticollis directly but is known to aggravate the condition, increasing pain. ST can occur at any age but occurs most often in middle-aged women.

Diagnosing torticollis can be difficult because the symptoms resemble other diseases or conditions, including Parkinson's disease, epilepsy, and muscular dystrophy. Many physicians are also unfamiliar with the disorder, complicating diagnosis.

Acute torticollis can develop as a result of blunt trauma to the head or neck or even from falling asleep in an uncomfortable position, involves acute pain and spasm in the neck, and may resolve by itself in a few days or a couple of weeks. Torticollis due to taking medications such as dopamine receptor blockers resolves quickly when the medicine is discontinued. Chronic or persistent torticollis, however, is painful and debilitating and may interfere with the ability to function. The spasms in the neck that occur with ST differ from person to person; the head can tilt forward (anterocollis), backward (retrocollis), or left or right (laterocollis) or can move from side to side (rotational ST). A "mixed" torticollis involves turning and shaking of the head.

Incidence and Prevalence: The incidence of idiopathic torticollis is estimated to be about 3 per 10,000 people or about 90,000 individuals (“Spasmodic Torticollis/Cervical Dystonia”). About 90% of cases are idiopathic, and 10% to 20% are from defined causes (Reynolds). However, the exact incidence is not known because many individuals go undiagnosed or their condition has been misdiagnosed. Idiopathic torticollis is more common in women than men by a 2:1 ratio (Reynolds).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Age and gender are risk factors: the risk is higher in women than in men, with onset occurring most often between ages 30 and 50 (Reynolds). An increased risk for developing torticollis may be associated with an injury to the head or neck, an infection, or use of certain medications. There may also be a genetic link, since 5% of individuals with torticollis report at least one relative with this condition (“Spasmodic Torticollis/Cervical Dystonia”). However, a family history may also suggest inherited generalized dystonia (Reynolds). The risk is increased with exposure to heavy metals or carbon monoxide.

Source: Medical Disability Advisor



Diagnosis

History: The individual may complain of constant neck pain, stiffness of the neck muscles, limited range of motion of the neck, and headache. The individual may also describe various head movements and tremors in the arms. A history of neck or cervical spine injury or a family history of head tremors may be reported. A thorough history of illnesses or injuries and medications taken is obtained.

Physical exam: Both head and neck posture (tonic components) and head movements (phasic components) will be evaluated. Upon examination, enlargement of the neck muscles and shoulder elevation on the affected side may be observed. A shortening of the neck muscles may be noted. The individual's head will tilt toward the affected side while the chin points to the unaffected side. The chin may also point up or down. Head tremor or spasmodic jerking of the head may be observed. Tremors in the arms may also be noted. Swallowing difficulty may be observed. The individual may be self-conscious and show signs of depression.

Tests: X-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scanning may be done to rule out cervical disc disease, other spinal abnormalities, or other underlying diseases or conditions. No standard laboratory tests are employed to diagnose ST. Swallowing tests using imaging and contrast media may be performed. If genetic torticollis is suspected, DNA testing may be done to identify specific genetic dystonias. Specialized eye examinations may be performed to rule out ophthalmopathies as a possible cause.

Source: Medical Disability Advisor



Treatment

Treatment for ST is not standardized since symptoms vary from person to person. If an injury, cervical disc disease, infection, or medication use is determined to be an underlying cause, it will be corrected first in an attempt to relieve symptoms. In idiopathic torticollis, oral medications are the mainstay of treatment, including anticholinergic drugs, glutamate release inhibitors, muscle relaxants, and analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDS). Injection of botulinum toxin to paralyze the affected muscle is often the treatment of choice, offering relief for several months. Heat, cervical spine traction, and massage may be used to treat head and neck pain. Stretching exercises and neck braces may help alleviate muscle spasms. Neck spasms and head movements often stop during sleeping hours and resume on waking; for this reason, some individuals may obtain relief by lying down on their back for periods during the day. Stress management may be advised to help reduce muscle tension and pain. If other treatments fail, surgical treatments are sometimes used, such as selective peripheral denervation (Bertrand procedure) and deep brain stimulation, which is the controlled delivery of electric pulses to areas of the brain involved with movement. Combinations of treatments may be required to resolve symptoms.

Source: Medical Disability Advisor



Prognosis

In most individuals, torticollis progresses gradually over a period of months to years. Complete remission sometimes occurs. Remission rates of 12% to 21% have been reported, especially in younger individuals during the first 5 years after onset of the disease (“Spasmodic Torticollis/Cervical Dystonia”). The majority of remissions are only temporary. In many cases, torticollis may persist for life and can result in restricted movement and postural deformity.

After surgery, the mobility of the neck may not return completely to normal, and some individuals may experience numbness on the back of the head that extends to the top.

Source: Medical Disability Advisor



Rehabilitation

Physical therapy is usually necessary to stretch muscles that may have shortened due to prolonged periods of involuntary contraction and to strengthen the muscles that are still innervated.

Source: Medical Disability Advisor



Complications

Individuals with prolonged torticollis may develop degenerative osteoarthritis of the cervical spine, an increase in size (hypertrophy) of the sternocleidomastoid muscle, and neurological symptoms such as numbness and tingling of the limbs due to compressed nerve roots in the neck. Prolonged postural changes of the head and neck can also lead to spinal radiculopathies and / or spinal stenosis or scoliosis. An individual’s embarrassment because of ST may lead to social isolation and / or depression.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions depend on the severity of the individual's condition (e.g., range of motion). Driving, operating heavy machinery, and any other tasks involving neck and head motions may need to be reduced or eliminated.

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 torticollis been confirmed?
  • Has an underlying cause such as injury, infection, or medication use been identified?
  • How is underlying cause being addressed?
  • Have conditions with similar symptoms been ruled out?
  • Does individual have symptoms of torticollis such as neck pain, stiffness of the neck muscles, or limited range of motion of the neck? Does individual have other symptoms? Does individual have anterocollis, retrocollis, laterocollis, or rotational torticollis?
  • Is individual under significant stress?

Regarding treatment:

  • Is underlying cause responding to treatment?
  • Have oral medications been prescribed? Is individual responding to treatment?
  • Was massage or heat therapy effective?
  • Was individual placed in traction? Did traction work?
  • Would individual benefit from botulinum toxin injections?
  • Have stress management techniques been employed?
  • Have surgical procedures been performed?

Regarding prognosis:

  • Does individual have restricted movement or postural deformity? Has individual had a remission?
  • What is individual's pain level?
  • To what level is function impaired?
  • Would a more aggressive form of treatment, such as surgical intervention, be warranted?
  • Has individual experienced any complications?
  • Does individual have an underlying condition that may affect recovery, such as cervical osteomyelitis, cervical osteoarthritis, or cervical disc disease?

Source: Medical Disability Advisor



References

Cited

"Spasmodic Torticollis/Cervical Dystonia." Torticollis.org. National Spasmodic Torticollis Association. 9 Jul. 2009 <http://www.torticollis.org/>.

Reynolds, Norman C., and Jianxin Ma. "Torticollis." eMedicine. Eds. Stephen T. Gancher, et al. 10 Dec. 2008. Medscape. 10 Jul. 2009 <http://emedicine.medscape.com/article/1152543-overview>.

Source: Medical Disability Advisor






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