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.

Displacement, Cervical Intervertebral Disc Without Myelopathy


Related Terms

  • Cervical Disc Herniation
  • Cervical Disc Prolapse
  • Cervical Disc Protrusion
  • Disc Herniation
  • Disc Protrusion
  • Disc Rupture
  • Herniated Disc
  • Herniated Nucleus Pulposus (HNP)
  • Slipped Disc

Differential Diagnosis

Specialists

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

Comorbid Conditions

  • Curvature of the spine (scoliosis)
  • Depression
  • Low back pain
  • Mechanical instability
  • Obesity
  • Psychiatric disorders
  • Rheumatologic disease (including rheumatoid arthritis and ankylosing spondylitis)
  • Spondylosis with or without facet joint arthritis

Factors Influencing Duration

Length of disability depends on the location and number of affected discs, and whether nerve root compression has resulted in cervical radiculopathy. Other factors include the severity of any neurological involvement, and whether these neurological deficits are improving, static, or worsening over time. The individual's age and whether surgery was performed are important factors influencing the duration of disability. Psychosocial factors, including the individual's attitude and willingness to return to work and to comply with a home exercise program contribute to the outcome. Dependence on pain medications can be an important factor influencing duration for some individuals, especially if the employer has a policy precluding use of controlled substances in those with safety sensitive jobs.

Medical Codes

ICD-9-CM:
722 - Intervertebral Disc Disorders
722.0 - Cervical Intervertebral Disc Displacement without Myelopathy; Neuritis (Brachial) or Radiculitis Due to Displacement of Cervical Intervertebral Disc
722.2 - Displacement of Intervertebral Disc without Myelopathy, Site Unspecified; Discogenic Syndrome NOS; Herniation of Nucleus Pulposus NOS; Neuritis or Radiculitis due to Displacement or Rupture of Lumbar Intervertebral Disc

Diagnosis

History: Important items to note in the history include: information about pain (onset, location, quantity, quality, setting, aggravating and alleviating factors, associated symptoms), percentage of pain that is axial (neck) vs. peripheral (upper limb) pain, and history of neck injury. Disc-related pain without nerve root involvement may be vague and diffuse. Radicular pain from nerve root compression typically follows a dermatomal pattern in upper limb; neck pain may be paradoxically absent. The pain may have begun with no apparent cause, or there may be a history of injury to the neck. Some episodes begin during or shortly after the person does a “low violence” activity that the individual has done many times before, and this “minor trauma” may be blamed for the event by both health care providers and patients. The location of the pain, sensory loss, and muscle weakness in the limb usually allow the physician to determine which nerve root is most likely to be compressed by a disc herniation.

These individuals sometimes rest the symptomatic upper extremity on the top of their head to decrease pain. Coughing or sneezing makes the pain worse, and affected individuals may report that they are more comfortable sleeping in a reclining chair than in a bed. If treatment is not sought, individuals may notice increasing weakness in the affected limb. A history of prior or existing systemic illness should be obtained, including chronic disease (e.g., diabetes, heart disease, atherosclerosis, nervous system disorders, arthritis, infections, malignancies, or weight loss).

Physical exam: Cervical intervertebral disc displacement usually limits range of motion of the neck. The exam may show that neck movement aggravates pain, particularly when bending the head backward (hyperextension) and turning the head from side to side (rotation). The manual application of cervical compression and distraction during the physical exam may help to differentiate between disc pain and pain from other causes. Pain may increase when downward pressure is applied to the top of the head (cervical compression test) and may be relieved by traction (cervical distraction test). Examination should include assessment of muscle strength and changes in sensation and reflexes in the upper extremities. Lower extremities may be examined to rule out signs of myelopathy.

Tests: Laboratory blood tests are usually not necessary, but may include erythrocyte sedimentation rate (ESR) to evaluate inflammation, white blood count analysis to rule out infection, rheumatoid factor, thyroid and parathyroid studies, and liver function studies. Human leukocyte antigens may be typed. Results of these tests help rule out other conditions.

Imaging studies show the extent of degenerative changes, but do not give any information about function. Plain x-rays show narrowing of the disc space and bone spur (osteophyte) formation, if present, as well as possible metastatic disease, spinal deformity, and spine stability. If mechanical instability is suspected as a cause of recurrent pain, it can be documented by x-rays taken with the neck bent forward (flexion) and bent backward (hyperextension).

MRI or myelography combined with CT are considered the best ways to diagnose a herniated cervical disc. Electromyography (EMG) may distinguish nerve root compression from a peripheral nerve problem such as carpal tunnel syndrome or ulnar nerve entrapment. Nevertheless, a normal EMG does not rule out nerve root compression. As in the lumbar spine, asymptomatic herniations are frequently seen in normal volunteers. For this reason, disc herniations on imaging studies must correlate with the clinical signs of nerve root deficit observed on physical examination.

Source: Medical Disability Advisor






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