AMA Guides® Newsletter - Issue Archive

Articles

1. Carpal Tunnel Syndrome: Challenges in Impairment Rating

   James B. Talmage

   Pages 1–3

   DOI: 10.1001/amaguidesnewsletters.1996.NovDec01

   Abstract

   According to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) the impairment rating of patients with Carpal Tunnel Syndrome (CTS) begins with a documented, objectively verifiable diagnosis by nerve conduction testing and is not based on symptoms only. A motor latency of more than 4.0 msec or a sensory latency of more than 3.7 msec clearly defines CTS, but the relative slowing of the median nerve should not be the basis of a CTS diagnosis for an impairment rating. After correct diagnosis, the next consideration is rating the impairment of patients with CTS who have not had surgery. The AMA Guides provides tables that summarize the calculations of common impairments and typically involve the maximal value of the median nerve's loss of function times a severity multiplier. Examples show the calculations for examples of impairment, including complete transection of the median nerve at the wrist, with and without severe reflex dystrophy (causalgia); a patient with CTS who has decreased two-point recognition (7-15 mm) but normal motor function, with and without normal sensation on two-point testing and no motor weakness. The article also discusses the questions that should be answered to determine if a patient who has had surgery for CTS has a permanent disability.
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2. Erratum:

   Pages 2–2

   DOI: 10.1001/amaguidesnewsletters.1996.NovDec02

   Abstract

   This article explores the specific concepts in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) that apply to assessing impairments of the brain. The AMA Guides emphasizes deficits that can be identified during a standard neurological evaluation and using standard clinical techniques. Complex and integrative cerebral functions are evaluated according to five criteria: disturbances of consciousness and awareness; aphasia or other communication disturbances; mental status and integrative functioning abnormalities; emotional and behavioral disturbances; and special types of preoccupation or obsession. The AMA Guides recommends that clinicians should first evaluate patients for aphasia. Tables show how other cerebral functions are evaluated, and the discussion includes major motor and sensory abnormalities; movement disorders; episodic neurological disorders; and sleep and arousal disorders. An example case is presented and evaluated according to the five criteria: the patient shows impairments in mental status functioning and behavioral status; mental status impairment is evaluated using a table to assign a percentage impairment, and a similar approach based on examination and tables is used to evaluate the patient's behavioral impairment and episodic seizures; finally, the clinician chooses the greater between mental and behavioral status and combines with the value regarding episodic behaviors, giving a total impairment rating.
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3. Literature Review

   Kathryn L. Mueller

   Pages 3–3

   DOI: 10.1001/amaguidesnewsletters.1996.NovDec03

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) has been adopted by many jurisdictions for evaluating permanent impairment. The AMA Guides is formally accepted by means of adoptive language in each jurisdiction's statutes or regulatory code, and this adoptive language falls into one of three types: The first type specifies a particular edition of the AMA Guides for use. Such language has the advantage of being unambiguous, but it fails to take into account subsequent editions. The second type of adoptive language specifies use of the latest or most recent edition of the AMA Guides and ensures currency; states such as Kentucky, New Hampshire, and New Mexico are jurisdictions that employ this type of language. The third type of adoptive language does not indicate which edition of the AMA Guides to use, and in these jurisdictions the courts must decide which edition to use. A chart lists 26 states, the edition of the AMA Guides used in the state, and the source; the chart also includes states such as Arizona, Georgia, Massachusetts, Nevada, South Carolina, and Washington in which the adoptive language is unclear regarding which edition to use, and in these jurisdictions a court would decide which edition should be used.
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4. Impairment Tutorial: Rating Central Nervous System Disorders

   William Shaw, Lorne Direnfeld

   Pages 4–5

   DOI: 10.1001/amaguidesnewsletters.1996.NovDec04

   Abstract

   The term nonverifiable radicular complaints is an oxymoron because if the complaint is radicular one should know the cause, but the word nonverifiable contradicts such knowledge. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) explains that nonverifiable radicular complaints “follow anatomic pathways but cannot be verified by neurologic findings.” A frequent error in impairment rating is to assign patients to Category II based on incorrect use of nonverifiable radicular complaints when Category I or 0% impairment is the correct rating. Some physicians inappropriately use the Range of Motion model and cite tables from the third edition. Other physicians may place a patient in Category II using the Injury Model without a specific basis in the AMA Guides, but the key point is that a diagnosis of nonverifiable radicular complaints indicates that the physician can identify the nerve root involved. Absent the latter, the patient does not have nonverifiable radicular complaints. The Injury Model is the preferred method in rating spinal injury in the AMA Guides, Fourth Edition, and this model clearly intends to place patients with some back pain, some leg pain, and some leg numbness—but not a true radicular pattern—in Category I.
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5. Impairment Questions and Answers

   Pages 5–5

   DOI: 10.1001/amaguidesnewsletters.1996.NovDec05

6. Legal Update: Editions of the Guides Mandated by Various Jurisdictions

   James J. Mangraviti

   Pages 6–6

   DOI: 10.1001/amaguidesnewsletters.1996.NovDec06

7. Clinical Update: Nonverifiable Radicular Complaints

   James B. Talmage

   Pages 7–7

   DOI: 10.1001/amaguidesnewsletters.1996.NovDec07