AMA Guides® Newsletter - Issue Archive

Articles

1. The Challenge of Hand Arm Vibration Syndrome (HAVS)

   Richard T. Katz

   Pages 1–3, 9-11

   DOI: 10.1001/amaguidesnewsletters.2007.JanFeb01

   Abstract

   Hand arm vibration syndrome (HAVS) has been defined as a constellation of vascular, neurological, and musculoskeletal signs and symptoms in workers who use hand-held vibrating tools (eg, drills, grinders, saws, or jackhammers); pathological features affect primarily vascular, neurological, and muscle tissues. Researchers have hypothesized changes in central nervous system processing, but no significant somatotopic cortical changes have been found using functional magnetic resonance imaging. Differential diagnosis of HAVS includes a variety of anatomical, circulatory, and vasospastic disorders and was standardized in the Stockholm Workshop classification scale (1987). Available laboratory tests generally are incapable of grading the severity of individual cases, and no protocol reliably distinguishes between psychogenic and organic abnormalities. Some proposed tests are impractical, and multimodality testing is confounded by statistical fallacies. Vascular tests, including the cold provocation tests, correlate poorly with disease staging according to the Stockholm Scale, and plethysmography before and after cold provocation, were found to be unsatisfactory. Job tasks that involve vibrating machines are associated with musculoskeletal symptoms but sorting out the roles and latency periods of vibration, repetitive movements, grip and push factors, and worker postures is imprecise. The AMA Guides to the Evaluation of Permanent Impairment, does not provide directions about rating impairment associated with HAVS, but evaluators can use Chapter 16 The Upper Extremities, basing the rating on motion, neurological, and/or vascular deficits.
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2. Questions and Answers

   James B. Talmage, J. Mark Melhorn, Christopher Brigham

   Pages 4–5

   DOI: 10.1001/amaguidesnewsletters.2007.JanFeb02

   Abstract

   This Case Exercise presents and critiques the case of a 52-year-old right hand dominant male who received a Qualified Medical Evaluation regarding his right wrist injury; the examination report includes several erroneous conclusions that are discussed following the case presentation: The examinee is a retail clerk at a liquor store who complained of progressive right hand pain and numbness in 2004; the examination took place in 2006, and the examiner reports an extensive list of relevant reports reviewed. Because the patient declines a carpal tunnel release procedure, the physician declares the patient to be at maximum medical improvement and uses tables in the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, to rate 19% whole person impairment and to apportion 90% to work activities. Readers can pause at this point to evaluate the case and then compare their results with the analysis. The author notes that the report does not discuss activities of daily living and does not report in detail the results of physical testing. Nor does the written report correctly explain how the rating was performed, with a detailed discussion of the rating process with reference to specific criteria and to specific tables, figures, and page numbers. As written, the report provides inadequate information to grade sensory or motor deficits and suggests the use of subjective reports, not objective findings.
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3. Case Exercise: Erroneous Rating of Carpal Tunnel Syndrome

   Christopher R. Brigham, James B. Talmage

   Pages 5–8

   DOI: 10.1001/amaguidesnewsletters.2007.JanFeb03