AMA Guides® Newsletter - Issue Archive

Articles

1. Upper Extremities Impairment Evaluation: Overview of Sixth Edition Approaches

   Christopher R. Brigham, Craig Uejo, J. Mark Melhorn, James B. Talmage

   Pages 1–5

   DOI: 10.1001/amaguidesnewsletters.2008.MarApr01

   Abstract

   In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, the chapter on the upper extremities is the longest and most complex, which reflects the complexities of the upper limb and the type of injuries encountered. This chapter incorporates the following changes: The International Classification of Functioning, Disability, and Health (ICF) Model of Functioning and Disability, developed by the World Health Organization, is used to provide a common basis for the description of human functioning and impairments. The principles of assessment have been simplified and clarified. Specific diagnosis-based rating tables for the most common injuries and diagnoses have been added, and an extensive discussion shows the definition of impairment classes and corresponding ranges of impairment for upper and lower extremities. A table and accompanying diagnosis-based impairment example provide examples of upper extremity diagnoses and associated class definitions and default impairment values. The physical examination has been simplified, and functional assessment is provided through focused history-taking, including information about activities of daily living and a functional assessment tool. The criteria for diagnosis of complex regional pain syndrome have been updated for consistency with current standards and other chapters. Among other modifications, the approach to entrapment neuropathy (eg, carpal tunnel syndrome) has changed, and only electrodiagnostically confirmed entrapment cases are ratable.
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2. Errata

   Pages 5–5

   DOI: 10.1001/amaguidesnewsletters.2008.MarApr02

   Abstract

   Although most chapters in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, instruct evaluators to perform impairment ratings by first assigning a diagnosis-based class and then assigning a grade within that class, Chapter 13, The Central and Peripheral Nervous System, continues to use a methodology similar to that of the fifth edition. The latter was criticized for duplicating materials that were presented in other chapters and for producing different ratings, so the revision of Chapter 13 attempts to maintain consistency between this chapter and those that address mental and behavioral disorders, loss of function in upper and lower extremities, loss of bowel control, and bladder and sexual function. A table titled Summary of Chapters Used to Rate Various Neurologic Disorders directs physicians to the relevant chapters (ie, instead of Chapter 13) to consult in rating neurologic disorders; the extensive list of conditions that should be addressed in other chapters includes but is not limited to radiculopathy, plexus injuries and other plexopathies, focal neuropathy, complex regional pain syndrome, visual and vestibular disorders, and a range of primary mood, anxiety, and psychotic disorders. The article comments in detail on sections of this chapter, identifies changes in the sixth edition, and provide guidance regarding use of the new edition, resulting in less duplication and greater consistency.
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3. Impairment Tutorial: Neurological Impairment Evaluation: Overview of Sixth Edition Approaches

   Lorne Direnfeld, Christopher R. Brigham, Elizabeth Genovese

   Pages 6–8

   DOI: 10.1001/amaguidesnewsletters.2008.MarApr03

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), does not provide a Diagnosis-based estimate of impairment due to syringomyelia, a disorder in which a cyst (syrinx), develops within the central spinal cord and destroys neural tissue as it expands. The AMA Guides, however, does provide an approach to rating a syringomyelia based on objective findings of neurological deficits identified during a neurological examination and demonstrated by standard diagnostic techniques. Syringomelia may occur after spinal cord trauma, including a contusion of the cord. A case study illustrates the rating process: The case patient is a 46-year-old male who fell backwards, landing on his upper back and head; over a five-year period he received a T5-6 laminectomy and later partial corpectomies of C5, C6, and C7, cervical discectomy C5-6 and C6-7; iliac crest strut graft fusion of C5-6 and C6-7; and anterior cervical plating of C5 to C7 for treatment of myelopathy; postoperatively, the patient developed dysphagia. The evaluating physician should determine which conditions are ratable, rate each of these components, and combine the resulting whole person impairments without omission or duplication of a ratable impairment. The article includes a pain disability questionnaire that can be used in conjunction with evaluations conducted according to Chapter 3, Pain, and Chapter 17, The Spine.
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4. Case Study: Rating Syringomelia by Fifth Edition

   Lorne Direnfeld

   Pages 9–12

   DOI: 10.1001/amaguidesnewsletters.2008.MarApr04

5. Pain Disability Questionnaire

   Pages 11–11

   DOI: 10.1001/amaguidesnewsletters.2008.MarApr05