AMA Guides® Newsletter - Issue Archive

Articles

1. Do Rear-End Motor Vehicle Collisions Cause Rotator Cuff Tears?

   Charles N. Brooks, James R. Funk, J. Mark Melhorn, James B. Talmage, Christopher R. Brigham

   Pages 3–7

   DOI: 10.1001/amaguidesnewsletters.2014.JanFeb01

   Abstract

   The rotator cuff comprises four muscles and their tendons, the supraspinatus, infraspinatus, teres minor, and subscapularis. Rotator cuff tears (RCTs) are common and most frequently involve the supraspinatus, and usually occur through tendon rather than muscle. Clinical manifestations vary depending on the size and age of the tear, the individual's physical demands, psychosocial factors, and other variables; tears may range from the asymptomatic to large, full-thickness, and retracted tears that cause pain, weakness, and at least partial disability. Individuals involved in rear-end motor vehicle collisions (MVCs) may complain of “shoulder” pain, and magnetic resonance imaging may reveal the presence of shoulder cuff tears, high-energy trauma can cause rotator cuff tears, but the tensile forces encountered in rear-end MVCs almost certainly do not cause rotator cuff tears de novo. Because rear-end collisions and RCTs are common and often involve claims or lawsuits, physicians may be asked to assess the causation of the RCTs. Treatment should be based on clinical findings and not the results of imaging; the same applies to causation analysis: Involvement in a rear-end MVC does not establish causality for a rotator cuff tear. The medical literature is devoid of evidence indicating that rear-end collisions cause RCTs, but compelling evidence in the biomechanical literature shows that low-speed rear-end MVCs do not cause RCTs.
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2. Maximum Medical Improvement

   Charles N. Brooks, Christopher R. Brigham

   Pages 8–10

   DOI: 10.1001/amaguidesnewsletters.2014.JanFeb02

   Abstract

   Most acute injuries and illnesses resolve, ie, reach maximum medical improvement (MMI), within days or weeks and without permanent impairment. Fractures, more severe soft tissue injuries and illness, and conditions that require surgery take longer to reach MMI, often about a year, with a range of six months to two years. Serious head, spinal cord, and other catastrophic injuries commonly take two or more years to reach MMI. These more severe injuries and illnesses understandably are more likely to result in permanent impairment. However, various parties to the claim process may request impairment rating prematurely: The claimant or plaintiff whose injury or illness has resulted in loss of income and financial hardship may push for an early impairment award or settlement. The surgeon who has operated and is done with postoperative follow-up may want to be rid of claim forms and move on to other patients. The overburdened adjuster may want to get the claim closed, thereby diminishing their workload. But rating impairment prior to MMI, ie, before it is permanent, often results in erroneously inflated ratings. In general, functional status, physical findings, and/or clinical study results improve over time, sometimes with and sometimes without treatment. This usually results in a concurrent decrease in, and sometimes even resolution of, impairment. With knowledge of the appropriate terminology and definitions, the evaluating physician should be able to render an opinion regarding MMI that is both understandable and legally sustainable in the applicable jurisdiction.
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3. Clinical Assessment of Cervical Myelopathy

   Marjorie Eskay-Auerbach, Charles N. Brooks

   Pages 10–11

   DOI: 10.1001/amaguidesnewsletters.2014.JanFeb03

   Abstract

   Myelopathy literally indicates any pathology of the spinal cord, but the term most commonly is used when the cord pathology results from degenerative disease. Specific names usually are used if the disorder is traumatic (spinal cord injury), infectious (myelitis), or neoplastic (the name of the tumor is used). Cervical myelopathy (CM) may result in symptoms such as clumsiness, loss of dexterity, imbalance or poor coordination; muscle weakness; pain; and, in severe cases, bowel, bladder, or sexual dysfunction. When impairment is rated, if the evaluator finds objective evidence of myelopathy when the individual is at maximum medical improvement, neurological impairment is combined with that for the spine. A detailed and thorough neurologic examination is the current standard for the diagnosis of CM, but diagnosis is challenging in the early stages. Correlation of patient symptoms and imaging studies, both plain radiographs and magnetic resonance imaging scans, is essential for correct diagnosis. When imaging studies are equivocal or insensitive, other studies such as electrodiagnostic testing and cerebrospinal fluid analysis may be considered. When CM is defined as the presence of more than one long-tract sign, spinal cord compression in isolation did not cause myelopathy, and up to 20% of those with cord compression did not exhibit CM.
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4. Book Review: HIPAA Plain & Simple: After the Final Rule, Third Edition

   Pages 12–12

   DOI: 10.1001/amaguidesnewsletters.2014.JanFeb04

5. Q&A: Rating Wrist Fusion Using the AMA Guides, Fifth Edition or AMA Guides, Sixth Edition

   Mark Melhorn, Charles N. Brooks, James Talmage, Christopher Brigham

   Pages 13–15

   DOI: 10.1001/amaguidesnewsletters.2014.JanFeb05