AMA Guides® Newsletter - Issue Archive

Articles

1. Sacroiliac Joint Pain: Clinical and Impairment Rating Issues

   Marjorie Eskay-Auerbach, James B. Talmage

   Pages 3–7

   DOI: 10.1001/amaguidesnewsletters.2014.NovDec01

   Abstract

   The sacroiliac joint (SIJ) is an accepted source of pain in patients with ankylosing spondylitis and other spondyloarthropathies, osteoarthritis, infections, and tumors, but the occurrence of isolated SIJ pain in the absence of such diseases is controversial. The term, sacroiliac joint dysfunction, which is used widely, describes pain from an SIJ that has no identifiable lesion but is presumed to have some mechanical etiology. Practitioners currently have no universally accepted gold standard for identifying a disc, facet joint, of SIJ as the pain generator. Treatment options for SIJ pain include medications, physical therapy, bracing, manual therapy, injections, radiofrequency neurotomy, and arthrodesis. Optimal management of patients with SIJ pain remains controversial. In the AMA Guides, Sixth Edition, a clinically established and causally related diagnosis of SIJ dysfunction is rated using the first row in Table 17-4. Surgery does not change the diagnosis or rating: The SIJ is not a motion segment of the lumbar spine, and SIJ fusion is not an alteration of motion segment integrity. Clinically, pain presumed to be from SIJ dysfunction is low back pain, so if this is the clinical diagnosis, the spine chapter in the AMA Guides, Fifth Edition, should be used. In such cases, the first step is to determine whether to use the diagnosis-related estimate or the range-of-motion method, and the article provides guidance about situations in which the use of each is appropriate.
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2. AMA Guides, Sixth Edition: Spinal Impairment Case Examples

   Jeffrey Hazlewood, James B. Talmage, Marjorie Eskay-Auerbach

   Pages 8–12

   DOI: 10.1001/amaguidesnewsletters.2014.NovDec02

   Abstract

   Chapter 17, The Spine and Pelvis, of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, is used frequently when determining an individual's permanent impairment rating at maximum medical improvement (MMI). Frequently, ratings for diagnoses of “nonverifiable back pain,” herniated discs, nonverifiable radicular pain, and radiculopathy are requested. Definitions of terminology used in the AMA Guides may differ from those used by some physicians when they see patients, and evaluators should use terminology that is consistent with that of the AMA Guides. For example, for the purposes of the AMA Guides, radiculopathy is defined as “significant alteration in the function of a single or multiple nerve roots and is usually caused by mechanical or chemical irritation of one or several nerves.” This article presents fifteen cases, the whole person impairment associated with each case, and a discussion of the process whereby the rating was obtained. Accurate and fair ratings of common cases of injury-related back and leg pain require a thorough knowledge of the definitions outlined in the AMA Guides, Sixth Edition, as well as thorough knowledge of the peripheral nervous system. Also, an accurate and detailed subjective history of pain reports (including true “radicular” referral patterns) and objective physical examination, as well as a review of the medical records and previous documentations, are essential.
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3. Q&A: Rating Multilevel Cervical Fusion

   Christopher R. Brigham, James B. Talmage, Marjorie Eskay-Auerbach, Charles Brooks

   Pages 13–14

   DOI: 10.1001/amaguidesnewsletters.2014.NovDec03