AMA Guides® Newsletter - Issue Archive

Articles

1. Key Principles in Using the Guides (Part I)

   Henry J. Roth, Christopher R. Brigham

   Pages 1–2

   DOI: 10.1001/amaguidesnewsletters.1997.JanFeb01

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides) Fourth Edition, is based on fundamental principles, particularly Chapter 1, Impairment Evaluations, Chapter 2, Records and Reports, and the Glossary. This article (continued in the next issue) discusses and clarifies 21 key principles for using the AMA Guides. For example, the AMA Guides applies only to permanent impairments, and impairment percentages are estimates, not precise determinations. All impairment ratings should be combined to express an impairment of the whole person. The AMA Guides establishes an evaluation process, and the medical rating itself is not the process or purpose addressed. An impairment estimate is simply a number and does not convey information about the effects of the impairment on the person's activities of daily living. A definition of normal requires nuanced evaluations in which physicians are asked to express opinions about the absence or presence of disability. Examiners should evaluate the patient's full range of possible active motion without the application of moderate pressure to the joint. Some patients with extremity pain or other symptoms may not have evidence of permanent impairment, and if the effects on different organ systems contribute to impairment, these estimates should be combined. [Continued in the March/April 1997 The Guides Newsletter]
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2. Impairment Tutorial: Impairment of the Lower Extremity

   William S. Shaw

   Pages 2–4

   DOI: 10.1001/amaguidesnewsletters.1997.JanFeb02

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, introduces a new system of rating lower extremity impairments that allows use of more than one method for arriving at a rating. Such flexibility allows the rater greater leeway to assess each patient's unique status but requires the clinician to clearly understand the diagnosis, pathoanatomy, and expected sequelae of a condition. For example, diminished muscle function can be evaluated in four ways (gait, atrophy, weakness, and peripheral nerve injury), but impairments should be estimated under only one of these criteria. Tables in the AMA Guides give impairment values for the whole person, as well as for the lower extremity and the part, where applicable. Impairments can be calculated in several broad categories, including the following: limb length discrepancy; gait derangement; unilateral atrophy; manual muscle testing; range of motion measurements and ankylosis; arthritis; amputations; skin loss; diagnosis-based estimates; peripheral nerve; vascular disorders; and causalgia and reflex sympathetic dystrophy. Each category includes general guidelines that help raters decide when to use that specific section. In addition to clarifying and discussing the categories, the article provides references to specific sections and tables in the AMA Guides, Fourth Edition.
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3. Literature Review

   James B. Talmage

   Pages 4–8

   DOI: 10.1001/amaguidesnewsletters.1997.JanFeb03

   Abstract

   Evaluating physicians should understand how their impairment evaluations are used, and to these ends Section 1.5 of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, discusses impairment and workers’ compensation. Permanent disability rewards may be paid according to a schedule that associates impairments of certain body parts, functions, or systems (eg, amputation or loss of sight or hearing) with specific awards. Typically, a schedule in the workers’ compensation law equates disability and a maximum number of weeks of benefits, but what occurs when an injured worker has both scheduled and unscheduled injuries? Under Colorado statute, scheduled injuries involve those to the neck, head, torso, and any injury not specifically enumerated in the statutory schedule. Because schedules usually do not cover all conditions following injuries, nonscheduled awards are available and are based on the extent of impairment, the nature of the injury, and the employee's occupation, experience, training, and age. The Colorado Supreme Court ruled that when a work-related injury results in both a scheduled and a nonscheduled injury, the scheduled injury must be converted to a whole person impairment rating and combined with the nonscheduled injury's whole person impairment when calculating permanent disability benefits. In its decision, the court relied heavily on and cited provisions in the AMA Guides.
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4. Legal Update: Scheduled and Nonscheduled Injuries

   James J. Mangraviti

   Pages 5–5

   DOI: 10.1001/amaguidesnewsletters.1997.JanFeb04

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition, includes two methods of evaluating low back impairment following injury, the Diagnosis-related estimates (DRE) method and the Range of Motion (ROM) method. The DRE method should be used first, and the ROM method should be used only when the patient's injury is difficult to categorize or when two examiners disagree about how to categorize a patient. The final rating always comes from the DRE category, never from the ROM method. Two groups of findings help determine into which DRE category to place the patient: First are structural inclusions (eg, fracture patterns on an x-ray) that are objective and automatically place a patient into a DRE category. Second are differentiators such as guarding, loss of reflexes, or loss of bowel or bladder control. In addition, unlisted objective findings may help categorize a patient but may require interpretation; examples include muscle spasm, nonverifiable root pain, anatomical numbness, anatomical weakness, and straight-leg raising. This article discusses the interpretation of sometimes partially subjective findings, thus objectifying them: guarding; muscle spasm; dysmetria; nonverifiable root pain; loss of reflexes; atrophy; straight-leg raising; anatomical numbness; weakness; EMG; loss of motion segment integrity; loss of bowel or bladder control, bladder studies; and range of motion.
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5. Impairment Questions and Answers

   Pages 5–5

   DOI: 10.1001/amaguidesnewsletters.1997.JanFeb05

6. Clinical Update: Objectifying the Low Back Pain Exam

   Robert H. Haralson

   Pages 6–7

   DOI: 10.1001/amaguidesnewsletters.1997.JanFeb06