AMA Guides® Newsletter - Issue Archive

Articles

1. Assessing Impairment and Disability in the Pain Patient

   Steven D. Feinberg, Christopher R. Brigham, Lee Ensalada

   Pages 3–10

   DOI: 10.1001/amaguidesnewsletters.2016.JanFeb01

   Abstract

   Assessing impairment and/or disability in the pain patient often is difficult due to both administrative and clinical issues; in addition, the terms impairment and disability are misunderstood. Chronic pain complaints may be associated with significant disability, but typically the physician defines clinical issues, functional deficits, and, when requested, impairment; disability most often is an administrative determination. The biopsychosocial approach currently is viewed as most appropriate perspective for understanding, assessing, and treating chronic pain disorders and acknowledges a complex and dynamic interaction among biological, psychological, and social factors. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, discusses the assessment of pain and eligibility requirements for pain-related impairment (PRI). Some physicians feel that the AMA Guides’ approach to PRI does not adequately address the “disability” and functional loss caused by some chronic pain states, but the AMA Guides is limited, mostly, to describing measurable objective changes or impairment. The AMA Guides is not intended to be used for direct estimates of loss of work capacity (disability), and impairment percentages derived according to the AMA Guides criteria do not measure work disability. Impairment ratings in the AMA Guides already have accounted for impairment-associated pain, including that experienced in areas distant to the specific site of pathology.
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2. A Review of the Evaluation, Treatment, and Rating of Lateral Epicondylitis

   Justin J. Arnett, Steven Mandel, Steve M. Aydin, Christopher R. Brigham

   Pages 10–13

   DOI: 10.1001/amaguidesnewsletters.2016.JanFeb02

   Abstract

   Lateral epicondylitis, often called “tennis elbow,” is a musculoskeletal condition characterized by pain around the lateral elbow and adjacent forearm with resisted wrist extension or passive terminal wrist flexion with the elbow in full extension, plus tenderness over and/or just distal to the lateral epicondyle. The name is a misnomer because the pathology is neither inflammatory nor located in the lateral epicondyle but rather represents a chronic tendinosis with disorganized tissue and neovessels of the tendon originating from the extensor carpi radialis brevis muscle and less commonly the extensor digitorum communis muscle, which originate on the lateral epicondyle. Clinical assessment involves understanding the chronology, precipitating activities, current symptoms, and interference with activities of daily living. Physical examination is performed bilaterally and includes palpitation provocative testing, measuring elbow and wrist motions, and neurological evaluation. Many treatments have been proposed, but little quality evidence supports any specific approach; more than 90% of cases are managed nonoperatively. Severe cases that have failed at least months of nonoperative management may warrant surgical assessment, but studies of surgical results for treatment of lateral epicondylitis are limited. Impairment rating may be necessary in a minority of cases and involves using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, based on diagnosis-based impairment and using Table 15-4, Elbow Regional Grid: Upper Extremity Impairments.
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3. Hernia Impairment Ratings and the AMA Guides, Sixth Edition

   Blaisdell Jay, James Talmage

   Pages 14–14

   DOI: 10.1001/amaguidesnewsletters.2016.JanFeb03

   Abstract

   Of the many types of abdominal wall hernias, inguinal hernias are, by far, the most common type and typically present in males in workers’ compensation cases who report the cause as heavy lifting. The AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition, indicates that genetics (family history) is the strongest risk factor. Conditions that chronically increase intra-abdominal pressure (eg, obesity, ascites, or pregnancy) and smoking are statistically associated with abdominal wall hernias, but no good studies show an increased risk of hernia formation in laborers. Abdominal hernias with palpable defects or protrusions usually are corrected with surgery, and the outcome typically warrants an impairment of 0%. In the AMA Guides, Sixth Edition, Section 6.6, Hernias, and Table 6-10, Criteria for Rating Permanent Impairment Due to Hernias, are used for ratings. The rating scheme in the internal medicine chapters differs from that found in the musculoskeletal chapters because the rater uses a key factor of two of three potential variables—history, physical findings, and objective findings—to select the impairment class. Like the grade modifiers in the musculoskeletal chapters, the other variables (other than the key factors) then are used to modify the impairment rating within the impairment class. Most hernias are not due to injury and result in 0% whole person permanent impairment after repair.
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4. Q&A: Upper Extremity Arthroplasty

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

   Pages 15–15

   DOI: 10.1001/amaguidesnewsletters.2016.JanFeb04