AMA Guides® Newsletter - Issue Archive

Articles

1. Assessing Sexual Dysfunction, Part 1: Male Sexual Dysfunction

   Seth D. Cohen, Steven Mandel, David B. Samadi

   Pages 3–8

   DOI: 10.1001/amaguidesnewsletters.2016.MarApr01

   Abstract

   To properly assess men and women with sexual dysfunction, evaluators should take a biopsychosocial approach that may require consultation with multiple health care professionals from various fields in order to get to the root of the sexual dysfunction; this multidisciplinary methodology offers the best chance of successful treatment. For males, this article focuses on erectile dysfunction (ED) and hypogonadism. The initial evaluation of ED involves a thorough case history, preferably taken from the patient and partner, physical examination, and proper laboratory and diagnostic tests, including an acknowledgment of the subjective complaint. The diagnosis is established on the basis of an individual's report of the consistent inability to attain and maintain an erection sufficient to permit satisfactory sexual intercourse. Initial workups for ED should entail a detailed history that can be obtained from a validated questionnaire such as the International Index of Erectile Function and the Sexual Health Inventory for Men. Hypogonadism is evaluated using the validated Androgen Deficiency in the Aging Male questionnaire and laboratory testing for testosterone deficiency. Treatments logically can begin with the least invasive and then progress to more invasive strategies after appropriate counseling. The last and most important treatment component when caring for men with sexual dysfunction—and, arguably, the least practiced—is close follow-up.
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2. Impairment Assessment of Male Sexual Dysfunction

   Christopher R. Brigham, Randy Soo Hoo

   Pages 9–10

   DOI: 10.1001/amaguidesnewsletters.2016.MarApr02

   Abstract

   Impairment assessment of male sexual dysfunction using both the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth and Sixth Editions, must be done with appropriate evaluation and objective findings in order to support ratable sexual dysfunction. The fifth edition specified that the absence of sexual functioning results in a maximum rating of 20% whole person impairment (WPI); in the sixth edition, the maximum is 15%. In the AMA Guides, Fifth and Sixth Editions, sexual dysfunction is discussed in Chapter 7, The Urinary and Reproductive Systems, and in Chapter 13, The Central and Peripheral Nervous System. In the fifth edition, Section 7.7, Male Reproductive Organs, provides guidance for impairment percentages for male reproductive organs for men aged 40–65 years; age adjustment is made for males younger than 40 (WPI is increased 50%) and older than 65 (WPI is decreased 50%). Section 13.7d, Sexual System Neurologic Impairments, in the fifth edition of the AMA Guides directs evaluators to use Table 13-21, Criteria for Rating Neurologic Sexual Impairments. In the sixth edition, Section 7.7 similarly offers guidance for impairment percentages for male reproductive organs for men aged 40–65 years but, unlike the fifth edition, allows a 10% upward or downward adjustment at the evaluator's discretion based on the individual's age and level of premorbid sexual functioning. In the sixth edition, Table 7-6, Criteria for Rating Permanent Impairment Due to Penile Disease, presents four classes and three grades.
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3. Case Study: Use of Electrodiagnostic Evaluation to Assess Lumbar Radiculopathy

   Edward Dagher, James B. Talmage, Lorne Direnfeld, Christopher R. Brigham

   Pages 11–13

   DOI: 10.1001/amaguidesnewsletters.2016.MarApr03

   Abstract

   The electrodiagnostic examination is an important diagnostic tool that defines the location, pathophysiology, severity, and chronicity of a wide array of neuromuscular disorders. The test comprises two parts, a nerve conduction study (NCS) and needle electromyography (EMG), and is an extension of the neuromuscular portion of the physical examination. Together, NCS and EMG provide complementary information about the integrity of the peripheral nervous system. The article presents a case example that is evaluated using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. The case describes a 52-year-old woman who had a back injury that was managed conservatively for fifteen months and then underwent a three-level lumbosacral instrumented posterolateral fusion (the rationale is unclear from the records). Her pain persisted and treatment has included chronic narcotics; she reported multiple physical and psychological complaints and difficulties, and illness behavior and unreliable self-reports failed to corroborate her reports. Needle EMG must be performed on the patient's paraspinal muscles for proper evaluation of radiculopathy, and in this case there was no evidence of involvement of any ventral ramus and thus no evidence was documented of nerve root abnormality involving two or more limb muscles that receive innervation from the same nerve root. For this individual, the changes seen in paraspinal EMGs were unlikely to be due to a true lumbar radiculopathy, which was not convincingly established.
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4. Q&A: Rating Facial Numbness

   James B. Talmage

   Pages 13–13

   DOI: 10.1001/amaguidesnewsletters.2016.MarApr04

5. Q&A: Cervical MRI with Flexion-Extension Views and Alteration of Motion Segment Integrity

   Patrick Luers, Gunnar Andersson, Christopher R. Brigham, Charles N. Brooks, James B. Talmage

   Pages 14–15

   DOI: 10.1001/amaguidesnewsletters.2016.MarApr05

6. Q&A: Rating Ilioinguinal Nerve Injury

   James B. Talmage

   Pages 15–15

   DOI: 10.1001/amaguidesnewsletters.2016.MarApr06