AMA Guides® Newsletter - Issue Archive

Articles

1. The Challenge of Evaluating RSD Impairment and Disability (Part II)

   Leon H. Ensalada

   Pages 1–4

   DOI: 10.1001/amaguidesnewsletters.1998.JanFeb01

   Abstract

   Part II of this two-part series continues the discussion of diagnostic and treatment issues related to reflex sympathetic dystrophy (RSD) and presents approaches to assessing pain and disability associated with complex regional pain syndrome (CRPS). CRPS encompasses CRPS Type I (RSD) and CRPS Type II (causalgia), but the approach of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition is problematic. The current approach may not account for the complete impairment, and RSD/CRPS I by definition does not involve a specific peripheral nerve disorder. Causalgia/CRPS II by definition involves a specific peripheral nerve disorder, and the physician can assess impairment due to pain and sensory deficit or loss of power and motor deficits by multiplying the graded percent deficit with the maximum allowable impairment for the specific peripheral nerve. RSD/CRPS I by definition does not involve disruption of a peripheral nerve, but the criteria recommended by the AMA Guides may be difficult to use. The fourth edition of the AMA Guides advises that, in general, only one evaluation method should be used to evaluate a specific impairment, and a table specifies which tests should not be used together, those that may be used in combination, if appropriate, and those for which combination is not specified.
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2. Tools and Resources: Lower Extremity Conditions: Combination vs Duplication

   Randall Lea, William Shaw

   Pages 4–4

   DOI: 10.1001/amaguidesnewsletters.1998.JanFeb02

   Abstract

   This article discusses uses of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) in Australia and New Zealand. In addition to its use in the United States, the AMA Guides also is used in Australia, New Zealand, Canada, and some European countries such as Ireland, the Netherlands, and Norway. Use of the AMA Guides varies from country to country, depending on local workers’ compensation or personal injury legislation. In Australia, the AMA Guides is used in various state systems, but the editions used or recommended may differ. Often, cases in which the impairment predates December 1988 (when the current Commonwealth Workers’ Compensation Act became effective) are assessed in terms of the AMA Guides, Fourth Edition. Although many physicians use the Fourth Edition, others refer to the Table of Disabilities (Div 4/S66 of the New South Wales Workers’ Compensation Act) and Victoria prefers the AMA Guides, Second Edition. At the federal level, Australia has adopted the Guide to the Assessment of the Degree of Permanent Impairment (1989 but under revision at the time of writing). In New Zealand, the Accident Compensation Commission officially adopted use of the AMA Guides, Fourth Edition, in 1997.
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3. Legal Update: Use of the Guides Down Under

   Mohammed I. Ranavaya, Dwight K. Dowda

   Pages 5–5

   DOI: 10.1001/amaguidesnewsletters.1998.JanFeb03

   Abstract

   Evaluations of the cervical and the lumbar spine are similar with the major exception that injury in the cervical spine may cause spinal cord damage that results in long-tract signs (weakness, numbness, or paralysis). The AMA Guides to the Evaluation of Permanent Impairment recognizes eight categories of cervical spine injury, and the first five are similar to those used for the lumbar spine. Category I involves no objective findings. Category II includes objective findings such as true muscle spasm, dysmetria, or nonverifiable radicular symptoms. Category III is radiculopathy and is assessed when the patient shows signs such as the loss of relevant reflexes or unilateral atrophy with a greater than 2-cm decrease in circumference compared with the unaffected side. Category IV is loss of motion segment integrity or multilevel neurologic compromise and indicates 3.5 mm or more translation of one vertebra on another on flexion and extension x-rays. Category V is severe upper extremity neurologic compromise that requires the use of upper extremity external functional or adaptive devices. Categories VI, VII, and VIII reflect a significant change in evaluating method and include long-tract signs in addition to upper extremity involvement. Category VI includes cauda equina–like symptoms without bowel or bladder involvement. Category VII is the same as Category VI but with bowel or bladder involvement. Category VIII is paraplegia, defined as complete or near-complete loss of function in the lower extremities.
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4. Clinical Update: Evaluation of the Cervical Spine

   Robert H. Haralson

   Pages 6–7

   DOI: 10.1001/amaguidesnewsletters.1998.JanFeb04

5. Literature Review

   Linda Cocchiarella

   Pages 7–7

   DOI: 10.1001/amaguidesnewsletters.1998.JanFeb05