AMA Guides® Newsletter - Issue Archive

Articles

1. Instability of the Wrist

   Mark S. Cohen

   Pages 1–3

   DOI: 10.1001/amaguidesnewsletters.1998.MarApr01

   Abstract

   Wrist trauma can disrupt the ligamentous support between the carpal bones, leading to instability of the carpus and pain, loss of motion, and loss of function. The most common patter of wrist instability is scapholunate instability that results from a fall on the outstretched hand, possibly with twisting motion. The second most common carpal instability pattern is that between the triquetrum and the lunate, termed lunotriquetral instability. The AMA Guides to the Evaluation of Permanent Impairment directs physicians to use frontal and lateral roentgenographic projections of the wrist to evaluate carpal instabilities and to rate impairment as mild, moderate, or severe. Carpal height can be used to assess impairment. Carpal translation is a medial or lateral translation of the entire carpus on the forearm (radius and ulna). Arthritic changes also can impair wrist stability and are seen roentgenographically as loss of joint space in the wrist. The degree of carpal instability lies on a continuum of loss of carpal bone support and amount of collapse, and, although little absolute difference exists between a 28-degree radiolunate angle and a 31-degree measurement, these two measurements yield different impairment ratings. Also, some forms of instability (eg, dynamic carpal instability) appear roentgenographically if the wrist is stressed, and examiners have freedom to assign impairment without reproducible, objective measures.
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2. Clinical Update: Functional Capacity Evaluations and Disability

   Glenn Pransky

   Pages 4–5

   DOI: 10.1001/amaguidesnewsletters.1998.MarApr02

   Abstract

   According to the AMA Guides to the Evaluation of Permanent Impairment, a functional capacity evaluation (FCE) measures an individual's physical abilities via a set of activities in a structured setting and provides objective data about the relationship between an impairment and maximal ability to perform work activities. A key distinction between FCEs and self-reported activities of daily living is that the former involve direct observation by professional evaluators. Numerous devices can quantify the physical function of a specific part of the musculoskeletal system but do not address the performance of whole body tasks in the workplace, and these devices have not been shown to predict accurately the ability to perform all but the simplest job tasks. Information about reliability has been proposed as a way to identify magnification and malingering, but variability due to pain and poor comprehension of instructions may cause variations in assessments. Structured work capacity evaluations involve a set of activities but likely underestimate the individual's ability to do jobs that involve complex or varying activities. Job simulations involve direct observation of an individual performing actual job tasks, require a skilled and experienced evaluator, and raise questions about expense, time, objectivity and validity of results, and interpretation of results in terms of the ability to perform specific jobs. To understand the barriers to return to work, examiners must supplement FCEs with information regarding workplace environment, accommodations, and demotivators.
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3. Literature Review

   Richard T. Katz

   Pages 5–5

   DOI: 10.1001/amaguidesnewsletters.1998.MarApr03

4. Impairment Questions and Answers

   Christopher R. Brigham

   Pages 6–6

   DOI: 10.1001/amaguidesnewsletters.1998.MarApr04

5. Tools and Resources: Impairment Due to Other Disorders of the Upper Extremity Cross-usage Table

   Marc T. Taylor

   Pages 7–7

   DOI: 10.1001/amaguidesnewsletters.1998.MarApr05