AMA Guides® Newsletter - Issue Archive

Articles

1. Comparative Analysis of Third Edition, Revised; Fourth; and Fifth Edition Ratings: The State of Colorado Study

   Christopher R. Brigham, Kathryn Mueller, Douglas Van Zet, Debra J. Northrup, Edward B. Whitney, Martha M. McReynolds

   Pages 1–11

   DOI: 10.1001/amaguidesnewsletters.2004.JanFeb01

   Abstract

   In 2002, the Department of Labor and Employment, the State of Colorado, performed a study to identify changes among the Third Edition, Revised (December 1990); the Fourth Edition (June 1993); and the Fifth Edition (November 2000) of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). This three-part article summarizes the differences found. The study was based on a random sample of 250 cases identified by the Division of Workers’ Compensation of the State of Colorado and stratified into three broad categories: 40 upper extremity cases, 60 lower extremity cases, and 150 whole person cases. Only case records with adequate documented evidence to enable rating among all three editions of the AMA Guides were included. The average age of the examinee was 42.9 years (SD, 11.1 years, range, 18 to 71 years, 171 [68%] male); equal percentages of men and women were present in the upper extremity impairment ratings (20 men, 20 women), but lower extremity and whole person impairments occurred primarily among males (73% and 71% men, respectively). Interrater reliability was obtained from an independent expert medical review of 20% of the cases. Three figures show percentages of upper extremity, lower extremity, and whole person impairment according to the edition used; ratings generally are lower with more recent editions.
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2. Impairment Tutorial: Convert, Add, or Combine?

   Ian Blair Fries, Charles N. Brooks

   Pages 4–12

   DOI: 10.1001/amaguidesnewsletters.2004.JanFeb02

   Abstract

   The presence of multiple ratable entities, including symptoms, physical findings, test results, diagnoses, and/or procedures, complicates impairment evaluation; further, patients may have several findings in the same anatomic area and/or findings unrelated to the condition being rated. In complex cases involving a final extremity or whole person impairment (WPI), the examining physician must consider all possible ratable impairments, discarding duplicative or mutually exclusive ratings and converting, adding, or combining to obtain the final rating. Failure to follow the instructions detailed in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) is a common source of error in impairment rating. The AMA Guides provides multipliers and, for the upper extremity, tables to convert a body part impairment to an extremity and then to a whole person rating. Jurisdictional requirements vary, but rating physicians commonly are asked to provide a single impairment percentage for the limb or whole person; when two or more impairments are involved, the rater must add or combine the percentages, carefully following the specific instructions in the AMA Guides. Adding two ratings is no different than deriving any other arithmetic sum, but impairment percentages much more commonly are combined than added to ensure that, no matter how many impairments are present, the total is never greater than 100% loss of an extremity or 100% WPI.
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3. Clinical Update: Thoracic Outlet Syndrome

   Christopher R. Brigham, Charles N. Brooks, James B. Talmage

   Pages 6–9

   DOI: 10.1001/amaguidesnewsletters.2004.JanFeb03

   Abstract

   The diagnosis, cause, and treatment of thoracic outlet syndrome (TOS) are challenging, and the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) gives no specific instructions about rating impairments associated with this disorder. TOS is a group of symptoms and signs, including pain, weakness, paresthesias, numbness, swelling, and/or coldness arising at the base of the neck or superior chest but involving the upper limbs. Causes include compression of the brachial plexus (neurogenic TOS) or, less frequently, subclavian vein and/or artery (vascular TOS). Provocative tests for TOS attempt to induce symptoms and/or signs by compressing the subclavian artery or vein or brachial plexus, but palpitation of the radial pulse in various extremity positions is of limited diagnostic value. Diagnostic studies may include radiographs of the cervical spine, upper chest, and/or shoulder; MRI scans of the thoracic outlet; arteriography or venography, and electrodiagnostic testing. The differential diagnosis for TOS is broad and includes cervical radiculopathy, superior sulcus tumor, other peripheral nerve entrapment syndromes, complex regional pain syndrome, and psychiatric disease. The evaluator must determine if the symptoms, physical findings, and diagnostic study results support the diagnosis; the report should list the rating options considered, discuss the rationale for selecting the method(s) used, and explain how the percentage was calculated.
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