AMA Guides® Newsletter - Issue Archive

Articles

1. Motion Analysis of the Cervical Spine

   Patrick R. Luers

   Pages 1–11

   DOI: 10.1001/amaguidesnewsletters.2004.SepOct01

   Abstract

   The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, defines a motion segment as “two adjacent vertebrae, the intervertebral disk, the apophyseal or facet joints, and ligamentous structures between the vertebrae.” The range of motion from segment to segment varies, and loss of motion segment integrity is defined as “an anteroposterior motion of one vertebra over another that is greater than 3.5 mm in the cervical spine, greater than 2.5 mm in the thoracic spine, and greater than 4.5 mm in the lumbar spine.” Multiple etiologies are associated with increased motion in the cervical spine; some are physiologic or compensatory and others are pathologic. The standard radiographic evaluation of instability and ligamentous injury in the cervical spine consists of lateral flexion and extension x-ray views, but no single pattern of injury is identified in whiplash injuries. Fluoroscopy or cineradiographic techniques may be more sensitive than other methods for evaluating subtle abnormal motion in the cervical spine. The increased motion thus detected then must be evaluated to determine whether it represents normal physiologic motion, normal compensatory motion, motion related to underlying degenerative disk and/or facet disease, or increased motion related to ligamentous injury. Imaging studies should be performed and interpreted as instructed in the AMA Guides.
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2. Case Study: Carpal Tunnel Syndrome

   Pages 4–10

   DOI: 10.1001/amaguidesnewsletters.2004.SepOct02

   Abstract

   This Case Study involves a 49-year-old, right-handed laborer whose impairment rating was performed by two surgeons in California following right- and left-hand endoscopic carpal tunnel release surgeries. He was evaluated by both physicians as permanent and stationary with 30% disability according to one rater and 19% by the second rater. Both raters used grip strength measurements tested using a dynamometer by the first evaluating physician and also discussed by the second evaluator. Both evaluators assessed permanent disability. The authors of this Case Study now pause to ask about problems associated with these reports and how the case should be rated; readers are encouraged to perform their own assessments before continuing with the answers and discussion that appear several pages later in this issue of The Guides Newsletter. The authors note that neither report met standards defined in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides): both histories are inadequate (eg, results of any sensory testing), as is the clinical discussion. Further, the AMA Guides indicates that it is inappropriate to rate the individual based on weakness of grip strength. In this, as in other aspects of the initial ratings, the evaluators should have followed the AMA Guides more closely, citing appropriate text and tables both for the conduct of the tests and arriving at appropriate impairment ratings. Doing so, in this instance, would result in a rating of 2% whole person permanent impairment.
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3. Clinical Update: Assessing Common Issues in Electrophysiologic Studies

   Mitchell K. Ross

   Pages 6–12

   DOI: 10.1001/amaguidesnewsletters.2004.SepOct03

   Abstract

   Electrodiagnosis is a quantitative electrophysiologic test that may identify and localize the site of neurologic dysfunction and detect subclinical changes and compensatory processes. Electrodiagnostic (EDX) studies useful in evaluating the peripheral nervous system and spinal cord include electromyography (EMG), nerve conduction studies, and somatosensory evoked potentials. The primary uses of these tests are to evaluate radiculopathy, entrapment neuropathy, or other peripheral nerve study, and results must be presented completely, concisely, and in a standardized format understandable to nonelectromyographers (who may include adjusters, attorneys, hearing officers, and judges with varying degrees of knowledge about clinical neurology). Needle EMG remains the most sensitive electrophysiologic test for determining radiculopathy. Any EDX report should contain the fundamental test results and a summary of the findings and should make clear when facts other than neurophysiological data are included. Reports must be internally consistent to avoid compromising the report's integrity. Errors of fact and technique, incomplete or irrelevant data, and over-, mis-, and underinterpretation of data are too frequent in EMG reports. EDX studies objectively define peripheral nerve injuries, entrapment neuropathies, and radiculopathies; the findings must be clearly presented with supportable conclusions. Carpal tunnel syndrome practice parameters from the American Academy of Neurology and the American Academy of Physical Medicine and Rehabilitation are provided.
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