Chapter 17: The Lower Extremities
- Introduction
- 17.1 Principles of Assessment
- 17.2 Methods of Assessment
- 17.2a Converting From Lower Extremity to Whole Person Impairment
- 17.2b Limb Length Discrepancy
- 17.2c Gait Derangement
- 17.2d Muscle Atrophy (Unilateral)
- 17.2e Manual Muscle Testing
- 17.2f Range of Motion
- 17.2g Joint Ankylosis
- 17.2h Arthritis
- 17.2i Amputations
- 17.2j Diagnosis-Based Estimates
- 17.2k 17.2k Skin Loss
- 17.2l 17.2l Peripheral Nerve Injuries
- 17.2m Causalgia and Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy)
- 17.2n Vascular Disorders
- 17.3 Lower Extremity Impairment Evaluation Procedure Summary and Examples
- Example 17-20 7% Impairment Due to Peripheral Nervous System Injury
- Example 17-21 8% Impairment Due to Decreased Range of Motion From Hip Dislocation and Fixation
- Example 17-22 10% Impairment Due to Limb Length Discrepancy, Malalignment of the Tibial Shaft Fracture, and Atrophy
- Example 17-23 10% Impairment Due to Undisplaced Tibial Plateau Fracture and Peroneal Neuropathy
- Example 17-24 15% Impairment Due to Hip Replacement
- Example 17-25 25% Impairment Due to Transmetatarsal Amputation
- Box 17-1 Choosing a Lower Extremity Impairment Rating
- 1. Establish the diagnosis.
- 2. Determine whether MMI has been reached.
- 3. Identify each lower extremity anatomic region with abnormalities that are related to illness/ injury in question. List potential methods.
- 4. Calculate impairment according to text and tables for each applicable method.
- 5. Identify and calculate illness/injury related to peripheral nervous system impairment.
- 6. Identify and calculate all illness/injury related to the peripheral vascular system.
- 7. Identify and calculate all injury impairment related to CRPS.
- 8. If no other method is available, then determine impairment due to gait derangement if clinically applicable.
- 9. Consult lower extremity cross-usage table (Table 17-2) to determine possible method groupings.
- 10. Consider all medical data available and select the largest and most clinically appropriate methods for each illness/injury; combine each parameter within each individual grouping in order to determine impairment for each leg. Numeric figures should be in whole person units.
- 11. Use the Combined Values Chart (p. 604) to combine whole person impairments from each regional impairment calculated in step 10 of the same limb. This allows the examiner to determine the lower extremity rating for that particular extremity. The lower extremity impairment rating for each limb is then converted to whole person impairment using Table 17-3. If both lower extremities are involved, the impairment rating for each extremity is first converted to a whole person impairment before being combined with the whole person impairment for the contralateral extremity.
- References
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Lea RD, Gerhardt JJ. Current concepts review range of motion measurement. Bone Joint Surg. 1995;77:784–798.
-
2.
Mayer T, Kondraske G, Beals S, Gatchel R. Spinal range of motion: accuracy and sources of error with inclinometric measurement. Spine. 1997;22:1976–1984.
-
3.
Gerhardt JJ. Documentation of Joint Motion. Rev 3rd ed. Portland, Ore: Oregon Medical Association; 1992.
| All Time | Past Year | Past 30 Days | |
|---|---|---|---|
| Full Text Views | 207 | 207 | 58 |
AMA Guides® Editorial
AMA Guides® Education
© 2024 American Medical Association. All Rights Reserved.
Powered by PubFactory