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Abstract
The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, introduced the concept of diagnosis-based impairments (DBI), and a modified version of this method can be used in rating peripheral nerve injury in general (Section 5.4) and upper limb entrapment syndromes (Section 15.4f). The first portion of this article reviews the evaluation of upper extremity nerve impairment and summarizes inclusion criteria and causation correlation for carpal tunnel syndrome, Guyon's canal syndrome, cubital tunnel syndrome, anterior interosseous, Wartenberg's syndrome, and radial tunnel syndrome. Very mild nerve entrapments do exist and may fail to meet the AMA Guides criteria for impairment related to a diagnosis of nerve entrapment. Electrodiagnostic examination includes nerve conduction studies that assess the largest, most heavily myelinated axons, and needle electromyelography, which detects muscle membrane instability but not the sensory function of nerves. A case example from the AMA Guides, Sixth Edition, shows the process of permanent impairment rating in a case of carpal tunnel syndrome. Determination of impairment for peripheral nerve entrapments can be easily accomplished once one understands how to determine if the nerve under consideration from the electrodiagnostic evaluation demonstrates a conduction delay, a conduction block, or an axon loss. This establishes the test findings that usually are the only objective findings present.
- Abstract
- 15.4 Peripheral Nerve Impairment
- Diagnosis
- Median Nerve Entrapment at the Wrist (Carpal Tunnel Syndrome or CTS)
- Ulnar Nerve Entrapment at the Wrist (Guyon's Canal Syndrome)
- Ulnar Nerve Entrapment at the Elbow (Cubital Tunnel Syndrome)
- Median Nerve Entrapment in the Proximal Forearm (Anterior Interosseous)
- Radial Nerve Entrapment at the Wrist (Wartenberg’'s Syndrome)
- Radial Nerve Entrapment at the Elbow (Radial Tunnel Syndrome or RNE)
- Assessment Requirements = Diagnosis, History, Physical Findings, and Functional Scale
- Impairment Rating
- Case Example
- Summary
- Reference
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1.
Melhorn JM et al.. AMA Guides to the Evaluation of Disease and Injury Causation. 2nd ed. Chicago: AMA; 2013.1.
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2.
World Health Organization. Identification and control of work-related diseases. Geneva, Switzerland: World Health Organization; 1985:1–85. Technical report series No. 714.
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3.
Guyon F. Note sur une disposition anatomique propre a la face anterieure de la region du poignet et non encore decrite par le docteur. Bull Soc Anat Paris. 1861\;6:184–186.
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4.
Hegmann KT, ed. ACOEM Occupational Medicine Practice Guidelines. 3rd ed. Elk Grove Village, IL: American College of Occupational and Environmental Medicine; 2011.
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5.
Katz RT. Ulnar neuropathy at the elbow due to repetition: myth or reality. AMA Guides Newsletter. 2006;(Sept/Oct):1–3, 7–10.
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6.
Plate AM, Green SM. Compressive radial neuropathies. Instr Course Lect. 2000;49:295–304.
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7.
Eaton CJ, Lister GD. Radial nerve compression. Hand Clin. 1992;8:345–357.
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8.
Carlson N, Logigian EL. Radial neuropathy. Neurol Clin. 1999;17:499–523, vi.
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