The Challenge of Evaluating RSD Impairment and Disability (Part II)
Leon H. Ensalada A practicing clinical specialist in occupational medicine and pain medicine. He is president and CEO of Corporate Health Systems, Inc., Nashville, Tenn. He is board certified by the American Board of Pain Medicine, the American Board of Independent Medical Examiners, the American Board of Forensic Examiners, and the American Board of Forensic Medicine. He is board eligible by the American Board of Preventive Medicine in Occupational and Environmental Medicine.

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Part II of this two-part series continues the discussion of diagnostic and treatment issues related to reflex sympathetic dystrophy (RSD) and presents approaches to assessing pain and disability associated with complex regional pain syndrome (CRPS). CRPS encompasses CRPS Type I (RSD) and CRPS Type II (causalgia), but the approach of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition is problematic. The current approach may not account for the complete impairment, and RSD/CRPS I by definition does not involve a specific peripheral nerve disorder. Causalgia/CRPS II by definition involves a specific peripheral nerve disorder, and the physician can assess impairment due to pain and sensory deficit or loss of power and motor deficits by multiplying the graded percent deficit with the maximum allowable impairment for the specific peripheral nerve. RSD/CRPS I by definition does not involve disruption of a peripheral nerve, but the criteria recommended by the AMA Guides may be difficult to use. The fourth edition of the AMA Guides advises that, in general, only one evaluation method should be used to evaluate a specific impairment, and a table specifies which tests should not be used together, those that may be used in combination, if appropriate, and those for which combination is not specified.

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    State of Minnesota, Department of Labor and Industry. Permanent Partial Disability Schedule. Effective July 1, 1993.

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