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Abstract
The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, offers several categories to describe impairment in the shoulder, including shoulder amputation, abnormal shoulder motion, peripheral nerve disorders, subluxation/dislocation, and joint arthroplasty. This article clarifies appropriate methods for rating shoulder impairment in a specific patient, particularly with reference to the AMA Guides, Section 3.1j, Shoulder, Section 3.1k, Impairment of the Upper Extremity Due to Peripheral Nerve Disorders, and Section 3.1m, Impairment Due to Other Disorders of the Upper Extremity. A table shows shoulder motions and associated degrees of motion and can be used in assessing abnormal range of motion. Assessments of shoulder impairment due to peripheral nerve lesion also requires assessment of sensory loss (or presence of nerve pain) or motor deficits, and these may be categorized to the level of the spinal nerves (C5 to T1). Table 23 is useful regarding impairment from persistent joint subluxation or dislocation, and Table 27 can be helpful in assessing impairment of the upper extremity after arthroplasty of specific bones of joints. Although inter-rater reliability has been reasonably good, the validity of the upper extremity impairment rating has been questioned, and further research in industrial medicine and physical disability is required.
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1.
Ensalada LH. The challenge of evaluating RSD impairment and disability (part 1). The Guides Newsletter. November/December 1997;3-5.
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Ensalada LH. The challenge of evaluating RSD impairment and disability (part II). The Guides Newsletter. January/February 1998;1-4.
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3.
Swanson AB, Goran-Hagert C, de Groot Swanson G. Evaluation of impairment of hand function. In: Hunter JM, Schneider LH, Mackin E, Callahan A, eds. Rehabilitation of the Hand. St. Louis, Mo: CV Mosby Co.; 1978:31-69.
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Gloss DS, Wardle MG. Reliability and validity of American Medical Association's Guide to Ratings of Permanent Impairment. JAMA. 248:2292-2296.
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Rondinelli RD, Dunn W, Hassanein KM, et al.Simulation of hand impairments: Effects on upper extremity function and implications toward medical impairment rating and disability determination. Arch Phys Med Rehabil. 1997;78:1358-1563.
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6.
Pryor ES. Flawed promises: Critical evaluation of the AMA Guides to the Evaluation of Permanent Impairment. Harvard Law Review. 1990;103:964-976.
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