QUESTION: How would impairment from anterior chest wall pain be rated using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition? One year ago, a 50-year-old male was pushing a heavy cart, heard a “pop” in his right anterior chest wall, and had sudden pain. Despite various treatments, he reports continued significant pain and functional limitations. On physical examination, he had localized right anterior chest wall tenderness. Later, another physician reported muscle guarding. Neither of us performed symptom validity testing, nor did we complete the AMA Guides' Table 18-4, Ratings Determining Impairment Associated With Pain (5th ed, 576–577). However, using the fifth edition of the AMA Guides, Chapter 18, Pain, I gave the patient a rating of 2% whole person impairment (WPI). The other physician felt my approach underrated the patient's functional difficulties,...
