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James B. Talmage

Abstract

In assessing spinal impairment, it is imperative to distinguish between limb pain or numbness that might be radicular, but with no objective verification, from symptoms that represent, in fact, true radiculopathy, ie, pain, numbness, or weakness that was related to objective radiculopathy. In the sixth edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), this distinction determines what row in the spine tables is used to rate impairment. Failure to discern between nonverifiable radicular complaints and true radiculopathy is a source of frequent errors in spinal impairment rating. True radiculopathy is pain, numbness, and/or weakness from nerve root damage, most commonly from a disc herniation. This article will review how the AMA Guides has dealt with the concept of radiculopathy through the years.

in AMA Guides® Newsletter
James B. Talmage

Abstract

Spinal examination findings of “spasm” and “facet pain” are unreliable. A thorough neurological examination can help differentiate true symptomatic radiculopathy from nonverifiable radicular complaints. Manual muscle testing may miss subtle findings. The correct diagnosis for most low-back injuries in the worker's compensation setting is “nonspecific spinal pain.”

in AMA Guides® Newsletter
James B. Talmage

Abstract

The International Association for the Study of Pain and the World Health Organization have added a new diagnosis, chronic primary pain, and a new pain mechanism, nociplastic pain, to physicians' vocabularies. This new concept explains many pain presentations that have lacked a method of classification. The implications of this new concept regarding treatment options and for determining maximum medical improvement and permanent impairment are evolving. Incorporating the chronic primary pain diagnosis and the nociplastic pain mechanism into practice will require planning and action by physicians. In this article, the history of these terms and their applicability for the AMA Guides to the Evaluation of Permanent Impairment and related publications will be discussed.

in AMA Guides® Newsletter
Restricted access
James B. Talmage

Abstract

Evaluating physicians should understand how their impairment evaluations are used, and to these ends Section 1.5 of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, discusses impairment and workers’ compensation. Permanent disability rewards may be paid according to a schedule that associates impairments of certain body parts, functions, or systems (eg, amputation or loss of sight or hearing) with specific awards. Typically, a schedule in the workers’ compensation law equates disability and a maximum number of weeks of benefits, but what occurs when an injured worker has both scheduled and unscheduled injuries? Under Colorado statute, scheduled injuries involve those to the neck, head, torso, and any injury not specifically enumerated in the statutory schedule. Because schedules usually do not cover all conditions following injuries, nonscheduled awards are available and are based on the extent of impairment, the nature of the injury, and the employee's occupation, experience, training, and age. The Colorado Supreme Court ruled that when a work-related injury results in both a scheduled and a nonscheduled injury, the scheduled injury must be converted to a whole person impairment rating and combined with the nonscheduled injury's whole person impairment when calculating permanent disability benefits. In its decision, the court relied heavily on and cited provisions in the AMA Guides.

in AMA Guides® Newsletter
James B. Talmage
in AMA Guides® Newsletter
James B. Talmage

Abstract

The AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition, uses the Injury Model to rate impairment in people who have experienced back injuries. Injured individuals who have not required surgery can be rated using differentiators. Challenges arise when assessing patients whose injuries have been treated surgically before the patient is rated for impairment. This article discusses five of the most common situations: 1) What is the impairment rating for an individual who has had an injury resulting in sciatica and who has been treated surgically, either with chemonucleolysis or with discectomy? 2) What is the impairment rating for an individual who has a back strain and is operated on without reasonable indications? 3) What is the impairment rating of an individual with sciatica and a foot drop (major anterior tibialis weakness) from L5 root damage? 4) What is the rating for an individual who is injured, has true radiculopathy, undergoes a discectomy, and is rated as Category III but later has another injury and, ultimately, a second disc operation? 5) What is the impairment rating for an older individual who was asymptomatic until a minor strain-type injury but subsequently has neurogenic claudication with severe surgical spinal stenosis on MRI/myelography? [Continued in the September/October 1997 The Guides Newsletter]

in AMA Guides® Newsletter
James B. Talmage
in AMA Guides® Newsletter
James B. Talmage
in AMA Guides® Newsletter
James B. Talmage

Abstract

This is a brief introduction to maximum medical improvement (MMI), which is pertinent to permanent impairment assessment. The definition and explanation of MMI according to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, is discussed.

in AMA Guides® Newsletter