Search Results
You are looking at 1 - 10 of 175 items for
- Author or Editor: James B. Talmage x
- Refine by Access: All content x
Abstract
The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Third Edition, exclusively used the Range of Motion (ROM) Model to rate motion of the spine. The fourth edition requires the additional use of an inclinometer and also indicates that the Injury Model is the primary method for evaluating the spine; the ROM Model can be used as the differentiator or tie breaker. The ROM and the Injury Models cannot be used interchangeably, and the final rating always should be based on the Injury Model, not the ROM Model. One of the goals of changing the evaluation method is to create a more reproducible rating system. Because the Injury Model uses only objective findings present at the time of examination or found in the record, it is more reproducible. A further difference between the Injury and ROM Models is that in the former the examining physician rates the results of the injury, not the results of the treatment. The AMA Guides also requires that the patient's condition be stable—ie, not likely to change for one year. In the spine, the results of the injury, not the treatment, are rated, and often this can be done within several days of the injury.
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.
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.”
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.
