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William S. Shaw
in AMA Guides® Newsletter
William S. Shaw

Abstract

The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, introduces a new system of rating lower extremity impairments that allows use of more than one method for arriving at a rating. Such flexibility allows the rater greater leeway to assess each patient's unique status but requires the clinician to clearly understand the diagnosis, pathoanatomy, and expected sequelae of a condition. For example, diminished muscle function can be evaluated in four ways (gait, atrophy, weakness, and peripheral nerve injury), but impairments should be estimated under only one of these criteria. Tables in the AMA Guides give impairment values for the whole person, as well as for the lower extremity and the part, where applicable. Impairments can be calculated in several broad categories, including the following: limb length discrepancy; gait derangement; unilateral atrophy; manual muscle testing; range of motion measurements and ankylosis; arthritis; amputations; skin loss; diagnosis-based estimates; peripheral nerve; vascular disorders; and causalgia and reflex sympathetic dystrophy. Each category includes general guidelines that help raters decide when to use that specific section. In addition to clarifying and discussing the categories, the article provides references to specific sections and tables in the AMA Guides, Fourth Edition.

in AMA Guides® Newsletter
William S. Shaw
in AMA Guides® Newsletter
Restricted access
William S. Shaw
in AMA Guides® Newsletter
William S. Shaw
and
Charles N. Brooks

Abstract

The process of assessing lower extremity impairment described in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, differs from that in previous editions. This article addresses common questions that arise in knee and hip impairment rating according to the new edition. Anatomic, diagnostic, or functional methods can be used to estimate lower extremity impairments. Functional methods include ratings based on diminished range of motion, weakness, or gait derangement. In general, only one method should be used to rate impairment associated with an injury or illness. Section 3.2i, Diagnosis-related Estimates, in the AMA Guides lists impairment ratings for many knee conditions and operative procedures. Decreased range of motion, ankylosis, diminished muscle function, and joint space narrowing are some rating methods for the knee. Similar anatomic, diagnostic, and functional methods may be used to rate impairment due to hip pathology, but most hip impairments are estimated by range-of-motion deficits. Assessing lower extremity impairments requires a thorough medical evaluation, careful analysis, experience, and clear judgment; evaluators must determine the applicable rating methods, use the methods to rate the impairment, and then decide which method or combination best describes the impairment, without overlooking or duplicating ratings. [A related Lower Extremity Impairment Checklist and Worksheet appears on page 4 of this issue of The Guides Newsletter. A related Quick Reference, Motion at the Wrist, Elbow, and Shoulder, appears on page 5.]

in AMA Guides® Newsletter
William S. Shaw
and
Charles N. Brooks
in AMA Guides® Newsletter