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Stephen L. Demeter
,
Christopher Brigham
,
James B. Talmage
,
J. Mark Melhorn
, and
Steven D. Feinberg

determined for musculoskeletal injuries? Each of the 3 most recent editions of the AMA Guides uses a variety of methods to determine musculoskeletal impairment, including the following: Ranges of motion and joint ankylosis Joint laxity and instability Diagnosis-related estimates Abnormalities identified in imaging studies Anatomical deformities including amputations Symptoms Surgical outcomes Nerve function as described historically, as present on physical examination, or as seen in electrodiagnostic studies Motor function as described historically

in AMA Guides® Newsletter
Christopher R. Brigham

Most impairments are expressed ultimately as a whole person impairment. The musculoskeletal chapters provide tables for converting regional impairments to whole person impairments using a percentage relationship. The following table (pages 14–15) incorporates the conversion factors for extremity impairments and spinal impairments. Upper extremity impairment conversions are provided for the digits in Table 16–1 (5th ed, 438), the hand in Table 16–2 (5th ed, 439), and the upper extremity in Table 16–3 (5th ed, 439). Conversions of lower extremity

in AMA Guides® Newsletter
Charles N. Brooks

degenerative arthritis of the lumbar facet or sacroiliac joints can be referred distally into the buttock and, less commonly, the posterior thigh. Pain referred into the leg below the knee is more suggestive of neural impingement, eg, a lumbar disc herniation and/or foraminal stenosis. The astute listener or reader will ask, “What does this person really mean by leg? Is he referring to the leg per se, the thigh, the whole lower extremity, or some portion of the lower limb and the low back?” For scheduled musculoskeletal permanent partial disabilities, the Longshore and

in AMA Guides® Newsletter
James B. Talmage
and
Christopher R. Brigham

The evaluation of an individual with pain complaints following a musculoskeletal injury is common. Pain complaints without objective findings do not result in ratable impairment. Pain is subjective and cannot be measured objectively. It is perceived consciously and is evaluated in light of past experiences. The Guides notes: Pain is a subjective perception. Usually no exact relationships exist among the degree of pain, extent of pathologic change, and extent of impairment. Decreased ability to carry out daily activities may be one result of pain

in AMA Guides® Newsletter
Stephen L. Demeter
,
Charles N. Brooks
, and
J. Mark Melhorn

addresses the musculoskeletal system. It differs in many respects from the first three articles, which primarily focused on the apportionment of an impairment rating between aging and other causes. For example, how much of a rating for hypertension should be apportioned to the normal processes of aging? In contrast, this article on age-related musculoskeletal changes focuses primarily on causation. All tissues degenerate over time, and, apart from the skin, perhaps the most noticeable changes are in the musculoskeletal system. Muscular strength and endurance diminish

in AMA Guides® Newsletter
Christopher R. Brigham
and
James B. Talmage

QUESTION: I have 2 questions that focus on how to apportion a preexisting impairment that is not listed in the musculoskeletal diagnosis-based impairment grids. The preexisting impairment is metastatic disease. The patient is a 64-year-old male with metastatic squamous cell carcinoma (primary head and neck), stage IV, who had metastasis to the left proximal femur, which was refractory to radiation therapy (33 treatments). The metastatic disease to the left femur was present symptomatically 7 months prior to his work-related injury, with biopsy

in AMA Guides® Newsletter
Christopher R. Brigham
,
Stephen L. Demeter
, and
E. Ranolph Soo Hoo

that certain exposures, particularly tobacco, may contribute to other problems (eg, tobacco use increases the risk of musculoskeletal issues). The Agency for Toxic Substances and Disease Registry 1 provides an excellent and up-to-date summary of what should be included in conducting an appropriate exposure history (see Box 1 ). Box 1. What Should an Exposure History Be Composed of? An exposure history has three components: Exposure Survey Work History Environmental History The main aspects of an exposure history will be elicited through the

in AMA Guides® Newsletter

Abstract

Lesions of the peripheral nervous system (PNS), whether due to injury or illness, commonly result in residual symptoms and signs and, hence, permanent impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, divides PNS deficits into sensory and motor and includes pain in the former. This article, which regards rating sensory and motor deficits of the lower extremities, is continued from the March/April 2000 issue of The Guides Newsletter. Procedures for rating extremity neural deficits are described in Chapter 3, The Musculoskeletal System, section 3.1k for the upper extremity and sections 3.2k and 3.2l for the lower limb. Sensory deficits and dysesthesia are both disorders of sensation, but the former can be interpreted to mean diminished or absent sensation (hypesthesia or anesthesia) Dysesthesia implies abnormal sensation in the absence of a stimulus or unpleasant sensation elicited by normal touch. Sections 3.2k and 3.2d indicate that almost all partial motor loss in the lower extremity can be rated using Table 39. In addition, Section 4.4b and Table 21 indicate the multistep method used for spinal and some additional nerves and be used alternatively to rate lower extremity weakness in general. Partial motor loss in the lower extremity is rated by manual muscle testing, which is described in the AMA Guides in Section 3.2d.

in AMA Guides® Newsletter