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The AMA Guides, Sixth Edition, introduced the concept of diagnosis-based impairments (DBI). In an effort to achieve uniformity, the majority of musculoskeletal impairments can be approached using the DBI model. This method was modified for use in rating peripheral nerve injury in general (Section 15.4) and upper limb entrapment syndromes (Section 15.4f). In this article, the terms “nerve compression,” “entrapment,” “compromise,” and “focal functional loss” are all considered appropriate descriptive terms and are used interchangeably. In the AMA Guides
Peripheral nerve impairments are determined by clinically grading the percentage of motor and sensory loss experienced by the examinee. The Guides , fourth edition, discusses this method in detail on pp. 46-57 and pp. 150-152. The six steps required to rate a peripheral nerve impairment of the upper extremity are detailed below. 1. Identify the nerve or nerves affected . Many charts are available in the Guides to aid this determination. For example, upper extremity nerve charts include: Table 10 (4th ed., 47) – functions of brachial plexus nerves
Physicians use a variety of methodologies within the AMA Guides, Sixth Edition, to rate nerve injuries, depending on the type of injury and location of the nerve. Traumatic injuries that cause impairment to the peripheral or brachial plexus nerves are rated using Section 15.4e, Peripheral Nerve and Brachial Plexus Impairment (6th ed, 429–432), for upper extremities and Section 16.4c, Peripheral Nerve Rating Process (6th ed, 533–538), for lower extremities. Verifiable nerve lesions that incite the symptoms of complex regional pain syndrome, type II
QUESTION: Are the multiple impairments added or combined for a patient with multiple peripheral nerve impairments in a lower extremity (LE) injury according to the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment (AMA Guides) , Sixth Edition Does it automatically mean that the cited ratings should be added simply because the impairments are listed in the same rating chart May a peripheral nerve impairment be combined with a diagnosis-based impairment ANSWER: Multiple peripheral nerve injuries of the LE are combined
distance specified in Appendix 15-B, so no mathematical conversion of the latency for distance correction is necessary. The measured amplitude was normal (6.95 mV), further confirming that just conduction delay is present (mild neuropathy). The ulnar nerve motor study in our example shows severe neuropathy, or partial axon loss from a lesion at the elbow. In a normal peripheral nerve, axons become smaller, going from proximal to distal in a limb, and the limb becomes slightly cooler, so normally there is mild progressive slowing of the nerve conduction velocity in each
Introduction Peripheral nerve impairments of the lower extremity (LE) are rated using Section 16.4, Peripheral Nerve Impairment (6th ed, 531-538), and Table 16-12, Peripheral Nerve Impairment (6th ed, 534) in the sixth edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). Because complex regional pain syndrome, type II (CRPS II), formerly known as causalgia, involves an “unambiguous” lesion to a specific peripheral nerve, it is also rated using Section 16.4 and Table 16-12. Complex regional pain syndrome, type I (CRPS I
