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In the AMA Guides, Sixth Edition, range of motion (ROM) is used to calculate the physical examination modifier when the diagnosis-based impairment (DBI) method is used; ie, Table 15-8, Physical Examination Adjustment: Upper Extremities (6th ed, 408) and Table 16-7, Physical Examination Adjustment: Lower Extremities (6th ed, 517). It can also be used as a stand-alone rating, primarily with the upper extremity. The DBI is the preferable method for calculating upper and lower extremity ratings. However, in instances specified by the regional grid, the
Range of motion (ROM) is used to help calculate the physical examination modifier when employing the diagnosis-based impairment (DBI) method, as reflected in Chapter 15's Table 15-8, Physical Examination Adjustment: Upper Extremities (6th ed, 408), and in Chapter 16's Table 16-7, Physical Examination Adjustment: Lower Extremities (6th ed, 517). It can also be used as a stand-alone rating, more often with the upper extremities than with the lower. The DBI is the preferable method for calculating upper and lower extremity ratings; however, in instances
extension, abduction, adduction, and external and internal rotation. Section 3.2e, “Range of Motion” (4th ed., 77-78), discusses validity criteria for lower extremity range of motion measurements in general and provides percentage impairment ratings for deficits of joints, including the hip, along with examples. Hip motions are generally measured using a large goniometer, although an electronic inclinometer may also be used. The techniques described in the Guides are based on the “neutral zero position” described by Cave and Roberts, wherein the goniometer's axis is
there was an injury likely to cause posttraumatic arthritis (eg, a comminuted intra-articular fracture), there was insufficient time between the trauma and MRI scan demonstrating arthritis for it to have developed, indicating the arthritis was incidental, pre-existing, and causally unrelated to the torsional injury. However, a physician wishing to consider all impairment in that knee joint could incorporate the arthritis-related impairment by increasing the grade modifier for clinical studies. Range of Motion Rating Range of motion (ROM) is an integral
issue of The Guides Newsletter. Anatomic, diagnostic, and/or functional methods may be used to estimate lower extremity impairments. Limb length discrepancy and muscle atrophy are examples of the former (anatomic method). The diagnosis-based estimates section provides ratings not only for diagnoses per se (eg, lower extremity fractures or ligamentous laxity), but also provides ratings for surgical procedures, such as hip replacement, patellectomy, and meniscectomy. Examples of functional methods include ratings based on diminished range of motion, weakness, or gait
Arecent request for an impairment rating using both the Fourth and Sixth Editions of the AMA Guides ® to the Evaluation of Permanent Impairment (AMA Guides ® ) demonstrated 2 interesting facts. First, in the Sixth Edition, Table 15-34 , Shoulder Range of Motion (6th ed, 475) has the following 2 typographical errors: 1. Grade Modifier 3 (column 6) and the Internal Rotation (IR) (row 12) lists: ≤ 20° ER = 8% UEI. This should be: ≥ 20° ER = 8% UEI 2. Grade Modifier 4 (column 7) and IR (row 12) lists: 20° to 50° IR = 6% UEI, ≥60° IR or 10
-479), provide guidance. In the Sixth Edition, direction is provided in Section 15.7a, Clinical Measurements of Motion (461-464), and Section 15.7g, Shoulder Motion (472-478). The shoulder has greater mobility than any other joint in the body. A major contributor to this mobility is the shallow socket of the glenohumeral joint, which provides the shoulder with a nearly global range of motion (ROM). Movement in the shoulder is usually composite rather than in a single plane. Therefore, it is difficult to isolate single movements. In assessing impairment due to abnormal motion
Shoulder injuries are among the most common reasons for filing a claim within many workers’ compensation systems. Greater familiarity with the methodology found in the AMA Guides, Sixth Edition, Chapter 15, The Upper Extremities, will help physicians avoid common pitfalls associated with rating the shoulder and improve the reliability of impairment ratings. There are significant differences in rating process between the AMA Guides, Fifth Edition, and the AMA Guides, Sixth Edition. Range of Motion or Diagnosis-based Impairment One source of
for rating the work injury. Therefore, the primary pathology is the rotator cuff tear, the biceps tendon subluxation/pathology, or the labrum tear, and that diagnosis should be the diagnosis chosen for the IR. Range of Motion Rating Rating the UE injury by diagnosis is the preferred method (6th ed, 389), but impairment may alternatively be assessed using range of motion (ROM). The instructions on page 390 of the sixth edition indicate that if the diagnosis being considered includes an asterisk (*) in the table, rating by ROM may be used instead of
medical records. Condition Table Page Potential Impairments Impairments Included Limb length discrepancy 35 75 ______________ ______________ Gait derangement 36 76 ______________ ______________ Unilateral atrophy 37 77 ______________ ______________ Manual muscle testing 39 77 ______________ ______________ Range of motion 40-45 78 ______________ ______________ Ankylosis 46-61 79-82 ______________ ______________ Arthritis 62 83
