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Shaw Chiropractic
A Medical-Legal Newsletter for Personal Injury Attorneys
by Dr. Steven W. Shaw

AMA Impairment Guides:5th Edition, Part 5

Finally, after writing four newsletters I received several delayed back issues of The Guides Newsletter to which I subscribe. Interestingly, all three issues (November, January and March) cover topics which are in the past several Shaw Chiropractic newsletters. Even though the topics have been covered in my prior newsletters I will devote this newsletter to summarizing the views of The Guides Newsletter. Specifically, I will cite TABLE 3: FIFTH EDITION REVISIONS IN MUSCULOSKELETAL AND PAIN CHAPTERS from the November 2000 issue

Chapter 15: Spine

1. The nomenclature for the spine region has been returned to the conventional usage of cervical, thoracic and lumbar rather than cervicothoracic, thoracolumbar and lumbosacral.

2. The approaches are no longer called "models"; rather they are called methods.

3. Diagnostic Related Estimate (DRE) instructions are much more specific. They make crystal clear that with the exception of specific conditions the DRE method is the "preferred methodology". To use the ROM method, a patient would need to have multilevel fractures; multilevel radiculopathy; other multilevel spine injury; recurrent radiculopthy due to a new or recurrent disc injury; bilateral radiculopathy; or multiple episodes of pathology.

4. There are DRE ranges. They state "If residual symptoms or objective findings impact the ability to perform ADL despite treatment, the higher percentage range should be assigned".

5. DRE categories VI, VII and VIII have been eliminated. Spinal cord injuries are now evaluated in the chapter for Nervous System.

6. The "differentiators" are now better defined and have been renamed "clinical findings".

7. Altered motion segment integrity now includes both increased and decreased motion.

Chapter 16: Upper Extremity

1. Clarified criteria for rating weakness unrelated to other conditions.

2. Improved criteria for carpal instability.

3. Complex Regional Pain Syndromes (CRPS) are discussed and consistent throughout the book.

4. Nerve entrapment ratings have been clarified. This is particularly helpful for Carpal Tunnel Syndrome cases.

5. Finger ROMs have been expanded to include limitations from restricted excursion of tendons.

Chapter 17: Lower Extremity

1. Better explanation regarding which assessment measure is most appropriate.

2. A new table entitled "Guide to the Appropriate Combination of Evaluation Methods" has been added.

3. More case examples.

4. They provide a lower extremity worksheet.

Chapter 18: Pain

1. A more comprehensive overview of pain ratings is introduced.

2. Explanation of when pain should be rated as the major cause of suffering, dysfunction or medical intervention rather than part of an injury or illness of specific organ system.

3. They have developed a qualitative method for evaluating impairment due to chronic pain.

4. Clearer instruction about the integration of a pain rating with other ratings from the Guides.