The top Ontario Catastrophic Assessors and two
of the foremost authorities on the AMA
Guides in the
United States compare and contrast approaches to multiple case
studies including the following procedural issues:
- Choosing the proper assessment team
- Applying ranges of impairment
- Rating and scoring errors
- Methodological errors
- How to address causation issues
- The role of the clinician
and the following substantive issues:
- Scoring mental and behavioral impairments as a
percentage and the interplay between (f) and (g) scoring
- Scoring mild and moderate traumatic brain injury
- Scoring for chronic pain complaints
- Scoring for psychiatric illnesses
Click
here for Schedule of Events/Further Details
Email to
Register or Call 888-262-1202
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Rating Carpal Tunnel Syndrome - Assessment of Motor
Strength Using the Guides Fifth Edition
Carpal tunnel syndrome involves compression of the
median nerve; clinical assessment of the median nerve includes
evaluation of sensory and motor function. In this refresher we
will provide tips on assessing motor function of the median
nerve. In the Fifth Edition, Section 16.5b Impairment
Evaluation Methods, Grading Motor Deficits and Loss of Power
(page 483 - 486) explains "Clinical examination of the upper
extremity demands precise anatomic knowledge to properly
select the muscle tests that correlate to the specific nerve
structure(s) involved."
Abduction of the thumb is provided by both the abductor
pollicis brevis and abductor pollicis longus muscles. The
abductor pollicis brevis is innervated by the median nerve,
whereas the longus is innervated by the posterior interosseous
nerve. Therefore, abduction strength testing of the thumb will
not isolate median nerve function. In order to precisely
assess median nerve function, strength testing should focus on
the opponens pollicis muscle. The technique described was
discussed in the January/February 2006 edition of The
Guides Newsletter and was authored by James B. Talmage,
MD, Christopher R. Brigham, MD, and Charles N. Brooks, MD.
Strength of the opponens pollicis is assessed by having the
examinee adduct the thumb metacarpal and oppose the volar pulp
of the distal phalanges of thumb and little finger. The
evaluator then applies force in an attempt to return the thumb
to its anatomic position. Proper examination of the thenar
muscles will result in a more accurate assessment of strength
in the presence of CTS, and thus, a more reliable impairment
rating.
It is extremely rare to have muscular weakness with carpal
tunnel syndrome more severe than Grade 4; therefore the
maximum impairment contribution by muscular weakness is small
in comparison to sensory loss. Recall that the maximum motor
deficit for Grade 4 is 25% and the maximum loss for motor
function of the median nerve is 10% upper extremity
impairment; thus, the maximum motor impairment for Grade 4
weakness is 2.5% upper extremity (i.e. 25% x 10%). Also recall
that page 494 instructions "In compression neuropathies,
additional impairment values are not given for decreased grip
strength."
For
More Impairment Tips Click Here
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Intensive One-Day Seminar - 6th Edition in Honolulu and
Philadelphia
This unique one-day seminar provides a solid
orientation to the new Sixth Edition of the AMA Guides to
the Evaluation of Permanent Impairment. If you are
involved in performing or reviewing impairment assessments -
it is essential that you attend this seminar - you need to
learn the new Guides. Participants will demonstrate the
fundamental skills required to assess most common impairments,
based on new approaches.
Philadelphia Seminar Details:
- Date: May 23, 2008
- Time: 8:00am - 5:15pm
- Fees: $495 per person (discount fees available
for offices with more than 5 attendees)
- Location: The Downtown Club
150 S.
Independence Mall West, Suite 100
Philadelphia, PA 19106
www.downtownclub.com
Honolulu Seminar Details:
- Date: June 6, 2008
- Time: 8:00am - 5:15pm
- Fees: $495 per person (discount fees available
for offices with more than 5 attendees)
- Location: To Be Announced
