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Radiculopathy - Rating Tip of the Week
The preferred methodology in the
AMA Guides 5th ed. for rating impairment of the
spine is the Diagnosis- Related Estimate (DRE).
Table 15-3, Criteria for Rating Impairment Due
to Lumbar Spine Injury, Table 15-4, Criteria for
Rating Impairment Due to Thoracic Spine Injury,
and Table 15-6, Criteria for Rating Impairment
Due to Cervical Disorders, outline the five
applicable categories and impairment ranges
based upon historical, physical examination, and
other clinical findings. Box 15-1, Definitions
of Clinical Findings Used to Place an Individual
in a DRE Category, on pages 382-383 contains
essential definitions of clinical findings to
help assess the proper placement of an examinee
in a DRE category. In our experience, after
reviewing thousands of reports over the past
years, the diagnosis of Radiculopathy presents
one of the more challenging concepts when
determining the correct DRE placement. The
Guides define Radiculopathy as a “significant
alteration in the function of a nerve root or
nerve roots and is usually caused by pressure on
one or several nerve roots”. The most important
clinical components required to support the
diagnosis of a compressive Radiculopathy
include:
Pain, numbness, and/or paresthesias in a
dermatomal distribution;
An imaging study documenting correlating
concordant nerve root pathology;
Associated clinical findings such as loss of
relevant reflexes, muscle weakness and/or
atrophy of appropriate muscle groups, loss of
sensation in the corresponding dermatome(s) .
Electrodiagnostic studies are helpful in
supporting the diagnosis of a compressive
radiculopathy but are not required, and do not
substitute for imaging studies.
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