bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cervical Lordosis: The Significance of Decreased, Straightened, and Reversed Curves
Authors: Brooks Charles N. , Eskay-Auerbach Marjorie , Talmage James B. , Tencer Allan F. 
Published: December 2020

Abstract
The normal cervical spine is straight in the coronal plane and usually is lordotic (curved convex anteriorly) in the sagittal plane, and although cervical spine deformity occurs in the coronal plane (eg, scoliosis), sagittal plane deformities are more common. For example, cervical lordosis can be increased (hyperlordosis) within the normal range, decreased (hypolordosis), absent (a straight cervical spine with 0° of curvature on a lateral X ray), or reversed (kyphosis). Primary deformity of the cervical spine often is congenital (eg, wedge vertebra); secondary sagittal deformities may be due to disc degeneration accompanying aging, disease such as ankylosing spondylitis, or surgery (eg, for postlaminectomy kyphosis). Decreased, straightened, or reversed cervical lordosis (DSRCL) may be idiopathic and can be voluntary, and evaluators must differentiate DSRCL that does not change over time vs sagittal plane alignment that varies over time or with a change in posture or position. DSRCL usually is asymptomatic, but severe cervical kyphosis can cause neck pain, myelopathy, dysphagia, loss of horizontal gaze, and other symptoms that are sufficiently severe to result in disability and to require surgical correction. Reports of DSRCL due to spasm, particularly at times temporally remote to an injury, should be met with extreme skepticism. Kyphosis of sufficient severity to be symptomatic usually is a postoperative deformity, not an effect of whiplash.
Shoulder Impairment Ratings: Sixth Edition
Authors: Talmage James B. , Blaisdell Jay 
Published: December 2020

Abstract
In many workers’ compensation systems, shoulder injuries are among the most common reasons for filing a claim, and greater familiarity with the significant differences in rating processes between the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth and Sixth Editions will help physicians avoid common pitfalls and improve the reliability of impairment ratings. One source of confusion associated with rating a shoulder is determining whether to use the range-of-motion (ROM) method or the diagnosis-based impairment (DBI) method. The AMA Guides, Sixth Edition, clearly states that DBI is the primary method of evaluation for the upper limb and that range of motion is used primarily as a physical examination adjustment factor and only when a grid permits its use as an option. An impairment rating that is calculated using ROM may not be combined with a DBI-based impairment rating; DBI is the primary method, and ROM should be used “only under specific circumstances.” When measuring ROM, evaluators should record all six measurements of shoulder motion for each arm and use the injured arm as a baseline. If two or more diagnoses are possible under the DBI method, evaluators should choose the highest causally related impairment rating from the shoulder grid and modify the clinical studies grade modifier.
Assessing Impairment and Disability in the Pain Patient
Authors: Feinberg Steven D. , Brigham Christopher R. , Ensalada Lee 
Published: December 2020

Abstract
Assessing impairment and/or disability in the pain patient often is difficult due to both administrative and clinical issues; in addition, the terms impairment and disability are misunderstood. Chronic pain complaints may be associated with significant disability, but typically the physician defines clinical issues, functional deficits, and, when requested, impairment; disability most often is an administrative determination. The biopsychosocial approach currently is viewed as most appropriate perspective for understanding, assessing, and treating chronic pain disorders and acknowledges a complex and dynamic interaction among biological, psychological, and social factors. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, discusses the assessment of pain and eligibility requirements for pain-related impairment (PRI). Some physicians feel that the AMA Guides’ approach to PRI does not adequately address the “disability” and functional loss caused by some chronic pain states, but the AMA Guides is limited, mostly, to describing measurable objective changes or impairment. The AMA Guides is not intended to be used for direct estimates of loss of work capacity (disability), and impairment percentages derived according to the AMA Guides criteria do not measure work disability. Impairment ratings in the AMA Guides already have accounted for impairment-associated pain, including that experienced in areas distant to the specific site of pathology.
A Review of the Evaluation, Treatment, and Rating of Lateral Epicondylitis
Authors: Arnett Justin J. , Mandel Steven , Aydin Steve M. , Brigham Christopher R. 
Published: December 2020

Abstract
Lateral epicondylitis, often called “tennis elbow,” is a musculoskeletal condition characterized by pain around the lateral elbow and adjacent forearm with resisted wrist extension or passive terminal wrist flexion with the elbow in full extension, plus tenderness over and/or just distal to the lateral epicondyle. The name is a misnomer because the pathology is neither inflammatory nor located in the lateral epicondyle but rather represents a chronic tendinosis with disorganized tissue and neovessels of the tendon originating from the extensor carpi radialis brevis muscle and less commonly the extensor digitorum communis muscle, which originate on the lateral epicondyle. Clinical assessment involves understanding the chronology, precipitating activities, current symptoms, and interference with activities of daily living. Physical examination is performed bilaterally and includes palpitation provocative testing, measuring elbow and wrist motions, and neurological evaluation. Many treatments have been proposed, but little quality evidence supports any specific approach; more than 90% of cases are managed nonoperatively. Severe cases that have failed at least months of nonoperative management may warrant surgical assessment, but studies of surgical results for treatment of lateral epicondylitis are limited. Impairment rating may be necessary in a minority of cases and involves using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, based on diagnosis-based impairment and using Table 15-4, Elbow Regional Grid: Upper Extremity Impairments.
Hernia Impairment Ratings and the AMA Guides, Sixth Edition
Authors: Jay Blaisdell , Talmage James 
Published: December 2020

Abstract
Of the many types of abdominal wall hernias, inguinal hernias are, by far, the most common type and typically present in males in workers’ compensation cases who report the cause as heavy lifting. The AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition, indicates that genetics (family history) is the strongest risk factor. Conditions that chronically increase intra-abdominal pressure (eg, obesity, ascites, or pregnancy) and smoking are statistically associated with abdominal wall hernias, but no good studies show an increased risk of hernia formation in laborers. Abdominal hernias with palpable defects or protrusions usually are corrected with surgery, and the outcome typically warrants an impairment of 0%. In the AMA Guides, Sixth Edition, Section 6.6, Hernias, and Table 6-10, Criteria for Rating Permanent Impairment Due to Hernias, are used for ratings. The rating scheme in the internal medicine chapters differs from that found in the musculoskeletal chapters because the rater uses a key factor of two of three potential variables—history, physical findings, and objective findings—to select the impairment class. Like the grade modifiers in the musculoskeletal chapters, the other variables (other than the key factors) then are used to modify the impairment rating within the impairment class. Most hernias are not due to injury and result in 0% whole person permanent impairment after repair.
Assessing Sexual Dysfunction, Part 1: Male Sexual Dysfunction
Authors: Cohen Seth D. , Mandel Steven , Samadi David B. 
Published: December 2020

Abstract
To properly assess men and women with sexual dysfunction, evaluators should take a biopsychosocial approach that may require consultation with multiple health care professionals from various fields in order to get to the root of the sexual dysfunction; this multidisciplinary methodology offers the best chance of successful treatment. For males, this article focuses on erectile dysfunction (ED) and hypogonadism. The initial evaluation of ED involves a thorough case history, preferably taken from the patient and partner, physical examination, and proper laboratory and diagnostic tests, including an acknowledgment of the subjective complaint. The diagnosis is established on the basis of an individual's report of the consistent inability to attain and maintain an erection sufficient to permit satisfactory sexual intercourse. Initial workups for ED should entail a detailed history that can be obtained from a validated questionnaire such as the International Index of Erectile Function and the Sexual Health Inventory for Men. Hypogonadism is evaluated using the validated Androgen Deficiency in the Aging Male questionnaire and laboratory testing for testosterone deficiency. Treatments logically can begin with the least invasive and then progress to more invasive strategies after appropriate counseling. The last and most important treatment component when caring for men with sexual dysfunction—and, arguably, the least practiced—is close follow-up.
Compensability of Common Upper Extremity Conditions When Work Activities Are Repetitive
Authors: Melhorn J. Mark , Haley LuAnn , Brooks Charles N. 
Published: December 2020

Abstract
Repetitive illness sometimes is wrongly called repetitive injury or cumulative trauma, but the latter are misnomers because the employee cannot identify a specific injury as a cause of the symptoms. In workers’ compensation, such gradual illness claims may be compensable if the condition arises during the course of employment, which requires that it be caused by occupational duties, exposures, or equipment used on the employer's premises. Expert impairment evaluators face three requirements: they must know the best scientific evidence currently available regarding causation of the condition(s) in question, ie, generic causation; the facts of the individual case, ie, specific causation; and the legal threshold in the applicable jurisdiction for acceptance of a condition as work related. The AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition, is an excellent resource and provides the physician a blueprint for the assessment of causation in occupational injury and illness claims. The book adopts the methodology developed by the National Institute for Occupational Safety and Health and the American College of Occupational and Environmental Medicine. When asked to render opinions regarding causation, a physician is wise to consider this methodology in determining the work relatedness of the condition. Medical opinions based on an accepted methodology and the best scientific evidence will result in better patient outcomes.
Imprecision in the Evaluation of Workers’ Compensation Psychological Injury Claims
Authors: Warren Pamela A. 
Published: December 2020

Abstract
Psychological conditions with severe symptoms can result in considerable impairment in functioning, and psychological disability claims, also called behavioral health disability, have increased during the past two decades. A review of states’ workers’ compensation (WC) systems shows no overlap between systems; that is, all states and federal WC systems have unique terminology, rules, and laws. In order to thoroughly evaluate the individual, evaluators must use a biopsychosocial approach that combines aspects of biological, psychological, and psychosocial issues. Studies consistently demonstrate a high degree of comorbidity between physical and psychological conditions, but frequently only the former are identified and treated. Current disability systems use byzantine definitions of disability and require professional opinions and documentation that do not comport with current psychological standards of care, introducing imprecision. Many issues relating to WC terminology and laws can be addressed if the Daubert standard is incorporated into any amendment of WC state and federal laws. The Daubert standard requires that currently accepted scientific methods be used when a professional offers testimony as an expert or is submitting professional treatment records (eg, in a WC determination). Compliance with the Daubert standard requires more consistent, objective professional documentation and testimony to ensure even-handed decisions that align with standards of psychological care. One observer has suggested that the Daubert standard is a mechanism by which junk science is kept out of legal proceedings.
Do Imaging Findings Predict the Need for Work Restrictions?
Authors: Eskay-Auerbach Marjorie , Talmage James B. 
Published: December 2020

Abstract
Physicians frequently are asked to assess work ability in individuals with low back pain (LBP) who also require an impairment rating. Physicians may be tempted to base their decisions about the individual's work ability on spinal anatomy/diagnosis as established by imaging, because that may seem objective. However, a review of the current medical literature consistently demonstrates that anatomical abnormalities identified on imaging do not predict functional ability. Rather, recent studies have demonstrated a strong association between the number of symptoms and functional status, on the one hand, and the lack of correlation between findings on imaging and symptoms, on the other hand. For example, a systematic review by Mayo Clinic physicians of 33 published studies in which 3110 asymptomatic adults were imaged using magnetic resonance imaging (MRI) showed that, in middle age when most problematic back pain problems present, roughly half of asymptomatic adults had disc bulges, roughly one-third had disc protrusions, and roughly one-quarter had annular fissures. The authors of the present study also review related studies regarding low back pain and conclude that current scientific knowledge suggests that imaging alone is not useful in predicting function or in assessing future risk. Degenerative changes on imaging are not a sound basis for work restrictions because they do not correlate with risk or capacity.
Colorectal Cancer: Case Example
Authors: Brigham Christopher R. , Talmage James B. , Demeter Stephen L. 
Published: December 2020

Abstract
Under California Labor Code Section 3212.1, firefighters, forestry and fire protection workers, peace officers, and first responders receive a potentially rebuttable presumption of compensability for certain conditions, including cancer and leukemia. This case example illustrates the need for accurate clinical, causation, apportionment, and impairment assessments that are based on the facts, current science, and appropriate use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). A retired California firefighter in his mid-sixties presented for an impairment evaluation for the sequelae of his colon cancer; six years earlier, he was diagnosed with stage 1 colorectal cancer and received neoadjuvant chemotherapy and radiation therapy, followed by surgical resection with a diverting colostomy and take-down surgery. He is morbidly obese (body mass index, 45) and has hypertension. He reported fecal frequency, urgency, and incontinence and stated he had problems with erectile dysfunction (ED) before his diagnosis of colon cancer, but after diagnosis and treatment the problem worsened to impotence. The author presents impairment assessments of this case example according to the AMA Guides, Fifth Edition vs the Sixth Edition. According to the fifth edition, this individual's impairment for lower gastrointestinal tract impairment is 17% whole person impairment (WPI), and this is combined with 5% WPI for ED, resulting in 21% WPI. According to the sixth edition, the lower gastrointestinal tract impairment of 14% is combined with 5% WPI for ED, leading to an 18% WPI.
AMA Guides, Sixth Edition: Skin Impairment, An Overview
Authors: Blaisdell Jay , Talmage James B. 
Published: December 2020

Abstract
The most common source of occupational skin disease is contact dermatitis, an inflammation caused by exposure to an allergen. Whenever possible, the evaluating physician should rely on objective evidence such as lichenification, excoriation, and hyperpigmentation rather than subjective complaints. Patch testing, biopsy, and sensory discrimination tests are reliable tools at the evaluating physician's disposal. Disfigurements of the face are rated using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, Section 11.3, The Face, and Chapter 8, The Skin, is used for all other skin impairments. The evaluating physician records the history of the injury, evaluates the patient, and, in consultation with Table 8-3, notes any objective clinical studies to diagnose the pathology. The functional history, physical examination findings, and diagnostic test findings values then are assigned using Table 8-2; the functional history acts as the key factor and determines the patient's impairment class, physical examination, and diagnostic test findings, each acting as non-key factors, or modifiers. Finally, the non-key factors are used to modify the impairment rating from its default value within its impairment class, and the result is the final skin impairment rating expressed as whole person impairment. Chapter 8 is used only rarely in impairment rating in workers’ compensation cases, and examiners should study the chapter carefully before using it.
Reliability of Cervical Spine Palpation
Authors: Dagher Edward I. 
Published: December 2020

Abstract
Palpitation is an important component of a comprehensive musculoskeletal and neurologic examination of the cervical spine in individuals with neck pain, but examiners should not base diagnostic conclusions (eg, facetogenic pain) and interventional procedures on palpatory findings alone. A methodological approach to palpation of the posterior neck includes evaluation of the paraspinal musculature, the tissues that overlie the facet (zygapophyseal) joints, and the midline spinous processes. Although studies have shown low interexaminer reliability, palpation is an important component of the physical examination for determining general anatomic regions of symptoms and in establishing rapport with the examinee. In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, the diagnosis-related estimate (DRE) or injury method lists both muscle spasm and muscle guarding as potential physical exam findings by palpation. In this edition, the range-of-motion method for rating spinal impairment states that an examiner cannot find muscle spasm on exam and rate the individual's impairment on the same day because, by definition, the individual is not at maximum medial improvement. Despite acceptance by the AMA Guides, Fifth Edition, neither spasm nor guarding appears to be a reliable finding on palpation. The AMA Guides, Sixth Edition, provides a different method for determining spinal impairment, and the authors recommend limiting physical examination findings used in impairment rating to those with acceptable interrater reliability.
Maximum Medical Improvement: Jurisdictional Perspectives
Authors: Brooks Charles N. , Brigham Christopher R. 
Published: December 2020

Abstract
Maximum medical improvement (MMI) and its multiple synonyms are important terms to understand because one cannot determine permanent impairment until a condition has resolved or reached a stable plateau with respect to improvement. Further, in many jurisdictions MMI represents the date beyond which temporary or all benefits cease or time-loss compensation (temporary disability benefits) may be terminated. Because each arena is to some extent unique, evaluating physicians should become familiar with MMI or the term used and its definition in the applicable federal, state, or provincial law or insurance policy. A table shows the terminology used by various US workers’ compensation jurisdictions, but there is no universal definition for MMI. The fourth edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) says only that “an impairment should not be considered ‘permanent’ until the clinical findings, determined during a period of months, indicate that the medical condition is static and well stabilized. The AMA Guides, Fifth Edition, defines MMI as “a condition or state that is well stabilized and unlikely to change substantially in the next year, with or without medical treatment” but acknowledges the possibility of “some change.” Similarly the sixth edition states that MMI is the “point at which a condition has stabilized and is unlikely to change (improve or worsen) substantially in the next year, with or without treatment”; signs and symptoms may wax and wane, but further recovery or deterioration is not anticipated.
Do Low-Speed Vehicle Collisions Cause Intervertebral Disc Degeneration or Herniation?
Authors: Wood Rawson L. , Greenston Mathew J. , Bain Charles E. , Brooks Charles N. 
Published: December 2020

Abstract
Complaints of spinal pain are common after motor vehicle collisions (MVCs), and evaluators may be asked whether the collision caused permanent injury to the spine, including aggravating intervertebral disc degeneration (IDD) and/or causing a disc herniation. To determine causality, evaluators can use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) to understand if a low-speed collision caused IDD. Injury causation analysis (ICA) is the scientific method used to analyze the mechanism and magnitude of injury for people who experience an MVC. ICA involves comparing the mechanical forces involved in the incident with the body's injury tolerance. Low back pain (LBP) is a common complaint following MVCs, but the literature regarding automobile collision testing has been compared to the body of evidence regarding real-world collision data and shows that, for low-speed impacts, any injuries are minor and self-limiting. Further, disability due to LBP was predicted by an abnormal baseline psychological test profile or a previously disputed compensation claim. The motions, forces, and accelerations generated in low-speed collisions are less than those encountered in activities of everyday living. ICA suggests that disc degeneration and disc herniations are pre-existing and are not caused by low-speed MVCs. Although the pain caused by a muscle sprain associated with a low-speed collision may prompt imaging studies that show disc pathology, these are coincidental and are not causally related.